Recommended Dosage and Usage of Vyvanse (Lisdexamfetamine) for ADHD and Binge Eating Disorder
For ADHD, start Vyvanse at 30 mg once daily in the morning, titrate by 10-20 mg at weekly intervals to a maximum of 70 mg daily; for Binge Eating Disorder, start at 30 mg daily, titrate by 20 mg weekly to a target dose of 50-70 mg daily with a maximum of 70 mg daily. 1
Dosing Guidelines for ADHD
Initial Dosing and Titration
- Start with 30 mg once daily in the morning for adults and children 6 years and older 1
- Adjust dosage in increments of 10 mg or 20 mg at approximately weekly intervals 1
- Maximum recommended dosage: 70 mg once daily 1
- Take in the morning with or without food; avoid afternoon doses due to potential insomnia 1
Administration Options
- Swallow capsules whole, OR
- Open capsules and mix entire contents with yogurt, water, or orange juice
- Consume mixture immediately after mixing
- Never divide a single dose; always take at least one complete capsule or chewable tablet daily 1
Dosing Guidelines for Binge Eating Disorder
Initial Dosing and Titration
- Start with 30 mg once daily in adults 1
- Titrate in increments of 20 mg at approximately weekly intervals 1
- Target dose: 50-70 mg once daily 1
- Maximum recommended dosage: 70 mg once daily 1
Efficacy in Binge Eating Disorder
- Lisdexamfetamine is currently the only FDA-approved medication for moderate to severe binge eating disorder in adults 2
- Doses of 50-70 mg/day significantly reduce binge eating days per week compared to placebo 3
- Higher response rates observed with 50 mg (42.2%) and 70 mg (50%) doses compared to placebo (21.3%) for achieving 4-week binge eating cessation 3
Pretreatment Screening and Monitoring
Required Screening
- Assess for cardiac disease through history, family history of sudden death or ventricular arrhythmia, and physical examination 1
- Evaluate for motor or verbal tics or Tourette's syndrome before initiating treatment 1
Ongoing Monitoring
- Monitor vital signs, particularly blood pressure
- Follow up 1-2 weeks after dose changes
- Regular assessment of symptom control and side effects
- Screen for comorbid conditions (anxiety, depression, substance use, learning disabilities) 4
- Monitor for signs of abuse, misuse, and addiction throughout treatment 1
Safety Considerations
Common Side Effects
- Most common treatment-emergent adverse events include dry mouth, headache, and insomnia 2
- Most side effects are mild to moderate in intensity 2
- Weight loss may occur and should be monitored, especially in pediatric patients 1
Important Warnings
- High potential for abuse and misuse; assess risk before prescribing 1
- Not indicated or recommended for weight loss 1
- Avoid in patients with serious cardiac problems 1
- ECG monitoring recommended for patients taking medications known to prolong QTc intervals 5
Combination with Non-Pharmacological Treatments
- For ADHD: Evidence-based behavioral therapy should be implemented concurrently with medication 4
- For Binge Eating Disorder: Eating disorder-focused cognitive-behavioral therapy or interpersonal therapy is recommended as first-line treatment 5
- Lisdexamfetamine is suggested for adults with binge-eating disorder who prefer medication or have not responded to psychotherapy alone 5
Special Considerations
- Lisdexamfetamine's prodrug formulation may reduce abuse potential compared to other stimulants 4
- The medication is only activated after ingestion when metabolized by erythrocyte cells 4
- Avoid combining different stimulant medications due to potential increased side effects 4
- Longer-acting formulation provides coverage throughout the day, which may be beneficial for symptom control 4
By following these evidence-based dosing guidelines and monitoring protocols, clinicians can optimize the therapeutic benefits of lisdexamfetamine while minimizing potential risks for patients with ADHD or binge eating disorder.