Vyvanse (Lisdexamfetamine) Dosing Recommendations for Children with ADHD
For children with ADHD, Vyvanse (lisdexamfetamine) should be initiated at 30 mg once daily in the morning, with potential titration in 10-20 mg increments at weekly intervals to a maximum of 70 mg daily based on response and tolerability. 1
Initial Dosing and Titration
- Starting dose: 30 mg once daily in the morning
- Titration: Increase by 10-20 mg increments weekly as needed
- Maximum daily dose: 70 mg once daily
- Administration: Can be taken with or without food; capsule can be opened and contents dissolved in water if needed
Age-Specific Considerations
- Children 6-12 years: FDA-approved starting with 30 mg once daily
- Adolescents 13-17 years: Same dosing as children (30 mg initially, max 70 mg)
- Children under 6 years: Not FDA-approved for this age group
Monitoring Parameters
- Initial phase: Monitor every 3-4 weeks during dose titration 1
- Maintenance phase: Every 3-6 months once stabilized
- Key parameters to monitor:
- Vital signs (heart rate, blood pressure)
- Weight and height (growth parameters)
- Sleep quality
- Appetite changes
- Mood changes
- Symptom control
Clinical Advantages of Lisdexamfetamine
- Prodrug formulation: Lisdexamfetamine is inactive until metabolized in the blood to d-amphetamine 2
- Duration of action: Provides efficacy for a full treatment day (up to 14 hours) 3
- Once-daily dosing: Improves adherence and eliminates need for multiple daily doses 3
- Linear pharmacokinetics: Predictable dose-response relationship at therapeutic doses (30-70 mg) 3
Special Considerations
- Comorbid conditions: For children with comorbid anxiety, consider addressing both conditions simultaneously as untreated ADHD with anxiety leads to poorer outcomes 1
- Medication holidays: Consider periodic evaluation of continued need for medication, particularly during school breaks
- Alternative options: If inadequate response or intolerable side effects occur, consider switching to methylphenidate-based medications or non-stimulant options 1
Common Side Effects and Management
- Decreased appetite: Monitor weight regularly; encourage calorie-dense meals when appetite is better
- Sleep disturbances: Ensure morning administration; avoid afternoon dosing
- Headache: Usually transient; can be managed with adequate hydration
- Irritability: May improve with dose adjustment
Important Precautions
- Cardiovascular risk: Screen for personal or family history of cardiac issues before initiating
- Growth effects: Monitor height and weight regularly
- Psychiatric symptoms: Monitor for emergence or worsening of anxiety, agitation, or psychotic symptoms
- Substance abuse potential: As a Schedule II controlled substance, proper monitoring and prescribing practices are essential
Lisdexamfetamine's unique prodrug formulation provides extended symptom control throughout the day with once-daily dosing, making it an effective option for managing ADHD symptoms in children when properly dosed and monitored.