Can a patient continue Vyvanse (lisdexamfetamine) when trying to conceive?

From the Guidelines

Patients should not continue Vyvanse (lisdexamfetamine) when trying to conceive due to limited published information on its use in pregnancy and potential risks to the fetus, as indicated by the most recent study in 2024 1.

Key Considerations

• The study published in the American Journal of Obstetrics and Gynecology in 2024 1 highlights the lack of data on lisdexamfetamine use during pregnancy, making it essential to exercise caution.
• Lisdexamfetamine is a prodrug that is converted to dextroamphetamine, and its effects on the fetus are not well understood, which is a concern for pregnant women or those trying to conceive.
• While there are no published studies specifically on lisdexamfetamine during breastfeeding, the information available on amphetamine suggests potential risks, further emphasizing the need for caution.

Recommendations

• Patients planning to conceive should consult their healthcare provider to discuss the potential risks and benefits of continuing Vyvanse.
• A preconception consultation with both a psychiatrist and obstetrician can help develop a personalized plan, which may include tapering off the medication or switching to an alternative treatment with better safety data during pregnancy.
• Non-medication strategies for managing ADHD symptoms, such as behavioral therapy and organizational tools, should be optimized during this time to minimize the need for stimulant medications like Vyvanse.

Potential Risks

• The use of Vyvanse during pregnancy may be associated with potential risks to the fetus, including effects on fetal development and blood flow to the placenta.
• There is also a concern about increased risks of complications like preterm birth or growth restriction, although the current evidence is limited and more research is needed to fully understand these risks 1.

From the FDA Drug Label

Advise patients of the potential fetal effects from the use of lisdexamfetamine dimesylate capsules during pregnancy. Advise patients to notify their healthcare provider if they become pregnant or intend to become pregnant during treatment with lisdexamfetamine dimesylate capsules [see Use in Specific Populations (8. 1)].

The patient should notify their healthcare provider if they intend to become pregnant during treatment with Vyvanse (lisdexamfetamine). It is recommended that patients consult their healthcare provider before trying to conceive while taking Vyvanse. No direct information is provided in the drug label regarding the safety of continuing Vyvanse when trying to conceive, so a conservative clinical decision would be to err on the side of caution and consult a healthcare provider for guidance 2.

From the Research

Vyvanse (Lisdexamfetamine) and Conception

• There is limited research on the use of Vyvanse (lisdexamfetamine) during pregnancy and conception 3, 4, 5.
• Studies on ADHD medications, including stimulants like amphetamines, suggest that they may not increase the risk of major congenital anomalies 3, 4.
• However, the data on the use of Vyvanse during pregnancy is scarce, and most studies focus on its use in attention deficit hyperactivity disorder (ADHD) or binge eating disorder 6.
• The available evidence on ADHD medications during pregnancy suggests that the benefits of treatment may outweigh the risks for some women, but the decision to continue treatment should be made on a case-by-case basis 4, 5.

Considerations for Women Trying to Conceive

• Women trying to conceive who are taking Vyvanse should discuss their treatment options with their healthcare provider 5.
• The provider should consider the severity of the woman's condition, the potential risks and benefits of treatment, and the availability of alternative treatments 5.
• There is no clear evidence to suggest that Vyvanse is teratogenic, but more research is needed to fully understand its effects on fetal development 3, 4.

Current Recommendations

• The current evidence does not provide clear guidance on the use of Vyvanse during conception or pregnancy 4.
• Healthcare providers should use their clinical judgment to make decisions about treatment, taking into account the individual woman's circumstances and the potential risks and benefits of treatment 4, 5.