What are the recommendations for managing Vyvanse (lisdexamfetamine) in patients undergoing surgery?

Perioperative Management of Vyvanse (Lisdexamfetamine) for Surgery

Vyvanse (lisdexamfetamine) should be continued throughout the perioperative period without interruption. 1

Understanding Vyvanse

Vyvanse is a prodrug stimulant medication that is inactive until metabolized in the body to active d-amphetamine:

• Lisdexamfetamine consists of d-amphetamine covalently bonded to the amino acid l-lysine 2
• After oral ingestion, it undergoes rate-limited hydrolysis in the body, gradually releasing the active d-amphetamine component 2
• Commonly prescribed for attention deficit hyperactivity disorder (ADHD) and narcolepsy 1

Perioperative Recommendations

Preoperative Management

• Continue Vyvanse on the day of surgery - abrupt discontinuation of stimulants before surgery is not recommended 1
• Take the medication with a small sip of water even during NPO status 3
• Document the patient's regular dosing schedule in the medical record 4

Intraoperative Considerations

• Monitor for potential cardiovascular effects:
  • Blood pressure fluctuations may occur but are typically manageable with standard anesthetic techniques 1
  • Have vasopressors available if needed for blood pressure management 4
• Ensure adequate hydration throughout the procedure 3

Postoperative Management

• Resume the patient's regular Vyvanse dosing schedule as soon as oral intake is permitted 4
• If the oral route is unavailable for an extended period, discuss with psychiatry about temporary alternative medications 3
• Monitor for adequate pain control, as stimulants may potentially affect pain perception 4

Evidence Supporting Continuation

A study examining patients on chronic amphetamine therapy who underwent general anesthesia found:

• No significant hemodynamic instability during surgery 1
• No need to discontinue amphetamine medications before surgery 1
• Patients maintained cardiovascular stability throughout the perioperative period 1

Special Considerations

• Multimodal analgesia is particularly important for patients on stimulants:

  • Use non-opioid analgesics when possible (NSAIDs, acetaminophen) 4
  • Consider regional anesthesia techniques when appropriate 4
  • Dexamethasone (8mg IV) can be used to reduce postoperative pain 4

• Potential drug interactions to monitor:

  • Avoid medications that may increase sympathomimetic effects 5
  • Be cautious with vasopressors, as patients may have altered responses 4

Common Pitfalls to Avoid

• Avoid abrupt discontinuation of Vyvanse before surgery, as this can lead to:

  • Rebound symptoms of the underlying condition 1
  • Potential withdrawal effects 6
  • Decreased patient comfort and cooperation 3

• Avoid assuming cardiovascular instability will occur:

  • Evidence suggests patients on chronic amphetamine therapy maintain hemodynamic stability during surgery 1
  • Standard anesthetic techniques are typically sufficient 1

• Don't overlook postoperative medication resumption:

  • Have a clear plan for when and how to resume Vyvanse after surgery 4
  • Ensure continuity of care between surgical and medical teams 4

In conclusion, the evidence supports continuing Vyvanse throughout the perioperative period, with appropriate monitoring and attention to potential cardiovascular effects.