Recommended Dosing of Vyvanse for Binge Eating Disorder
For binge eating disorder (BED), the recommended dose of Vyvanse (lisdexamfetamine) is 50-70 mg once daily, with a starting dose of 30 mg and weekly titration of 20 mg until the therapeutic dose is reached. 1
Dosing Protocol for Binge Eating Disorder
The FDA-approved dosing schedule for Vyvanse in binge eating disorder is:
- Initial dose: 30 mg once daily in the morning
- Titration: Increase by 20 mg weekly
- Target therapeutic dose: 50-70 mg once daily
- Maximum dose: 70 mg per day 1
Since your patient is currently taking 20 mg, they are below the recommended therapeutic dose for BED treatment. The dose should be increased to 30 mg, then titrated upward according to the schedule.
Evidence Supporting Dosing Recommendations
The FDA approval of Vyvanse for BED was based on two pivotal phase III studies showing that doses of 50-70 mg/day significantly reduced binge eating days per week compared to placebo 2. Long-term studies (up to 52 weeks) have confirmed these findings and demonstrated that Vyvanse can markedly reduce the risk of BED relapse 2.
Special Considerations
Renal impairment:
- Severe renal impairment: Maximum dose is 50 mg/day
- End-stage renal disease: Maximum dose is 30 mg/day 1
Cardiovascular risk: Avoid use in patients with structural cardiac abnormalities, cardiomyopathy, serious cardiac arrhythmia, coronary artery disease, or other serious cardiac disease 1
Monitoring requirements:
- Blood pressure and pulse should be regularly monitored
- Assess for psychiatric adverse reactions
- If <5% weight loss is achieved after 12 weeks, consider discontinuing the medication 3
Common Side Effects
The most common adverse effects in BED patients include:
- Dry mouth (27.2%)
- Headache (13.2%)
- Insomnia (12.4%)
- Upper respiratory tract infection (11.4%)
- Decreased appetite
- Increased heart rate
- Constipation
- Feeling jittery
- Anxiety 1, 4
Important Warnings
- Abuse potential: Vyvanse is a Schedule II controlled substance with high potential for abuse and misuse 1
- Not for weight loss: Although weight loss may occur, Vyvanse is not indicated for weight loss or obesity treatment 1
- Long-term use: In a 12-month extension study, the safety profile remained consistent with that observed in shorter trials 4
Conclusion
For your patient currently taking 20 mg of Vyvanse, the dose should be increased to the FDA-approved starting dose of 30 mg once daily in the morning, then titrated by 20 mg weekly until reaching the therapeutic dose range of 50-70 mg for BED treatment. Regular monitoring of vital signs and assessment for adverse effects is essential throughout treatment.