Lisdexamfetamine Dosing for Binge Eating Disorder
For treating binge eating disorder (BED), lisdexamfetamine (Vyvanse) should be initiated at 30 mg once daily in the morning and titrated in increments of 20 mg at approximately weekly intervals to achieve the recommended target dose of 50-70 mg once daily, with a maximum recommended dosage of 70 mg daily. 1, 2
Dosing Protocol
- Start with 30 mg once daily in the morning 1, 2
- Titrate in increments of 20 mg at approximately weekly intervals 2
- Target dose range is 50-70 mg once daily 1, 2
- Maximum recommended dose is 70 mg once daily 2
- Discontinue if binge eating does not improve 2
Administration Guidelines
- Take in the morning with or without food 2
- Avoid afternoon doses due to potential for insomnia 2
- Can be taken as a whole capsule or opened and mixed with yogurt, water, or orange juice 2
- Do not divide a single dose; take at least one full capsule daily 2
Efficacy Evidence
- Clinical trials demonstrated that 50 mg and 70 mg doses (but not 30 mg) significantly reduced binge eating days per week compared to placebo 3, 4
- The 50 mg dose showed a least squares mean change of -1.49 in log-transformed binge eating days per week (P = .008 vs placebo) 3
- The 70 mg dose showed a least squares mean change of -1.57 in log-transformed binge eating days per week (P < .001 vs placebo) 3
- Four-week binge eating cessation rates were significantly higher with 50 mg (42.2%) and 70 mg (50.0%) compared to placebo (21.3%) 3
Special Populations
- In patients with severe renal impairment (GFR 15 to < 30 mL/min/1.73 m²), maximum dosage should not exceed 50 mg once daily 2
- In patients with end-stage renal disease (GFR < 15 mL/min/1.73 m²), maximum recommended dosage is 30 mg once daily 2
Monitoring and Safety Considerations
- Pre-treatment screening should assess for cardiac disease (history, family history of sudden death or ventricular arrhythmia, physical exam) 2
- Monitor for common side effects including dry mouth (27.2%), headache (13.2%), insomnia (12.4%), and upper respiratory tract infection (11.4%) 5
- Weight loss is expected; mean weight change of -4.3 kg was observed across treatment groups in clinical trials 3
- Monitor vital signs regularly; mean increases in pulse (4.41-6.31 bpm) and blood pressure (systolic: 0.2-1.45 mmHg; diastolic: 1.06-1.83 mmHg) have been observed 4
- Assess risk of abuse prior to prescribing and monitor for signs of abuse and dependence during treatment 2
Treatment Duration
- Long-term safety and efficacy have been demonstrated in 12-month extension studies 5
- The safety profile in long-term use appears consistent with the established profile for ADHD 5, 6
Important Cautions
- Lisdexamfetamine is contraindicated in patients with known hypersensitivity to amphetamine products 2
- Do not use in patients taking MAOIs or within 14 days of stopping MAOIs due to risk of hypertensive crisis 2
- Not indicated or recommended for weight loss, despite weight loss being a common side effect 2
- Avoid use in patients with structural cardiac abnormalities, cardiomyopathy, serious heart arrhythmia, or coronary artery disease 6