What can be done for a patient experiencing afternoon wear-off of Vyvanse (lisdexamfetamine)?

Managing Vyvanse (Lisdexamfetamine) Afternoon Wear-Off

For patients experiencing afternoon wear-off of Vyvanse (lisdexamfetamine), the most effective solution is to adjust the dosing schedule by either adding a small afternoon booster dose of immediate-release stimulant medication or splitting the Vyvanse dose with a second smaller dose taken at midday. 1

Understanding Vyvanse Wear-Off

Vyvanse is a long-acting prodrug stimulant that is converted to dextroamphetamine in the bloodstream. While designed to provide coverage throughout the day, some patients may experience diminished effects in the afternoon:

• Vyvanse is intended to provide efficacy for approximately 13-14 hours post-dosing 2
• Despite its long-acting design, individual metabolism can lead to variable duration of effect
• Afternoon wear-off can impact productivity, focus, and quality of life

Management Options for Afternoon Wear-Off

1. Dosing Adjustments

• Adjust timing of Vyvanse dose: Taking the medication earlier in the morning may shift the coverage window
• Consider dose increase: If currently on a suboptimal dose, increasing to the next available strength may extend duration (available in 20,30,40,50,60, and 70 mg doses) 3
• Split dosing: Taking a smaller second dose of Vyvanse in early afternoon (before 2:00 PM) to extend coverage 4

2. Add Supplemental Medication

• Short-acting stimulant booster: Adding a small dose of immediate-release methylphenidate or amphetamine in the afternoon when Vyvanse begins to wear off 4, 1
• Timing consideration: The supplemental dose should be given no later than 2:00 PM to avoid interfering with sleep 4
• Dosing recommendation: Start with a low dose (2.5-5 mg) of immediate-release stimulant and adjust as needed 4

3. Consider Alternative Long-Acting Formulations

• If afternoon wear-off persists despite adjustments, consider switching to a different long-acting stimulant or combination of formulations 1
• Options include methylphenidate extended-release formulations or combinations of immediate and extended-release preparations 1

Monitoring and Side Effect Management

When adjusting medication to address afternoon wear-off, monitor for:

• Sleep disturbances: Adding afternoon medication may exacerbate insomnia 4
• Appetite suppression: Extended coverage may further reduce appetite throughout the day 1
• Rebound irritability: Watch for irritability as medication effects diminish 4

Managing Common Side Effects

• For sleep difficulties: Ensure the last dose is taken no later than 2:00 PM 4
• For appetite suppression: Encourage high-calorie snacks or drinks when medication effects wear off in the evening 4
• For rebound irritability: Overlap dosing patterns to provide smoother transitions between doses 4

Practical Considerations

• Document the specific time when Vyvanse effects begin to diminish to guide timing of supplemental doses
• Consider behavioral strategies to help manage symptoms during periods of medication wear-off
• Regular follow-up every 3-4 weeks during dose adjustments is recommended to assess efficacy and side effects 1

Cautions and Contraindications

• Avoid combining multiple long-acting stimulants (e.g., Vyvanse with Adderall XR) due to increased risk of side effects without clear therapeutic benefit 1
• Be cautious with afternoon dosing in patients with cardiovascular conditions, as stimulants can increase blood pressure and heart rate 1
• Monitor for cumulative side effects when using multiple daily doses of stimulant medications

By systematically addressing Vyvanse afternoon wear-off through appropriate dosing adjustments or supplementation, most patients can achieve consistent symptom control throughout their day while minimizing side effects.