Starting Dose of Vyvanse for a 24-Year-Old Female with ADHD
The recommended starting dose of Vyvanse (lisdexamfetamine) for a 24-year-old female with ADHD is 30 mg once daily in the morning, with dosage adjustments in increments of 10-20 mg at approximately weekly intervals up to a maximum of 70 mg daily as needed. 1
Dosing Protocol
Initial Dosing
- Start with 30 mg once daily in the morning 2, 1
- Take with or without food 1
- Avoid afternoon doses to prevent insomnia 1
Dose Titration
- Adjust dose in increments of 10 mg or 20 mg at approximately weekly intervals 1
- Schedule follow-up within 2-4 weeks after medication adjustment to assess response and side effects 2
- Target dose range: 30-70 mg once daily 1
- Maximum recommended dose: 70 mg once daily 1
Administration Options
Vyvanse can be taken in several ways:
- Swallow capsule whole
- Open capsule and mix entire contents with yogurt, water, or orange juice
- Consume mixture immediately after mixing (do not store) 1
Monitoring Parameters
Initial Assessment
- Assess for cardiac disease (careful history, family history of sudden death or ventricular arrhythmia, physical exam) 1
- Evaluate for history of tics or Tourette's syndrome 1
- Check baseline vital signs and weight 2
Follow-up Monitoring
- Monitor for effectiveness in reducing ADHD symptoms
- Assess for common side effects:
- Monitor vital signs for changes in:
Clinical Considerations
Efficacy
- Lisdexamfetamine has demonstrated efficacy for up to 14 hours post-dose in adults 4
- Studies show significant improvements in ADHD rating scales, Clinical Global Improvement scores, and executive function assessments 4
- Response may begin as early as the first week of treatment 5
Contraindications
- Known hypersensitivity to amphetamine products
- Concurrent use of MAOIs or within 14 days of stopping MAOIs
- Glaucoma, symptomatic cardiovascular disease, hyperthyroidism, hypertension 1
Special Populations
- In patients with severe renal impairment (GFR 15 to <30 mL/min/1.73 m²), maximum dose should not exceed 50 mg once daily
- In end-stage renal disease (GFR <15 mL/min/1.73 m²), maximum dose is 30 mg once daily 1
Potential Pitfalls and Caveats
- Avoid using multiple stimulant formulations concurrently 2
- Be aware of high potential for abuse and misuse; educate patient about proper storage and disposal 1
- Acidifying agents (e.g., ascorbic acid) decrease blood levels, while alkalinizing agents (e.g., sodium bicarbonate) increase blood levels; adjust dosage accordingly 1
- Morning dosing is recommended to avoid insomnia 1
- Monitor for psychiatric symptoms or emergence of tics 2
Lisdexamfetamine is a prodrug stimulant that remains pharmacologically inactive until enzymatically converted to d-amphetamine, providing consistent symptom control throughout the day 4.