Initial Dosing of Vyvanse (Lisdexamfetamine) ER for ADHD Treatment
The recommended initial dose of Vyvanse (lisdexamfetamine) for ADHD treatment is 30 mg taken once daily in the morning, with subsequent titration based on response and tolerability. 1
Dosing Guidelines
Initial Dosing
- Start with 30 mg once daily in the morning for both adults and pediatric patients 6 years and older 1
- Take consistently at the same time each morning 2
- Administer orally with or without food 1
Titration Schedule
- Increase dose by 10-20 mg weekly based on response and tolerability 2, 1
- Titrate to the recommended target dose range of 30-70 mg per day 1
- Maximum daily dose should not exceed 70 mg 1
Special Populations
- For patients with severe renal impairment: Maximum dose is 50 mg/day 1
- For patients with end-stage renal disease (ESRD): Maximum dose is 30 mg/day 1
- For young children: Consider slower titration due to slower metabolism of stimulant medications 2
Monitoring and Follow-up
Initial Period
- Schedule follow-up within 2-4 weeks after starting medication 2
- Monitor both therapeutic effects and potential side effects 2
- Use standardized ADHD-specific rating scales to assess treatment response 2
Ongoing Monitoring
- Check vital signs (blood pressure, heart rate) regularly 2, 1
- Monitor growth (height and weight) in pediatric patients 1
- Assess for emergence of psychiatric adverse reactions 1
Common Side Effects to Monitor
Important Precautions
Cardiovascular Considerations
- Prior to treatment, assess for presence of cardiac disease 1
- Avoid use in patients with known structural cardiac abnormalities, cardiomyopathy, serious cardiac arrhythmia, coronary artery disease, or other serious cardiac disease 1
- Monitor blood pressure and pulse regularly 1
Psychiatric Considerations
- Screen for risk factors for developing a manic episode before initiating treatment 1
- Monitor for emergence of new psychotic or manic symptoms 1
- Consider discontinuation if such symptoms occur 1
Drug Interactions
- Contraindicated with MAO inhibitors or within 14 days of the last MAO inhibitor dose 1
- Use caution when combining with serotonergic agents due to risk of serotonin syndrome 1
Clinical Pearls
- Lisdexamfetamine is a prodrug that requires in vivo hydrolysis to gradually release active d-amphetamine 4, 5
- This unique pharmacokinetic profile allows for once-daily dosing with a duration of activity of approximately 12 hours 6
- The prodrug design may provide additional safety regarding abuse potential compared to immediate-release stimulants 6, 5
- Effectiveness has been demonstrated to last up to 14 hours post-dose in adults 4
Remember that while the initial dose is standardized at 30 mg daily, subsequent dose adjustments should be based on individual response and tolerability, with careful monitoring for both efficacy and side effects.