To what extent does Vyvanse (lisdexamfetamine) increase blood pressure?

Blood Pressure Effects of Vyvanse (Lisdexamfetamine)

Vyvanse (lisdexamfetamine) typically increases blood pressure by approximately 2 to 4 mmHg systolic and 1 to 3 mmHg diastolic, with concurrent increases in heart rate of about 3 to 6 beats per minute. 1

Mechanism and Magnitude of Blood Pressure Effects

Lisdexamfetamine, like other CNS stimulants, causes cardiovascular effects through its sympathomimetic activity. According to the FDA drug label, these effects include:

• Mean increase in blood pressure of about 2-4 mmHg systolic and 1-3 mmHg diastolic 1
• Mean increase in heart rate of about 3-6 beats per minute 1
• These effects are consistent with high-quality evidence from a recent Cochrane review showing amphetamines increase systolic BP by 1.93 mmHg (95% CI 1.54 to 2.31) and diastolic BP by 1.84 mmHg (95% CI 1.51 to 2.16) 2

Patient-Specific Factors Affecting Blood Pressure Response

The cardiovascular effects of Vyvanse may vary based on:

• Baseline blood pressure status: Patients with pre-existing hypertension may experience more significant increases
• Age: Effects may be more pronounced in older adults
• Dose: Higher doses generally correlate with greater cardiovascular effects
• Duration of treatment: Evidence suggests these effects are sustained with long-term use 2

Monitoring Recommendations

Due to these cardiovascular effects, the FDA label recommends:

• Monitor all patients taking Vyvanse for potential tachycardia and hypertension 1
• More frequent monitoring is warranted for patients with:
  • Pre-existing hypertension
  • Cardiac disease
  • Advanced age

Clinical Significance and Risks

While the average blood pressure increase may seem modest:

• These increases are sustained during treatment and normalize 1-2 days after discontinuation
• Even small increases in blood pressure (2 mmHg systolic or 1 mmHg diastolic) can increase cardiovascular risk 3
• Patients with borderline hypertension may cross into hypertensive range with Vyvanse treatment
• The International Society of Hypertension lists sympathomimetics like amphetamines as medication exacerbators of hypertension 4

Comparison to Other Medications

• Amphetamine compounds cause similar cardiovascular effects to other stimulants used for ADHD 5
• In contrast, SSRIs like fluoxetine have minimal effects on blood pressure or may slightly reduce it 6
• SNRIs cause an average increase of 2/1 mmHg in blood pressure, similar to but generally less than amphetamines 7

Important Precautions

• Avoid use in patients with serious cardiac disease, structural cardiac abnormalities, cardiomyopathy, serious arrhythmias, or coronary artery disease 1
• Use with caution in patients with pre-existing hypertension
• Consider alternative treatments in patients at high cardiovascular risk

The blood pressure effects of Vyvanse, while modest in most patients, represent a clinically significant consideration that warrants appropriate monitoring and risk assessment, particularly in patients with pre-existing cardiovascular conditions.