What are the risks of taking Vyvanse (lisdexamfetamine) every day for patients with Attention Deficit Hyperactivity Disorder (ADHD)?

Risks of Taking Vyvanse (Lisdexamfetamine) Daily for ADHD Patients

Daily use of Vyvanse (lisdexamfetamine) for ADHD carries several significant risks including cardiovascular effects, appetite suppression, growth impacts in children, and potential for insomnia, though most patients tolerate the medication well when properly monitored.

Common Side Effects

• Decreased appetite and weight loss are among the most common side effects, occurring in 27% of adults and up to 34% of adolescents taking lisdexamfetamine 1
• Insomnia affects approximately 27% of adults and 13% of adolescents on Vyvanse compared to much lower rates in placebo groups 1
• Dry mouth is reported by 26% of adult patients taking lisdexamfetamine 1
• Other common adverse reactions include anxiety (6%), diarrhea (7%), nausea (7%), and feeling jittery (4%) 1

Cardiovascular Risks

• Vyvanse and other stimulants typically cause mild increases in blood pressure and heart rate that are generally not clinically significant in most patients 2, 3
• Stimulant medications have been associated with a potential small increased risk of serious cardiovascular events including arrhythmias with a pooled relative risk of 1.39 (95% CI: 1.06-1.83), though cohort studies show a more modest and non-significant association (RR: 1.24,95% CI: 0.84-1.83) 4
• Patients with pre-existing cardiac conditions including structural cardiac abnormalities, cardiomyopathy, serious arrhythmias, or coronary artery disease should avoid Vyvanse 1
• Regular monitoring of blood pressure and pulse is recommended for all patients taking lisdexamfetamine 2

Growth Effects in Children and Adolescents

• Long-term use of Vyvanse can lead to suppression of growth in pediatric patients, requiring close monitoring of height and weight 1
• Studies show consistently medicated children may experience a slowing in growth rate with an average percentile change of -13.4% over 12 months 1
• Higher doses are associated with greater weight loss, with children ages 6-12 years losing between 0.9-2.5 pounds after just 4 weeks of therapy depending on dosage 1
• Children younger than 6 years experienced more significant long-term weight loss than older children, which is why Vyvanse is not indicated for this age group 1

Psychiatric and Neurological Risks

• Vyvanse may worsen or trigger psychiatric symptoms including psychosis, mania, aggression, or hallucinations in some patients 1
• Motor and verbal tics may emerge or worsen during treatment, requiring careful assessment before initiation and regular monitoring 1
• Serotonin syndrome is a rare but serious risk, especially when Vyvanse is combined with serotonergic medications 1
• Peripheral vasculopathy, including Raynaud's phenomenon, has been reported with stimulant medications, requiring careful observation for digital changes 1

Special Considerations

• Vyvanse is contraindicated with MAO inhibitors or within 14 days of discontinuing an MAO inhibitor due to risk of hypertensive crisis 1
• Patients with severe renal impairment should not exceed 50mg daily, while those with end-stage renal disease should be limited to 30mg daily 1
• Vyvanse is a controlled substance with potential for abuse and dependence, requiring careful prescribing and monitoring 5
• The medication is typically administered once daily in the morning to minimize sleep disturbances 6

Long-Term Risks

• The long-term cardiovascular effects of daily stimulant use remain an area of ongoing research, though current evidence suggests minimal risk in patients without pre-existing cardiac conditions 3, 7
• While there are theoretical concerns about potential long-term cardiac sequelae with chronic stimulant use, current epidemiological data suggest a low incidence of serious adverse effects 7
• Lisdexamfetamine is a prodrug that is converted to dextroamphetamine in the blood, which may provide more consistent drug levels throughout the day compared to immediate-release stimulants 5, 8

Monitoring Recommendations

• Regular monitoring should include vital signs (blood pressure and heart rate), weight and height (in children), and assessment for emergence of psychiatric symptoms 2
• Patients should be evaluated for cardiovascular risk factors before starting Vyvanse and periodically during treatment 1
• Growth monitoring is essential in pediatric patients, with consideration for treatment interruption if children are not growing or gaining weight as expected 1
• Monitoring for digital changes is necessary to identify potential peripheral vasculopathy early 1