What is the recommended dosage increase schedule for Vyvanse (lisdexamfetamine)?

Lisdexamfetamine (Vyvanse) Dosage Increase Schedule

For lisdexamfetamine (Vyvanse), the recommended dosage increase schedule is to start at 20-30 mg once daily in the morning and increase by 10 mg weekly to a maximum of 70 mg daily. 1

Initial Dosing and Titration Protocol

• Starting dose:

  • Adults and children 6 years and older: 20-30 mg once daily in the morning 1, 2
  • Take with or without food 2

• Titration schedule:

  • Increase by 10 mg weekly intervals 1
  • Some guidelines allow for increases of 10-20 mg at weekly intervals 2
  • Always use the smallest practical amount when increasing dosage 2

• Maximum recommended dose:

  • 70 mg once daily 1, 2

Administration Guidelines

• Administer once daily in the morning to avoid insomnia 2
• May be taken with or without food 2
• Can be administered in several ways:
  1. Swallow capsule whole
  2. Open capsule and mix entire contents with yogurt, water, or orange juice
  3. Consume mixture immediately after mixing 2
• Do not divide a single dose (take at least one full capsule daily) 2

Special Populations

• Patients with renal impairment:
  • Severe renal impairment (GFR 15 to <30 mL/min/1.73 m²): Maximum dose should not exceed 50 mg once daily
  • End-stage renal disease (GFR <15 mL/min/1.73 m²): Maximum recommended dose is 30 mg once daily 2

Monitoring and Assessment

• Assess for cardiac disease before initiating treatment 2
• Evaluate for tics or Tourette's syndrome before starting 2
• Monitor for signs of:
  • Insomnia
  • Decreased appetite
  • Weight loss
  • Cardiovascular effects 2, 3

Clinical Considerations

• Lisdexamfetamine is a prodrug that is converted to its active form d-amphetamine in the blood 4, 5
• The medication has a long duration of action, with efficacy demonstrated up to 14 hours post-dose in adults 6
• Therapeutic effects are typically seen within the first week of treatment at effective doses 3
• If adequate response is not achieved after titration to maximum dose, consider alternative treatments

Common Adverse Effects

• Decreased appetite
• Insomnia
• Upper abdominal pain
• Headache
• Irritability
• Weight loss
• Nausea 3

Important Precautions

• Avoid afternoon doses due to potential for insomnia 2
• Agents that alter urinary pH can impact blood levels (acidifying agents decrease levels, alkalinizing agents increase levels) 2
• Contraindicated in patients taking MAOIs or within 14 days of stopping MAOIs 2
• Assess risk for abuse, misuse, and addiction before prescribing and throughout treatment 2

Following this structured titration schedule allows for optimal therapeutic benefit while minimizing adverse effects. The gradual increase in dosage helps patients adjust to the medication and allows clinicians to find the lowest effective dose.