Vyvanse (Lisdexamfetamine) Starting Dose for Adults with ADHD
The recommended starting dose of Vyvanse (lisdexamfetamine) for adults with ADHD is 30 mg once daily in the morning. 1
Dosing Guidelines
Lisdexamfetamine (Vyvanse) is a prodrug stimulant medication that is FDA-approved for the treatment of ADHD in adults and pediatric patients 6 years and older. The medication should be administered according to the following protocol:
- Initial dose: 30 mg once daily in the morning 1
- Titration: Dose may be adjusted in increments of 10 mg or 20 mg at approximately weekly intervals 1
- Maximum dose: 70 mg once daily 1
Administration Instructions
For optimal efficacy and tolerability:
- Take Vyvanse in the morning to avoid insomnia 1
- Can be taken with or without food 1
- May be swallowed whole or opened and mixed with yogurt, water, or orange juice 1
- Do not divide a single dose (take at least one full capsule) 1
Monitoring and Adjustments
During the titration period:
- Weekly contact during initial titration is recommended 2
- Monitor for side effects and therapeutic response
- Adjust dose to achieve maximum benefit with minimum adverse effects
- Regular monitoring of vital signs, weight, and appetite is necessary 2
Common Side Effects
The most commonly reported treatment-related side effects include:
- Decreased appetite (49.4%) 3
- Weight decrease (18.2%) 3
- Insomnia (13.1%) 3
- Irritability (8.6%) 3
- Nausea (6.7%) 3
- Headache (5.7%) 3
Side effects are typically most prominent during the first 4-12 weeks of treatment 3.
Special Considerations
Renal impairment:
- For severe renal impairment (GFR 15 to <30 mL/min/1.73 m²): Maximum dose should not exceed 50 mg once daily
- For end-stage renal disease (GFR <15 mL/min/1.73 m²): Maximum dose is 30 mg once daily 1
Drug interactions:
- Agents that alter urinary pH can impact blood levels of amphetamine
- Acidifying agents decrease blood levels
- Alkalinizing agents increase blood levels 1
Contraindications
Vyvanse is contraindicated in patients with:
- Known hypersensitivity to amphetamine products
- Concurrent use of MAOIs or within 14 days of stopping MAOIs 1
- Advanced cardiovascular disease, high blood pressure, hyperthyroidism, glaucoma, agitation 2
- History of psychosis or mania 2
Efficacy
Lisdexamfetamine has demonstrated significant improvements in ADHD symptoms in adults with moderate to severe ADHD, with benefits in:
- ADHD rating scales
- Clinical Global Improvement scores
- Executive function assessments 4
- Efficacy has been demonstrated for up to 14 hours post-dose 4
Lisdexamfetamine's prodrug formulation provides a long duration of action and may have lower abuse potential compared to immediate-release stimulants 5.