What are the side effects of Vyvanse (lisdexamfetamine) in pediatric patients?

Side Effects of Vyvanse (Lisdexamfetamine) in Pediatric Patients

The most common side effects of Vyvanse in pediatric patients include decreased appetite, weight loss, insomnia, irritability, headache, and upper abdominal pain. These side effects are typically dose-dependent and may require monitoring and management strategies 1.

Common Side Effects

Cardiovascular Effects

• Increased blood pressure and heart rate 2
• Palpitations (2% incidence) 1
• Tachycardia 1

Gastrointestinal Effects

• Decreased appetite (34% in children 6-12 years) 1
• Weight loss (9% in children) 1
• Upper abdominal pain 1
• Dry mouth (4% in adolescents) 1
• Nausea and vomiting 1
• Diarrhea 1

Neuropsychiatric Effects

• Insomnia (13% in children) 1
• Irritability 1
• Anxiety 1
• Headache 1
• Dizziness 1
• Tremor (2% incidence) 1
• Potential exacerbation of motor and verbal tics 1
• Worsening of Tourette's syndrome 1

Serious Side Effects

Growth Effects

• Long-term suppression of growth in pediatric patients 1
• Reduction in height and weight gain 2

Psychiatric Adverse Reactions

• Risk of new or worsening psychosis or mania, particularly in patients with pre-existing psychiatric disorders 1
• Agitation (3% in adults, may also occur in children) 1
• Mood swings 1

Cardiovascular Concerns

• Risks to patients with serious cardiac disease 1
• Hypertension 1
• Increased risk when combined with other stimulants like caffeine 2

Other Serious Side Effects

• Peripheral vasculopathy, including Raynaud's phenomenon 1
• Serotonin syndrome (particularly when combined with serotonergic drugs) 1

Monitoring Recommendations

• Regular monitoring every 3-4 weeks during initial treatment phase and every 3-6 months once stabilized 2
• Monitor the following parameters:
  • Appetite and weight
  • Sleep patterns
  • Height and growth parameters
  • Blood pressure and heart rate
  • Emergence or worsening of tics or Tourette's syndrome
  • Psychiatric symptoms

Risk Factors and Precautions

• Family history of tics or Tourette's syndrome requires assessment before initiating treatment 1
• Avoid combining with MAOIs due to risk of hypertensive crisis 1
• Limit caffeine intake to less than 300 mg per day to prevent potential blood pressure elevations 2
• Use with caution in patients with pre-existing cardiac conditions 1
• Consider alternative behavioral therapies if side effects are severe 2

Management of Side Effects

• For appetite suppression and weight loss: Monitor weight regularly, encourage calorie-dense meals, and consider medication timing with meals
• For insomnia: Administer medication earlier in the day, practice good sleep hygiene
• For headaches: Ensure adequate hydration, consider temporary dose reduction
• For cardiovascular effects: Regular monitoring of blood pressure and heart rate

Vyvanse is a prodrug that is hydrolyzed to its active form d-amphetamine in the blood following oral administration 3. This unique pharmacokinetic profile allows for once-daily dosing with a duration of activity of approximately 12 hours 4, which may be beneficial for maintaining consistent symptom control throughout the school day.

When prescribing Vyvanse, it's important to start with the lowest effective dose and titrate gradually to minimize side effects while achieving optimal symptom control.