What is the best course of treatment for a 29-year-old female patient experiencing a panic attack after accidentally ingesting three 10mg Vyvanse (lisdexamfetamine) tablets instead of two?

Management of Vyvanse Overdose with Panic Attack in a 29-Year-Old Female

For a 29-year-old female experiencing a panic attack after accidentally taking 30mg of Vyvanse instead of 20mg, the most appropriate immediate management is to administer lorazepam 1mg orally, provide IV fluids for hydration, and monitor vital signs while consulting with her neurologist.

Initial Assessment and Management

Immediate Interventions:

• Administer lorazepam 1mg orally for rapid anxiety relief 1
• Start IV fluids to promote hydration and elimination of the medication
• Monitor vital signs (heart rate, blood pressure, respiratory rate, temperature)
• Consult with patient's neurologist regarding medication management

Understanding the Clinical Situation:

• The patient has taken 30mg of Vyvanse (lisdexamfetamine) instead of her usual 20mg dose
• The primary presenting symptom is a panic attack, likely triggered by:
  • Mild stimulant overdose
  • Psychological distress about the medication error
  • Physiological effects of increased sympathetic activation

Pharmacological Management

Benzodiazepine Treatment:

• Lorazepam 1mg orally is the preferred agent because:
  • It has an intermediate duration of action (reducing risk of interdose anxiety)
  • It provides rapid relief of acute anxiety symptoms 1
  • It can be repeated in 1-2 hours if needed (maximum 2mg) 2

Alternative Options if Lorazepam is Unavailable:

• Midazolam 2.5mg (if more rapid onset is needed) 1
• Diazepam 5-10mg (longer acting option) 2

Non-Benzodiazepine Alternatives:

• If benzodiazepines are contraindicated, consider:
  • Quetiapine 25mg as a non-benzodiazepine option 1
  • Olanzapine 2.5-5mg orally (available as orally disintegrating tablet) 1

Monitoring and Follow-up

Vital Sign Monitoring:

• Check vital signs every 15-30 minutes until stable
• Pay particular attention to:
  • Heart rate (tachycardia is common with stimulant overdose)
  • Blood pressure (monitor for hypertension)
  • Temperature (hyperthermia possible with stimulants)

Duration of Monitoring:

• Continue monitoring for at least 4-6 hours
• Longer observation may be needed if symptoms persist

Discharge Considerations:

• Ensure complete resolution of panic symptoms
• Confirm stable vital signs
• Review medication dosing instructions with patient
• Schedule follow-up with neurologist

Common Pitfalls to Avoid

• Don't underestimate psychological factors: Even a small overdose can trigger significant anxiety
• Avoid using multiple sedatives simultaneously: This increases risk of respiratory depression
• Don't dismiss the need for neurologist consultation: The patient's underlying condition requiring Vyvanse needs assessment
• Avoid discharging too early: Monitor until both physiological and psychological symptoms have resolved

Special Considerations

• This is a relatively minor overdose (1.5x therapeutic dose), so severe toxicity is unlikely
• The panic attack may be partially or wholly psychological in nature
• Reassurance and supportive care are important components of treatment
• Document the incident thoroughly for future reference

By following this approach, the patient should experience rapid relief of panic symptoms while the excess stimulant is metabolized and eliminated.