Vyvanse (Lisdexamfetamine) Dosing for ADHD
The recommended dosing for Vyvanse (lisdexamfetamine) in ADHD patients is to start at 30 mg once daily in the morning, with adjustments in increments of 10-20 mg at approximately weekly intervals up to a maximum of 70 mg once daily. 1
Initial Dosing and Administration
- Start with 30 mg once daily in the morning 1
- Take with or without food 1
- Avoid afternoon doses to prevent insomnia 1
- Administration options:
- Swallow capsule whole
- Open capsule and mix contents with yogurt, water, or orange juice (consume immediately) 1
Dose Titration
- Adjust dose in increments of 10 mg or 20 mg 1
- Allow approximately one week between dose adjustments 1
- Titrate to effective dose based on symptom control and tolerability
- Maximum recommended dose: 70 mg once daily 1
Special Populations
Renal Impairment:
- Severe impairment (GFR 15-30 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:
- Acidifying agents (e.g., ascorbic acid) decrease blood levels
- Alkalinizing agents (e.g., sodium bicarbonate) increase blood levels
- Adjust dosage accordingly when these agents are used 1
Monitoring and Follow-up
- Monitor every 3-4 weeks during dose titration 2
- Once stabilized, follow up every 3-6 months 2
- Parameters to monitor:
- Appetite and weight
- Sleep disturbances
- Mood changes
- Growth parameters
- Blood pressure and pulse 2
Efficacy Considerations
- Lisdexamfetamine has demonstrated faster and more robust treatment response compared to non-stimulants like atomoxetine 3
- Clinical response typically begins within the first 1-2 weeks of treatment 4
- Significant improvements are observed in ADHD rating scales, Clinical Global Improvement scores, and executive function assessments 5
- Effective symptom control can extend up to 14 hours post-dose in adults 5
Important Precautions
Contraindications:
- Hypersensitivity to amphetamine products
- Use of MAOIs within 14 days 1
Abuse Potential:
Cardiovascular Risk:
- Screen for cardiac disease before initiating treatment
- Assess family history of sudden death or ventricular arrhythmia 1
Remember that stimulant medications like Vyvanse have the strongest evidence (effect size 1.0) for treating ADHD compared to non-stimulants (effect size ~0.7) 2. The unique prodrug formulation of lisdexamfetamine provides extended symptom control with once-daily dosing, which may improve adherence compared to multiple daily dosing required with immediate-release stimulants.