What are the management options for an 11-year-old female (YOF) experiencing diarrhea and urinary urgency while taking Vyvanse (lisdexamfetamine) 10mg/day?

Management of Diarrhea and Urinary Urgency in an 11-Year-Old Female on Vyvanse

The most appropriate management for this 11-year-old female experiencing diarrhea and urinary urgency while taking Vyvanse 10mg/day is to discontinue Vyvanse and consider an alternative ADHD medication, as these are recognized adverse effects that can significantly impact quality of life.

Understanding the Side Effects

Vyvanse (lisdexamfetamine) is a central nervous system stimulant approved for ADHD treatment in patients 6 years and older 1. While the FDA label doesn't specifically list diarrhea and urinary urgency as common side effects in the primary sections, gastrointestinal symptoms are known potential adverse effects of stimulant medications:

• Diarrhea is listed among the most common adverse reactions in pediatric patients ages 6 to 17 years with ADHD 1
• Urinary urgency, while not specifically mentioned in the FDA label, can occur as part of the sympathomimetic effects of stimulants

Management Algorithm

Step 1: Discontinue Vyvanse

• The presence of multiple significant side effects affecting daily functioning warrants medication discontinuation
• Case reports document gastrointestinal adverse effects with lisdexamfetamine, including a case of an 11-year-old with constipation and retention of LDX capsules 2

Step 2: Consider Alternative ADHD Medications

• Non-stimulant options (e.g., atomoxetine, guanfacine, clonidine) may have fewer gastrointestinal and urinary side effects
• Alternative stimulant medications (methylphenidate-based) may be considered if stimulants are deemed necessary for adequate ADHD control

Step 3: Symptomatic Management of Current Symptoms

For diarrhea:

• Small, frequent volumes of oral rehydration solution (5-10 ml every 1-2 minutes) gradually increasing as tolerated 3
• Age-appropriate diet should be resumed, prioritizing starches, cereals, yogurt, fruits, and vegetables 3
• Avoid foods rich in simple sugars and fats 3

For urinary urgency:

• Implement urotherapy techniques including regular moderate drinking and voiding regimen 4
• Attention to good voiding posture to facilitate pelvic floor muscle relaxation 4
• Consider double voiding (several toilet visits in close succession) 4

Monitoring and Follow-up

1. Monitor resolution of symptoms after Vyvanse discontinuation

2. If symptoms persist despite medication discontinuation:

   • For persistent diarrhea: Consider gastroenterology consultation to rule out other causes
   • For persistent urinary urgency: Consider urology consultation for further evaluation

3. When initiating alternative ADHD medication:

   • Start at the lowest effective dose
   • Monitor closely for recurrence of gastrointestinal or urinary symptoms
   • Titrate slowly based on therapeutic response and side effect profile

Important Considerations

• Stimulant medications like Vyvanse should be used cautiously in patients with pre-existing gastrointestinal or urinary conditions
• The benefits of ADHD treatment must be balanced against the impact of side effects on quality of life
• Proper hydration is essential during the transition period, especially if diarrhea is significant

Conclusion

While Vyvanse is an effective medication for ADHD, the presence of significant diarrhea and urinary urgency in this 11-year-old female indicates the need for medication discontinuation and consideration of alternative treatments. These side effects can significantly impact quality of life and may lead to medication non-adherence if not addressed promptly.