Taking Atomoxetine in the Afternoon When Vyvanse Effects Wear Off
Yes, atomoxetine (Strattera) can be taken in the afternoon when the effects of Vyvanse (lisdexamfetamine) are wearing off, as atomoxetine can be administered in divided doses throughout the day. 1
Rationale for Afternoon Dosing of Atomoxetine
Atomoxetine offers several advantages when used as an afternoon medication:
- Unlike stimulants, atomoxetine provides "around-the-clock" effects and can be split into two equal doses administered in the morning and evening 1
- The FDA label specifically states that atomoxetine can be administered as a divided dose in the early morning and late afternoon 2
- Atomoxetine does not have the same potential for sleep disruption as stimulants, making it suitable for afternoon dosing 1, 3
Dosing Considerations
When adding an afternoon dose of atomoxetine:
- The total daily dose should be divided into two equal portions (morning and afternoon)
- The maximum recommended dosage is 1.4 mg/kg/day or 100 mg/day, whichever is lower 2
- Afternoon dosing has been shown to improve control of oppositional symptoms at home without negatively affecting school functioning 4
Benefits of Combined Approach
Adding atomoxetine in the afternoon when Vyvanse wears off may provide several benefits:
- Continuous ADHD symptom coverage throughout the day
- Reduced "rebound" effects that can occur as stimulants wear off
- Potentially improved management of late-day symptoms
- Atomoxetine has been shown to be effective as adjunctive therapy to stimulant medications 5
Potential Side Effects and Monitoring
When using atomoxetine in the afternoon, monitor for:
- Decreased appetite - though atomoxetine generally has less effect on appetite than stimulants 1
- Stomachaches - interestingly, twice-daily dosing has been associated with decreased rates of stomachaches compared to once-daily dosing 4
- Cardiovascular effects - most patients experience modest increases in heart rate and blood pressure, but these are generally not clinically significant 6
Important Considerations
- Atomoxetine does not work immediately like stimulants - therapeutic effects may take 6-12 weeks to fully develop 1
- Unlike stimulants, atomoxetine can be discontinued abruptly without rebound effects or discontinuation syndrome 7
- Atomoxetine is not a controlled substance and has negligible risk of abuse or misuse 3
Conclusion
Adding an afternoon dose of atomoxetine when Vyvanse wears off is a clinically appropriate strategy to maintain continuous ADHD symptom control throughout the day. Research shows that twice-daily dosing of atomoxetine is well-tolerated and may provide better control of symptoms in the late afternoon and evening hours 4.