Starting Dose of Vyvanse (Lisdexamfetamine) for ADHD
The recommended starting dose of Vyvanse (lisdexamfetamine) is 30 mg once daily in the morning for both adults and pediatric patients 6 years and older with ADHD. 1
Dosing Guidelines
- Initial dose: 30 mg once daily in the morning
- Titration: Dose may be adjusted in increments of 10 mg or 20 mg at approximately weekly intervals
- Maximum dose: Up to 70 mg once daily
- Administration: Take orally in the morning with or without food; avoid afternoon doses due to potential insomnia
Special Considerations
Administration Options
Vyvanse may be administered in several ways:
- Swallow capsules whole
- Open capsules and mix contents with yogurt, water, or orange juice
- Contents should be completely dispersed and consumed immediately
- Do not divide a single dose (always take at least one full capsule)
Dosage Adjustments
Renal impairment:
- Severe impairment (GFR 15 to <30 mL/min/1.73 m²): Maximum 50 mg once daily
- End-stage renal disease (GFR <15 mL/min/1.73 m²): Maximum 30 mg once daily
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
Pretreatment Screening
Before initiating Vyvanse, assess for:
- Presence of cardiac disease (careful history, family history of sudden death or ventricular arrhythmia, physical exam)
- Family history and clinical evaluation for motor or verbal tics or Tourette's syndrome
Efficacy and Clinical Response
Lisdexamfetamine has demonstrated robust efficacy in the treatment of ADHD. In comparative studies, it has shown a faster and more robust treatment response compared to non-stimulant medications like atomoxetine 2. The median time to first clinical response was 12 days for lisdexamfetamine compared to 21 days for atomoxetine.
Safety Profile
The safety profile of lisdexamfetamine is consistent with other long-acting stimulant medications. Common adverse effects include:
- Decreased appetite
- Headache
- Insomnia
- Potential increases in blood pressure and heart rate
- Weight loss
Follow-up Monitoring
Regular follow-up visits are recommended:
- Every 3-4 weeks during initial treatment phase
- Every 3-6 months once a stable response is achieved
- More frequent visits for patients with psychosocial stress, adherence problems, or side effect concerns
Lisdexamfetamine is a prodrug that is converted to active dextroamphetamine via hydrolytic enzymes located on erythrocytes, with onset of action within 1-2 hours post-dose and duration of up to 13 hours 3. This unique mechanism contributes to its long-acting properties and potentially lower abuse potential compared to immediate-release stimulants.