Can I add Adderall (amphetamine and dextroamphetamine) 30 mg Extended Release (XR) to Vyvanse (lisdexamfetamine)?

Combining Adderall XR 30mg with Vyvanse is Not Recommended

Combining Adderall XR 30mg with Vyvanse is not recommended as there is limited evidence supporting the use of multiple stimulants simultaneously for ADHD treatment, and this combination may increase the risk of adverse effects without clear therapeutic benefit. 1, 2

Rationale Against Combined Stimulant Use

Clinical Guidelines Perspective

• The American Academy of Child and Adolescent Psychiatry practice parameter explicitly states there is limited support for combining medications from the same class 1
• While two stimulant formulations (short and long acting) may occasionally be used to "sculpt" dosing for coverage throughout the day, using two extended-release stimulants like Adderall XR and Vyvanse lacks clinical support 1
• Both medications contain amphetamine-based compounds:
  • Adderall XR contains mixed amphetamine salts
  • Vyvanse (lisdexamfetamine) is a prodrug that converts to dextroamphetamine 3, 4

Safety Concerns

• Potential increased risk of:
  • Cardiovascular effects (tachycardia, hypertension)
  • Appetite suppression and weight loss
  • Sleep disturbances
  • Anxiety and irritability
  • Additive sympathomimetic effects 2, 5
• Higher combined doses may exceed maximum recommended daily amphetamine exposure

Alternative Approaches

If Current Treatment is Inadequate:

1. Optimize single-agent therapy first:

   • Ensure optimal dosing of either medication alone before considering combination therapy
   • Maximum recommended doses:
     • Amphetamine products: up to 50mg daily 2
     • Lisdexamfetamine: up to 70mg daily 3, 6

2. Switch to the alternative medication:

   • If Adderall XR is not effective, consider transitioning completely to Vyvanse
   • If Vyvanse is not effective, consider using Adderall XR alone
   • During medication transitions, there may be a brief overlap period, but this is not intended as a long-term strategy 1

3. Consider non-stimulant augmentation:

   • FDA-approved adjunctive options with stimulants:
     • Extended-release guanfacine
     • Extended-release clonidine 1, 2
   • These non-stimulant medications have evidence supporting their use as adjunctive therapy 1

4. Consider non-stimulant monotherapy:

   • Atomoxetine
   • Extended-release guanfacine
   • Extended-release clonidine
   • Viloxazine 2, 7

Monitoring and Follow-up

If medication changes are implemented:

• Schedule follow-up within 3-4 weeks to assess response 2
• Monitor for:
  • Efficacy using standardized rating scales
  • Side effects, particularly cardiovascular parameters
  • Growth parameters in children and adolescents

Key Caveat

The prescriber should have a clear rationale for any medication combination and develop a specific treatment and monitoring plan before implementation 1. The evidence does not support combining two amphetamine-based stimulants as a standard treatment approach for ADHD.