Perioperative Management of Lisdexamfetamine (Vyvanse)
Lisdexamfetamine (Vyvanse) should be continued through the perioperative period, including the morning of surgery, as there is no need to stop it before anesthesia based on current evidence. 1
Rationale for Continuation
- The Society for Perioperative Assessment and Quality Improvement (SPAQI) consensus statement recommends continuing stimulant medications like Adderall (amphetamine) through the perioperative period 1
- Lisdexamfetamine is a prodrug that converts to dextroamphetamine in the body, functioning similarly to other amphetamine medications 2
- Evidence from case series shows that patients on chronic amphetamine therapy can undergo general anesthesia safely without discontinuation 3
- The primary concerns about discontinuing stimulant medications include:
- Risk of withdrawal symptoms
- Potential exacerbation of the underlying condition being treated
- Negative impact on patient's perioperative experience
Special Considerations
Anesthesia Implications
- The anesthesiologist should be informed about lisdexamfetamine use due to potential interactions with certain anesthetic medications 1
- There are theoretical concerns about cardiovascular stability, but clinical evidence shows that patients on chronic amphetamine therapy maintain stable hemodynamics during surgery 3
- Unlike some medications that require discontinuation (such as ergotamine or naltrexone), amphetamines have not shown significant adverse interactions with anesthetic agents 1
Monitoring Recommendations
- Standard hemodynamic monitoring should be employed
- Be aware of potential for:
- Mild tachycardia
- Blood pressure fluctuations
- Possible increased anesthetic requirements
Evidence Quality Assessment
The recommendation to continue lisdexamfetamine is supported by:
- Guidelines from the Society for Perioperative Assessment and Quality Improvement 1
- Clinical case series demonstrating safety of amphetamine continuation 3
- Parallel evidence from studies of similar medications showing that discontinuation of chronic medications often leads to more harm than benefit 4
Contraindications to Continuation
While general continuation is recommended, consider holding lisdexamfetamine in patients with:
- Uncontrolled hypertension
- Severe cardiovascular disease
- Known adverse reactions to anesthetic agents when combined with stimulants
Summary
Lisdexamfetamine (Vyvanse) should be continued through the perioperative period, including on the day of surgery. The anesthesiologist should be informed about its use to allow for appropriate monitoring and medication management during anesthesia. This approach aligns with current guidelines and evidence demonstrating the safety of continuing amphetamine medications perioperatively.