What are the recommendations for managing decreased appetite in a patient taking Vyvanse (lisdexamfetamine) 30mg for Attention Deficit Hyperactivity Disorder (ADHD) who is considering a dose reduction to 20mg?

Managing Decreased Appetite with Vyvanse for ADHD

Reducing the Vyvanse dose from 30 mg to 20 mg is an appropriate strategy to manage decreased appetite while maintaining ADHD symptom control. 1

Understanding Appetite Suppression with Vyvanse

Decreased appetite is one of the most common side effects of lisdexamfetamine (Vyvanse):

• The FDA label reports decreased appetite occurs in 34% of pediatric patients (compared to 3% with placebo) 1
• In adults, decreased appetite affects 27% of patients (compared to 2% with placebo) 1
• Anorexia is reported in 2-5% of patients across age groups 1

Management Approach

1. Dose Adjustment

• First-line approach: Reduce Vyvanse dose from 30 mg to 20 mg as the patient is requesting
  • Lower doses are associated with less appetite suppression while potentially maintaining efficacy 1
  • Medication titration should achieve maximum benefit with tolerable side effects 2

2. Medication Timing Strategies

• Administer Vyvanse early in the morning to minimize appetite effects during main meals
• Consider having the patient eat a substantial breakfast before the medication takes effect

3. Nutritional Strategies

• Implement structured eating patterns with regular meal and snack times
• Focus on nutrient-dense, calorie-rich foods during periods of better appetite
• Consider liquid nutrition supplements if weight loss becomes concerning

4. Monitoring Parameters

• Track weight at each follow-up appointment 3, 2
• Use food diaries to identify patterns in appetite and eating behaviors 2
• Assess BMI percentile (for children/adolescents) or BMI (for adults) 2

Alternative Medication Options

If dose reduction doesn't adequately address appetite issues:

• Non-stimulant options: Consider medications with minimal effects on appetite
  • Guanfacine and clonidine have minimal effects on appetite and can be used as monotherapy or adjunctive therapy with stimulants 2
  • Atomoxetine (Strattera) may have less impact on appetite than stimulants

Important Considerations

• Weight monitoring: Systematic assessment of side effects, including weight loss, is essential 3

  • In pediatric patients, Vyvanse can cause weight loss of 0.9-2.5 pounds within 4 weeks of therapy 1
  • Long-term use may affect growth in pediatric patients 1

• Follow-up timing: After dose adjustment, follow up within 2-4 weeks to assess both appetite improvement and ADHD symptom control 3

• Behavioral interventions: Implement alongside medication adjustments to provide consistent structure and routine 2

Caution

Avoid discontinuing treatment prematurely as this can lead to reduced symptom control. The goal is to find the optimal balance between ADHD symptom management and minimizing side effects.

If the patient continues to experience significant appetite suppression despite dose reduction and other interventions, consider a full medication reassessment to explore other ADHD treatment options.