Vyvanse (Lisdexamfetamine) Dosing for ADHD
Recommended Dosing Protocol
The recommended starting dose of Vyvanse (lisdexamfetamine) for ADHD is 30 mg once daily in the morning, with titration in increments of 10-20 mg at approximately weekly intervals up to a maximum of 70 mg once daily. 1
Dosing Guidelines by Age Group
Adults with ADHD
- Starting dose: 30 mg once daily in the morning
- Titration: Increase by 10-20 mg at weekly intervals
- Target dose: 50-70 mg once daily
- Maximum dose: 70 mg once daily
Children and Adolescents (6 years and older)
- Starting dose: 30 mg once daily in the morning
- Titration: Increase by 10-20 mg at weekly intervals
- Maximum dose: 70 mg once daily
Administration Instructions
- Take Vyvanse once daily in the morning with or without food 1
- Avoid afternoon doses to prevent insomnia
- Administration options:
- Swallow capsule whole
- Open capsule and mix entire contents with yogurt, water, or orange juice
- Consume mixture immediately after mixing
- Do not divide a single dose
Dosage Adjustments
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 affect blood levels:
- Acidifying agents (e.g., ascorbic acid) decrease blood levels
- Alkalinizing agents (e.g., sodium bicarbonate) increase blood levels
- Adjust dosage accordingly 1
- Contraindicated with MAOIs or within 14 days of stopping MAOIs 1
Monitoring Parameters
- Monitor every 3-4 weeks during dose titration and every 3-6 months once stabilized 2
- At each visit, assess:
- Vital signs (blood pressure, pulse)
- Weight
- Sleep quality
- Symptom control
- Appetite changes
- Mood changes
Clinical Considerations
- Lisdexamfetamine is a prodrug stimulant that remains pharmacologically inactive until enzymatically converted to d-amphetamine, primarily by red blood cells 3
- Onset of action is typically within 1-2 hours with effects lasting up to 14 hours in adults 3
- Lisdexamfetamine has demonstrated faster and more robust treatment response compared to non-stimulant options like atomoxetine 4
- The prodrug formulation may confer lower abuse potential compared to immediate-release stimulants 5
Precautions and Contraindications
- Perform pretreatment screening for:
- Cardiac disease (careful history, family history of sudden death/arrhythmia, physical exam)
- History of tics or Tourette's syndrome 1
- Contraindicated in patients with:
- Known hypersensitivity to amphetamine products
- Concurrent use of MAOIs or within 14 days of MAOI use 1
- Use caution in patients with history of substance use disorders, though lisdexamfetamine may be considered due to its prodrug properties 5
Common Side Effects
- Decreased appetite (14.3%)
- Insomnia (19.5%)
- Headache (17.2%)
- Dry mouth (16.6%)
- Irritability (11.2%)
- Small increases in blood pressure and pulse 6
Vyvanse has demonstrated long-term safety and effectiveness for up to 12 months in adults with ADHD, with most treatment-emergent adverse events being mild to moderate in severity 6.