What are the management options for dark puffy under-eye bags, blurred vision, and constipation associated with the use of Vyvanse (lisdexamfetamine) and Adderall (amphetamine and dextroamphetamine)?

Management of Side Effects from Vyvanse and Adderall: Dark Under-Eye Bags, Blurred Vision, and Constipation

The most effective approach for managing dark puffy under-eye bags, blurred vision, and constipation associated with Vyvanse and Adderall is to implement targeted interventions for each symptom while maintaining ADHD symptom control through appropriate medication adjustments.

Understanding the Side Effects

These side effects are common with stimulant medications used for ADHD:

1. Dark puffy under-eye bags: Result from vasoconstrictive effects of amphetamines and sleep disturbances
2. Blurred vision: An anticholinergic side effect reported with amphetamine use 1
3. Constipation: Common side effect of stimulants due to their effects on gastrointestinal motility

Management Strategy for Dark Under-Eye Bags

• Medication adjustment:

  • Consider dose reduction if ADHD symptoms are well-controlled
  • Evaluate timing of medication - taking medication earlier in the day may reduce sleep disturbance
  • Consider switching between Vyvanse and Adderall if one causes more pronounced effects

• Lifestyle interventions:

  • Ensure adequate hydration (at least 8 glasses of water daily)
  • Implement good sleep hygiene with consistent sleep schedule
  • Limit caffeine intake to less than 300 mg per day 2
  • Apply cold compresses to reduce puffiness
  • Consider topical products containing caffeine, vitamin K, or retinol

Management Strategy for Blurred Vision

• Ophthalmologic evaluation: Rule out serious ocular conditions as amphetamines can cause various ocular effects 1

• Medication adjustments:

  • Consider dose reduction
  • Evaluate timing - blurred vision may be more pronounced at peak drug levels
  • Consider switching between medications if vision issues persist

• Supportive measures:

  • Artificial tears for dry eyes
  • Regular visual breaks when reading or using screens (20-20-20 rule: every 20 minutes, look at something 20 feet away for 20 seconds)
  • Proper lighting for reading and close work

Management Strategy for Constipation

• First-line interventions:

  • Stimulant laxative: Start with a stimulant laxative such as sennosides or bisacodyl 3
  • Polyethylene glycol: Add a heaping tablespoon (17g) with 8 oz of water twice daily 3
  • Increase fluid intake to at least 8 glasses of water daily
  • Increase physical activity when appropriate

• If constipation persists:

  • Assess for obstruction or other causes (hypercalcemia, hypokalemia) 3
  • Add osmotic laxatives such as lactulose or magnesium-based products 3
  • Consider medication adjustment (dose reduction or switching between stimulants)

• For refractory constipation:

  • Consider peripherally acting μ-opioid receptor antagonists if constipation is severe and unresponsive to standard treatments 3
  • Note: While these are primarily indicated for opioid-induced constipation, they may help with severe stimulant-related constipation in some cases

Medication Optimization

• Dosage considerations:

  • Start with lowest effective dose and titrate gradually 2
  • For amphetamines: Start with 5-10 mg daily, maximum up to 50 mg daily 2
  • Monitor response every 3-4 weeks during dose adjustment 2

• Timing optimization:

  • Taking medication earlier in the day may reduce sleep disturbances and related under-eye bags
  • Consider extended-release formulations for more consistent effects with fewer peaks and troughs

Monitoring and Follow-up

• Regular follow-up every 3-6 months once stabilized 2
• Monitor for:
  • ADHD symptom control
  • Side effect improvement
  • Vital signs
  • Weight and appetite
  • Sleep quality

Important Considerations

• Do not abruptly discontinue stimulant medications - taper gradually if discontinuation is necessary
• Document baseline symptoms to better track medication effects
• Avoid combining with other medications that have similar side effects when possible
• Consider non-stimulant alternatives (atomoxetine, guanfacine, clonidine) if side effects remain intolerable despite interventions 2

When to Seek Immediate Medical Attention

• Severe or sudden visual changes
• Signs of bowel obstruction (severe abdominal pain, vomiting)
• Cardiovascular symptoms (chest pain, palpitations, syncope)

By systematically addressing each side effect while maintaining appropriate ADHD treatment, most patients can achieve symptom control with minimal adverse effects.