What is the role of Vyvanse (lisdexamfetamine) in treating moderate to severe binge eating disorder in adults?

Lisdexamfetamine (Vyvanse) for Binge Eating Disorder

Lisdexamfetamine is the only FDA-approved medication for moderate to severe binge eating disorder (BED) in adults and should be considered a first-line pharmacological treatment option for this condition. 1, 2, 3

Efficacy and Clinical Evidence

• Lisdexamfetamine has demonstrated significant efficacy in reducing binge eating behaviors:

  • Reduces the number of binge eating days per week compared to placebo 4
  • Achieves binge eating cessation in 42-50% of patients (at 50-70mg doses) compared to 21% with placebo 4
  • Maintains effectiveness in both men and women and across different age groups (under and over 40 years) 5

• Dosing considerations:

  • FDA-approved dosage range: 50-70 mg/day 2
  • Requires dose titration (typically starting lower and increasing over 3 weeks) 4
  • Maintenance treatment may be needed to prevent relapse 3

Safety Profile and Monitoring

• Common side effects include:

  • Dry mouth, headache, and insomnia 3
  • Increased blood pressure and heart rate 2
  • Weight loss (average 4-5 kg over 12 weeks of treatment) 4

• Important safety considerations:

  • Lisdexamfetamine is a Schedule II controlled substance with potential for abuse and dependence 2
  • Contraindicated in patients taking MAOIs or within 14 days of stopping MAOIs 2
  • Should be avoided in patients with serious heart disease, uncontrolled hypertension, or history of substance abuse 1, 2
  • Regular monitoring of vital signs, particularly blood pressure and heart rate, is essential 2

Patient Selection and Clinical Approach

1. Confirm diagnosis of moderate to severe BED:

   • Recurrent episodes of excessive food consumption
   • Sense of loss of control during binge episodes
   • Marked distress regarding binge eating
   • Absence of compensatory behaviors (as in bulimia nervosa)

2. Assess for contraindications:

   • Cardiovascular disease or uncontrolled hypertension
   • History of substance abuse
   • Current use of MAOIs
   • Pregnancy or breastfeeding

3. Initiate treatment:

   • Start with lower dose and titrate to 50-70 mg/day over 3 weeks
   • Provide clear explanation about medication purpose and expectations
   • Emphasize that lisdexamfetamine is not approved for weight loss 2

4. Monitor treatment response and safety:

   • Regular assessment of binge eating frequency
   • Monitor vital signs, particularly blood pressure and heart rate
   • Track weight changes (though weight loss is not the primary goal)
   • Assess for side effects and signs of dependence

Considerations for Comprehensive Care

• Lisdexamfetamine should ideally be part of a treatment plan that includes:
  • Cognitive-behavioral therapy (CBT), which is a first-line therapy for BED 1
  • Interpersonal therapy (IPT) as an alternative psychological approach 1
  • Regular monitoring of eating behaviors and psychological symptoms

Important Caveats

• Lisdexamfetamine is not approved for weight loss, despite the weight loss observed in clinical trials 2, 6
• The medication should not be used in patients with eating disorders focused primarily on weight loss rather than binge eating behaviors 2
• Long-term safety and efficacy data beyond 12 months is limited 3
• Careful consideration is needed when prescribing to patients with comorbid psychiatric conditions, especially those with bipolar disorder or psychosis 2