Lisdexamfetamine (Vyvanse) Dosing Recommendations
For ADHD treatment in adults and children 6 years and older, start with 30 mg once daily in the morning, then titrate by 10-20 mg weekly as needed up to a maximum of 70 mg daily. 1
Initial Dosing and Administration
- Starting dose: 30 mg once daily in the morning
- Titration schedule: Increase by 10-20 mg at approximately weekly intervals
- Maximum dose: 70 mg once daily
- Administration timing: Take in the morning with or without food; avoid afternoon doses to prevent insomnia
- Administration methods:
- Swallow capsules whole, OR
- Open capsules and mix contents with yogurt, water, or orange juice (consume immediately)
Dosage Adjustments for Special Populations
- Severe renal 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
Pretreatment Screening
Before initiating lisdexamfetamine, assess:
- Cardiac disease (history, family history of sudden death/ventricular arrhythmia, physical exam)
- History of motor/verbal tics or Tourette's syndrome
- Risk for abuse, misuse, and addiction
Monitoring Recommendations
- During titration: Every 3-4 weeks
- Once stabilized: Every 3-6 months
- Monitor for:
- ADHD symptom improvement
- Side effects
- Vital signs (particularly blood pressure and heart rate)
- Weight and appetite changes
- Sleep disturbances
- Mood changes
Common Side Effects and Management
- Decreased appetite (27-34%): Take medication with or after meals
- Insomnia (13-27%): Ensure morning dosing, avoid doses after 2:00 PM
- Dry mouth (26-36%): Maintain adequate hydration
- Weight loss (3-9%): Monitor weight regularly
- Increased heart rate/blood pressure (2-7%): Monitor vital signs
- Anxiety (5-6%): Consider dose adjustment if significant
- Headache (30%): Typically transient
Clinical Response Expectations
Lisdexamfetamine has demonstrated a faster and more robust treatment response compared to non-stimulant medications like atomoxetine. In one head-to-head study, median time to first clinical response was 12 days for lisdexamfetamine versus 21 days for atomoxetine 2.
Important Precautions
- Drug interactions: Agents that alter urinary pH can affect blood levels (acidifying agents decrease levels, alkalinizing agents increase levels)
- Contraindications:
- Known hypersensitivity to amphetamine products
- Concurrent use or within 14 days of MAOIs
- Abuse potential: Educate patients on proper storage and disposal; regularly assess for signs of misuse
Lisdexamfetamine is a prodrug that remains pharmacologically inactive until enzymatically converted to d-amphetamine, providing long-acting symptom control for up to 14 hours post-dose 3. Long-term studies have shown sustained effectiveness for up to 12 months with a safety profile consistent with long-acting stimulant use 4.