Adderall 30mg XR to Vyvanse Conversion
When converting from Adderall XR 30mg to Vyvanse, the equivalent dose is 50-70mg of Vyvanse, with most patients requiring 70mg of Vyvanse to achieve similar efficacy to 30mg of Adderall XR.
Conversion Rationale
Vyvanse (lisdexamfetamine) is a prodrug that is converted to dextroamphetamine in the bloodstream through enzymatic processes. This conversion process affects the dosing equivalence between Adderall XR and Vyvanse:
- Adderall XR contains mixed amphetamine salts (both dextroamphetamine and levoamphetamine)
- Vyvanse contains only lisdexamfetamine which converts to dextroamphetamine
- The FDA label indicates that Vyvanse can be substituted on a mg-per-mg basis with its own formulations (capsules vs. chewable tablets) 1
- However, when converting from Adderall XR to Vyvanse, a higher dose of Vyvanse is typically needed
Dosing Algorithm
- Start with Vyvanse 30mg once daily in the morning (standard starting dose) 1
- Titrate in increments of 10-20mg at weekly intervals 1
- Target dose range of 50-70mg once daily for patients converting from Adderall XR 30mg
- Maximum recommended dose is 70mg once daily 1
Administration Considerations
- Take Vyvanse once daily in the morning with or without food 1
- Avoid afternoon dosing due to potential insomnia 1
- Vyvanse can be taken as:
- Swallowed whole capsule
- Opened capsule with contents mixed in yogurt, water, or orange juice 1
Clinical Advantages of Vyvanse
- Once-daily dosing due to long-acting properties
- Remains pharmacologically inactive until enzymatic conversion to d-amphetamine 2
- Demonstrated efficacy up to 14 hours post-dose in adults 2
- Less potential for abuse compared to immediate-release stimulants due to rate-limited hydrolysis 3
Monitoring and Adjustments
- Assess response after 1-2 weeks at each dose level
- Monitor for common side effects including:
- Cardiovascular effects (blood pressure, heart rate)
- Appetite suppression
- Sleep disturbances
- Mood changes
Important Cautions
- Pretreatment screening should assess for cardiac disease and history of tics or Tourette's syndrome 1
- Contraindicated in patients taking MAOIs or within 14 days of stopping MAOIs 1
- In patients with severe renal impairment, maximum dosage should not exceed 50mg daily 1
- In patients with end-stage renal disease, maximum dosage should not exceed 30mg daily 1
Remember that while this conversion recommendation is based on clinical evidence, individual patient response may vary, and dose adjustments may be necessary based on efficacy and tolerability.