Increasing Vyvanse Dosage for ADHD Treatment
It is appropriate to increase Vyvanse (lisdexamfetamine) by 20mg at a time when the initial 20mg dose is ineffective for ADHD treatment.
Dosage Adjustment Guidelines
The FDA label for lisdexamfetamine specifically states that dosage may be adjusted in increments of 10mg or 20mg at approximately weekly intervals up to the maximum recommended dosage of 70mg once daily 1. This provides clear guidance that 20mg increments are within the approved adjustment protocol.
Titration Process
- Starting dose: 30mg once daily in the morning (though you started at 20mg)
- Adjustment increments: 10mg or 20mg
- Titration frequency: Approximately weekly intervals
- Maximum daily dose: 70mg
Administration Considerations
- Take Vyvanse orally in the morning with or without food
- Avoid afternoon doses due to potential insomnia
- Can be taken as a whole capsule or opened and mixed with yogurt, water, or orange juice
- The entire mixture should be consumed immediately after mixing
Monitoring During Dose Adjustments
When increasing the dose, monitor for:
- Therapeutic response (improvement in ADHD symptoms)
- Side effects such as:
- Decreased appetite
- Weight loss
- Sleep disturbances
- Cardiovascular effects (increased heart rate, blood pressure)
- Mood changes
Special Considerations
- For patients with severe renal impairment, the maximum dosage should not exceed 50mg daily
- For patients with end-stage renal disease, the maximum recommended dosage is 30mg daily
- Agents that alter urinary pH can impact blood levels of amphetamine:
- Acidifying agents decrease blood levels
- Alkalinizing agents increase blood levels
Clinical Perspective
While the FDA label clearly permits 20mg increments, it's worth noting that some clinicians may prefer more gradual titration with 10mg increments to minimize side effects. However, the 20mg increment is well within the approved guidelines and may be more efficient for patients who are not experiencing adequate symptom control at the current dose.
Contraindications
Vyvanse is contraindicated in patients with:
- Known hypersensitivity to amphetamine products
- Patients taking MAOIs or within 14 days of stopping MAOIs
Remember that Vyvanse is a controlled substance with potential for abuse, so proper monitoring during dose adjustments is essential.