Can Vyvanse (lisdexamfetamine) cause hair loss?

Vyvanse (Lisdexamfetamine) and Hair Loss

Vyvanse (lisdexamfetamine) can cause hair loss as a side effect, though it is considered an uncommon adverse reaction that is typically reversible upon discontinuation or dose reduction of the medication.

Mechanism and Prevalence

Hair loss from stimulant medications like Vyvanse typically occurs through one of two mechanisms:

• Telogen effluvium: A delayed hair loss occurring 2-4 months after starting treatment, where hair follicles prematurely enter the resting phase 1
• Anagen effluvium: Less common with stimulants; involves abrupt cessation of mitotic activity in hair matrix cells 1

While specific data on lisdexamfetamine-induced hair loss is limited, stimulant medications as a class have been documented to occasionally cause alopecia. The prevalence is relatively low compared to other medications known to cause hair loss, such as:

• Lithium (12-19% of long-term users)
• Valproic acid (up to 12%, dose-dependent)
• Carbamazepine (≤6%) 2

Clinical Presentation and Diagnosis

When evaluating hair loss in a patient taking Vyvanse, it's important to:

• Establish a temporal relationship between medication initiation and onset of hair loss
• Rule out other common causes of hair loss:
  • Alopecia areata (autoimmune condition) 3
  • Telogen effluvium from other triggers (fever, severe illness, stress, childbirth) 4
  • Nutritional deficiencies
  • Androgenetic alopecia
  • Trichotillomania 3

Distinguishing features of medication-induced hair loss include:

• Diffuse thinning rather than patchy loss
• Absence of scalp inflammation
• Temporal relationship to medication initiation
• Reversibility with dose reduction or discontinuation

Management Approach

For patients experiencing hair loss while taking Vyvanse:

1. Confirm the diagnosis:

   • Exclude other causes of hair loss through history and examination
   • Consider dermoscopy to identify characteristic features of different hair loss types 3

2. Risk-benefit assessment:

   • Evaluate the therapeutic benefit of Vyvanse for the patient's ADHD symptoms
   • Consider the psychological impact of hair loss versus untreated ADHD

3. Management options:

   • Dose reduction: Consider lowering the dose if ADHD symptoms are well-controlled 2
   • Medication switch: Consider alternative non-stimulant options like atomoxetine if appropriate 5
   • Monitoring: If hair loss is mild and the therapeutic benefit is significant, continue medication with close monitoring
   • Discontinuation: In severe cases, discontinuation almost always leads to complete hair regrowth 2

4. Supportive measures:

   • Ensure adequate nutrition
   • Avoid harsh hair treatments
   • Consider cosmetic solutions during recovery phase

Important Considerations

• Hair loss is typically reversible after discontinuation or dose reduction of the medication 2
• The risk of hair loss should be weighed against the therapeutic benefits of Vyvanse in managing ADHD symptoms
• Patients should be informed about this potential side effect when starting treatment
• Stimulant medications have the strongest evidence (effect size 1.0) for treating ADHD 5

Other Common Side Effects of Vyvanse

For context, more common side effects of Vyvanse include:

• Decreased appetite
• Insomnia
• Headache
• Dry mouth
• Irritability 3, 6

These side effects are generally mild to moderate and often transient in nature 6.