Generic Vyvanse (Lisdexamfetamine) and Dosing Recommendations
The generic version of Vyvanse is lisdexamfetamine dimesylate, and the recommended starting dose is 30 mg once daily in the morning with gradual increases of 10-20 mg weekly to a maximum of 70 mg daily for adults and pediatric patients 6 years and older with ADHD.
Generic Information
Lisdexamfetamine dimesylate is the generic name for Vyvanse. It is a prodrug that is therapeutically inactive until metabolized in the body to its active form, d-amphetamine 1. Unlike immediate-release stimulants, lisdexamfetamine is converted to its active form through an enzymatic process predominantly associated with red blood cells 2.
Dosage Recommendations
Initial Dosing
- Start with 30 mg once daily in the morning 1
- Take orally with or without food 1
- Avoid afternoon doses to prevent insomnia 1
Dose Titration
- Adjust dosage in increments of 10 mg or 20 mg at approximately weekly intervals 1
- Allow 1-2 weeks between dose adjustments to assess full effects 3
- Maximum recommended dosage is 70 mg once daily 1
Administration Options
Lisdexamfetamine may be administered in one of the following ways 1:
- Swallow capsules whole
- Open capsules and mix entire contents with yogurt, water, or orange juice
- Consume mixture immediately (do not store)
Special Dosing Considerations
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
Drug Interactions
- Agents that alter urinary pH can impact blood levels of amphetamine
- Acidifying agents (e.g., ascorbic acid) decrease blood levels
- Alkalinizing agents (e.g., sodium bicarbonate) increase blood levels
- Adjust dosage accordingly 1
Monitoring Recommendations
- Monitor every 3-4 weeks during dose titration and every 3-6 months once stabilized 3
- Assess vital signs, weight, sleep quality, and symptom control at each visit 3
- Evaluate for cardiac disease before initiating treatment 3
- Screen for history of motor or verbal tics or Tourette's syndrome prior to treatment 1
Available Formulations
Lisdexamfetamine dimesylate capsules are available in the following strengths 1:
- 10 mg
- 20 mg
- 30 mg
- 40 mg
- 50 mg
- 60 mg
- 70 mg
Important Precautions
- Assess risk for abuse, misuse, and addiction before prescribing 1
- Avoid use with MAOIs or within 14 days of stopping MAOIs 1
- Morning administration is recommended to avoid insomnia 1
- Do not divide doses; take as a single daily dose 1
Clinical Efficacy
Lisdexamfetamine has demonstrated efficacy in multiple clinical trials for ADHD in both children and adults, with significant improvements in ADHD rating scales and executive function 4, 2. Its long-acting properties provide symptom control for up to 14 hours post-dose in adults 2.
The prodrug nature of lisdexamfetamine may contribute to its reduced abuse potential compared to immediate-release d-amphetamine, as demonstrated in studies with adult stimulant abusers 5.
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