What are the side effects of Vyvanse (lisdexamfetamine)?

Side Effects of Vyvanse (Lisdexamfetamine)

Vyvanse (lisdexamfetamine) commonly causes dry mouth, insomnia, decreased appetite, increased heart rate, constipation, feeling jittery, and anxiety as its most frequent side effects. 1

Common Side Effects

The FDA drug label identifies the following common side effects of Vyvanse:

• Gastrointestinal effects:

  • Dry mouth (36% of patients vs 7% on placebo)
  • Decreased appetite (8% vs 2%)
  • Constipation (6% vs 1%)
  • Upper abdominal pain
  • Nausea
  • Vomiting (2% vs 1%)
  • Diarrhea (4% vs 2%)

• Neuropsychiatric effects:

  • Insomnia (20% vs 8%)
  • Feeling jittery (6% vs 1%)
  • Anxiety (5% vs 1%)
  • Restlessness (2% vs 0%)
  • Irritability
  • Nightmares (2% vs 0%)
  • Increased energy (2% vs 0%)

• Cardiovascular effects:

  • Increased heart rate/tachycardia (7% vs 1%)

• Other effects:

  • Weight loss (4% vs 0%)
  • Hyperhidrosis (excessive sweating) (4% vs 0%)
  • Paresthesia (tingling sensation) (2% vs 1%)
  • Pruritus (itching) (2% vs 1%)

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Serious Side Effects

Vyvanse can cause several serious side effects that require immediate medical attention:

• Cardiovascular risks:

  • Sudden death in patients with pre-existing heart defects or serious heart problems
  • Stroke and heart attack
  • Increased blood pressure and heart rate 1

• Psychiatric effects:

  • New or worsening behavior problems
  • New or worsening bipolar illness
  • New psychotic symptoms (hallucinations, delusions)
  • New manic symptoms 1

• Serotonin syndrome when used with other serotonergic medications 1

• Potential for abuse and addiction as Vyvanse is a Schedule II controlled substance 1

Effects in Special Populations

Children and Adolescents

• Growth effects: Weight loss and slowing of growth rate in consistently medicated pediatric patients
  • In children 6-12 years: Weight loss of 0.9-2.5 pounds after 4 weeks (dose-dependent)
  • In adolescents 13-17 years: Weight loss of 2.7-4.8 pounds after 4 weeks (dose-dependent)
  • Long-term follow-up shows slowing in growth rate (approximately 2 cm less growth in height and 2.7 kg less growth in weight over 3 years) 1, 2

Adults

• Weight loss of 2.8-4.3 pounds after 4 weeks of therapy (dose-dependent) 1

Less Common and Post-Marketing Side Effects

The following side effects have been reported during post-approval use of Vyvanse:

• Cardiovascular: Cardiomyopathy, chest pain
• Neurological: Dyskinesia, dysgeusia, motor and verbal tics, seizures
• Psychiatric: Depression, aggression, bruxism (teeth grinding)
• Dermatological: Stevens-Johnson Syndrome, angioedema, urticaria, alopecia, dermatillomania
• Ocular: Mydriasis, diplopia, blurred vision, difficulties with visual accommodation
• Other: Hypersensitivity reactions, anaphylaxis, eosinophilic hepatitis, libido changes, prolonged erections, rhabdomyolysis, intestinal ischemia 1

Risk Factors and Monitoring

Patients should be monitored for:

• Pre-existing heart conditions
• History of psychiatric disorders
• Blood pressure and heart rate changes
• Weight and growth in pediatric patients
• Signs of substance abuse or diversion 2, 1

Drug Interactions

Important drug interactions include:

• MAO Inhibitors: Do not administer Vyvanse during or within 14 days of MAOI use (risk of hypertensive crisis)
• Serotonergic drugs: Increased risk of serotonin syndrome
• Other stimulants: Avoid concurrent use 1

Recommendations for Management

1. Before starting Vyvanse:

   • Screen for cardiovascular risk factors
   • Assess for personal or family history of psychiatric disorders
   • Establish baseline vital signs and weight

2. During treatment:

   • Monitor blood pressure, heart rate, and weight regularly
   • Watch for emergence of psychiatric symptoms
   • In children, monitor growth

3. For side effect management:

   • Take medication in the morning to minimize insomnia
   • Take with food to reduce gastrointestinal effects
   • Ensure adequate hydration for dry mouth
   • Consider dose reduction if side effects are problematic

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Vyvanse's side effect profile is consistent with other stimulant medications, with most adverse events being mild to moderate in intensity and often transient in nature 3. However, the serious risks associated with cardiovascular and psychiatric effects require careful patient selection and monitoring.