What are the indications and dosing guidelines for Vyvanse (lisdexamfetamine)?

Indications and Dosing Guidelines for Vyvanse (Lisdexamfetamine)

Indications

Vyvanse (lisdexamfetamine) is FDA-approved for the treatment of Attention Deficit Hyperactivity Disorder (ADHD) in adults and children 6 years and older, and for moderate to severe binge eating disorder (BED) in adults. 1

Vyvanse is not indicated or recommended for weight loss, despite the fact that weight loss may occur during treatment. The safety and effectiveness of Vyvanse for obesity treatment have not been established. 1

Pretreatment Assessment

Before initiating Vyvanse therapy, clinicians should:

1. Assess for cardiac disease through:

   • Careful history
   • Family history of sudden death or ventricular arrhythmia
   • Physical examination 1

2. Evaluate for history of motor or verbal tics or Tourette's syndrome 1

Dosing Guidelines

ADHD (Adults and Children 6+ Years)

• Starting dose: 30 mg once daily in the morning
• Titration: Increase by 10-20 mg at approximately weekly intervals
• Target dose range: 30-70 mg once daily
• Maximum dose: 70 mg once daily 1

Binge Eating Disorder (Adults)

• Starting dose: 30 mg once daily in the morning
• Titration: Increase by 20 mg at approximately weekly intervals
• Target dose range: 50-70 mg once daily
• Maximum dose: 70 mg once daily
• Discontinue if binge eating does not improve 1

Dosing in Renal Impairment

• 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 1

Administration Guidelines

• Take orally in the morning with or without food
• Avoid afternoon doses to prevent insomnia
• Can be administered by:
  1. Swallowing capsule whole, or
  2. Opening capsule and mixing contents with yogurt, water, or orange juice
     • Mix until completely dispersed
     • Consume immediately (do not store)
• Do not divide doses; take at least one full capsule daily 1

Monitoring

During treatment with Vyvanse, patients should be monitored for:

• Vital signs, particularly blood pressure and heart rate
• Growth parameters in children (height and weight)
• Emergence or worsening of psychiatric symptoms
• Signs of peripheral vasculopathy
• Development of tics or Tourette's syndrome 2, 1

Recommended monitoring schedule:

• Every 3-4 weeks during dose titration
• Every 3-6 months once stabilized 2

Contraindications

Vyvanse is contraindicated in patients with:

• Known hypersensitivity to amphetamine products
• Concurrent use of MAO inhibitors or within 14 days of stopping MAOIs 1

Common Side Effects

The most common adverse effects include:

• In ADHD patients: decreased appetite, anxiety, dry mouth, irritability, insomnia, nausea, upper abdominal pain, and weight loss 1
• In BED patients: dry mouth, insomnia, decreased appetite, increased heart rate, constipation, feeling jittery, and anxiety 1, 3

Important Considerations

1. Abuse potential: Vyvanse has high potential for abuse and misuse. Assess risk before prescribing and monitor throughout treatment. 1

2. Cardiovascular effects: Monitor blood pressure and heart rate regularly, especially in patients with pre-existing cardiovascular conditions. 2, 1

3. Growth suppression: In pediatric patients, monitor height and weight regularly. Consider interrupting treatment if growth is suppressed. 1

4. Drug interactions: Agents that alter urinary pH can affect blood levels of amphetamine. Acidifying agents decrease levels, while alkalinizing agents increase levels. Adjust dosing accordingly. 1

Vyvanse represents a long-acting stimulant option with proven efficacy in both ADHD and BED, with its prodrug formulation providing consistent drug delivery throughout the day. 4, 5