Long-Term Side Effects of Vyvanse (Lisdexamfetamine)
Vyvanse (lisdexamfetamine) can cause significant long-term side effects including cardiovascular problems, psychiatric issues, growth suppression in children, and potential for abuse and dependence.
Cardiovascular Effects
- Blood pressure and heart rate increases: Regular monitoring is essential as Vyvanse can cause sustained elevations 1, 2
- Risk of serious cardiac events: Particularly concerning in patients with pre-existing heart conditions or defects 2
- Sudden death risk: Has occurred in people with heart defects or serious heart disease 2
Neuropsychiatric Effects
New or worsening psychiatric symptoms:
- Behavior and thought problems
- Bipolar symptoms
- Psychotic symptoms (hallucinations, delusions)
- Manic symptoms 2
Serotonin syndrome risk: When combined with other serotonergic medications like SSRIs, SNRIs, triptans, and MAOIs 2
Motor and verbal tics: May emerge or worsen during treatment, including Tourette's syndrome 2
Physical Health Effects
Weight loss and appetite suppression: Persistent decreased appetite can lead to significant weight loss over time 2, 3
Sleep disturbances: Chronic insomnia can lead to cognitive impairment and other health issues 3, 4
Gastrointestinal effects: Abdominal pain, nausea, and other GI disturbances may persist 3, 4
Dependency and Abuse
Physical dependence: Can develop after prolonged use, even when taken as prescribed 2
High abuse potential: As a Schedule II controlled substance, Vyvanse has a significant risk for abuse and misuse 2
Addiction risk: May lead to substance use problems with long-term use 2
Less Common but Serious Effects
Potential liver effects: Though rare, liver injury has been reported with stimulant medications 5
Possible malignancy risk: Malignant neoplasms were reported in 0.5% of patients compared with 0.2% receiving placebo in some studies, though the relationship to the drug is unclear 5
Anaphylaxis: Reported in approximately 0.2% of treated patients 5
Monitoring Recommendations
- Blood pressure and heart rate should be checked regularly
- Monitor for emergence of psychiatric symptoms
- Assess sleep quality and appetite changes
- Evaluate for signs of physical dependence or abuse
- Consider periodic drug holidays to assess continued need and minimize tolerance development 1
Risk Mitigation
- Do not exceed maximum recommended daily dose of 70mg
- Avoid abrupt discontinuation after long-term use
- Do not combine with MAOIs or within 14 days of MAOI use
- Use caution when combining with other serotonergic medications
- Store medication securely to prevent diversion 2
Vyvanse's prodrug formulation (requiring enzymatic conversion to active d-amphetamine) provides consistent plasma concentrations throughout the day 4, but this doesn't eliminate the potential for serious long-term side effects that require ongoing monitoring and management.