Is Vyvanse (lisdexamfetamine) safe to take with propranolol?

Vyvanse and Propranolol Concurrent Use Safety

Vyvanse (lisdexamfetamine) can be safely taken with propranolol as there are no documented significant drug interactions between these medications that would affect morbidity or mortality.

Pharmacological Considerations

• Lisdexamfetamine (Vyvanse) is a prodrug that is converted to dextroamphetamine after ingestion, acting as a central nervous system stimulant by increasing dopamine and noradrenaline concentrations in the synaptic cleft 1
• Propranolol is a non-selective beta-blocker that reduces the effects of circulating catecholamines and can reduce heart rate, AV node conduction, and blood pressure 2
• Unlike some antidepressants that are potent CYP2D6 inhibitors (such as fluoxetine or paroxetine), lisdexamfetamine does not significantly inhibit CYP2D6 enzymes that metabolize propranolol, reducing the risk of drug interactions 3

Safety Profile

• The most common side effects of Vyvanse include decreased appetite (25-39% of patients) and insomnia (11-19%), which are typical for stimulant medications 4
• Propranolol's common side effects include hypotension, bradycardia, and potential worsening of heart failure in susceptible individuals 2
• When using these medications concurrently, monitor for:
  • Changes in blood pressure and heart rate, as Vyvanse may increase these parameters while propranolol decreases them 5
  • Sleep disturbances, as Vyvanse can cause insomnia while propranolol may cause sleep disturbances including vivid dreams 5

Monitoring Recommendations

• Blood pressure and heart rate should be monitored periodically, especially during the initial period of concurrent use 2
• Be alert for symptoms of:
  • Excessive beta-blockade (hypotension, bradycardia) which could theoretically occur if propranolol's effects predominate 3
  • Reduced efficacy of either medication due to their opposing effects on the sympathetic nervous system 2

Administration Guidelines

• Vyvanse is typically administered once daily in the morning to minimize sleep disturbances 5
• Propranolol can be administered in divided doses throughout the day depending on the indication and formulation 2
• Taking medications at different times of day may help minimize potential interaction effects (e.g., Vyvanse in the morning, propranolol later in the day) 5

Special Considerations

• If treating anxiety with propranolol, be aware that the combination with Vyvanse may have opposing effects, as propranolol can reduce anxiety symptoms while stimulants may occasionally exacerbate them 6
• In patients with cardiovascular conditions, the opposing effects of these medications on heart rate and blood pressure require careful monitoring 2
• Patients with a history of seizures should be monitored closely as both medications can potentially affect seizure threshold 4, 7

Clinical Efficacy

• The combination may be particularly useful in patients who require treatment for ADHD but experience anxiety or hypertension that would benefit from beta-blockade 6
• Lisdexamfetamine has shown efficacy for ADHD symptoms with improvements in attention, impulsivity, and activities of daily living 7

While these medications have opposing effects on certain physiological parameters, there is no evidence of dangerous interactions that would contraindicate their concurrent use when both are clinically indicated.