Maximum Recommended Dose of Vyvanse (Lisdexamfetamine)
The maximum recommended dose of Vyvanse (lisdexamfetamine) is 70 mg once daily, as established by FDA guidelines. 1
Dosing Guidelines
Lisdexamfetamine is administered according to the following protocol:
- Starting dose: 30 mg once daily in the morning
- Titration: Increase in increments of 10-20 mg at approximately weekly intervals 1
- Maximum dose: 70 mg once daily 2, 1
- Administration: Take in the morning with or without food; avoid afternoon doses due to potential insomnia 1
Special Population Considerations
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 dose should not exceed 30 mg once daily 1
Drug Interactions
- Agents that alter urinary pH can impact blood levels of amphetamine:
- Acidifying agents (e.g., ascorbic acid) decrease blood levels
- Alkalinizing agents (e.g., sodium bicarbonate) increase blood levels
- Dosage adjustments may be necessary when these agents are used concurrently 1
Monitoring During Titration
Before each dose increase, the following should be evaluated:
- Clinical response
- Patient tolerance
- Vital signs (blood pressure and heart rate)
- Weight (to assess for potential side effects like decreased appetite and weight loss) 2
Indications and Limitations
Lisdexamfetamine is FDA-approved for:
- Treatment of ADHD in adults and children 6 years and older
- Treatment of moderate to severe Binge Eating Disorder (BED) in adults 1, 3
Important: Lisdexamfetamine is not indicated or recommended for weight loss. Use of sympathomimetic drugs for weight loss has been associated with serious cardiovascular adverse events 1.
Common Adverse Effects
The most frequently reported adverse effects include:
Clinical Pitfalls to Avoid
- Exceeding maximum dose: Never exceed 70 mg daily, as higher doses have not been established for safety and may increase risk of adverse effects
- Afternoon dosing: Avoid administering in the afternoon due to increased risk of insomnia
- Dividing doses: Do not divide capsules; a single dose should not be split 1
- Rapid titration: Follow the recommended weekly titration schedule to minimize adverse effects
- Ignoring renal function: Failure to adjust dosing in patients with renal impairment can lead to excessive drug exposure
Remember that lisdexamfetamine is a prodrug that is converted to dextroamphetamine in the body, and it has a high potential for abuse and misuse. Careful patient selection and monitoring are essential for safe and effective treatment.