Vyvanse (Lisdexamfetamine) for Children with ADHD
Vyvanse (lisdexamfetamine) is a good choice for children with ADHD aged 6 years and older, particularly for adolescents with concerns about medication misuse or diversion, but it is not approved or recommended for children under 6 years of age. 1
Efficacy and Approval Status
- Vyvanse (lisdexamfetamine) is FDA-approved for treating ADHD in children 6 years and older 1
- Clinical studies demonstrate efficacy with duration of effect lasting from 1.5 hours up to 13 hours post-dose, providing all-day symptom control 2
- Vyvanse has shown superior efficacy compared to placebo in improving ADHD symptoms and overall quality of life in children and adolescents 3
- When compared to other ADHD medications like atomoxetine and OROS-methylphenidate, Vyvanse demonstrated statistically significant improvements in attention, impulsivity, and activities of daily living 3
Mechanism and Formulation Advantages
- Lisdexamfetamine is a prodrug that is only activated after ingestion when metabolized by erythrocyte cells to dexamphetamine, which reduces potential for abuse 4
- The prodrug formulation makes extraction of the stimulant more difficult, providing an advantage over some other stimulant medications 4
- Pharmacologically, it works by inhibiting dopamine and noradrenaline transporters and promoting the release of these neurotransmitters 5
Special Considerations for Adolescents
- Vyvanse is specifically recommended for adolescents when there are concerns about medication misuse or diversion 4
- The American Academy of Pediatrics guidelines recommend considering Vyvanse for adolescents due to its lower abuse potential compared to other stimulants 4
- For adolescents who drive, Vyvanse's long duration of action provides symptom control while driving, which is an important safety consideration 4
Safety Profile and Adverse Effects
- Common adverse effects include decreased appetite (47%), insomnia (27%), headache (17%), irritability (16%), and abdominal pain (16%) 2
- Most adverse events are mild to moderate in severity and consistent with those commonly reported with other amphetamine products 6
- Like other stimulants, Vyvanse may affect growth, so regular monitoring of height and weight is recommended 4
- Cardiovascular monitoring is necessary as with all stimulants, though evidence does not strongly support an association between stimulant medications and serious cardiovascular events 7
Age Restrictions and Contraindications
- Vyvanse is NOT indicated for children under 6 years of age 1
- Pediatric patients younger than 6 years experienced more long-term weight loss than older patients, which is a significant concern 1
- For preschool-aged children (4-5 years), behavior therapy should be the first-line treatment, not medication 4
- Vyvanse has a high potential for abuse and misuse, which can lead to substance use disorder including addiction, requiring careful patient assessment and monitoring 1
Treatment Algorithm
- For children 6 years and older with ADHD:
- For adolescents with ADHD and concerns about medication misuse:
Important Precautions
- Prior to initiating treatment, assess for cardiac disease, tics, or Tourette's syndrome 1
- Monitor vital signs, growth parameters, and watch for psychiatric adverse effects 1
- Vyvanse should be taken in the morning to avoid insomnia 1
- The medication should not be divided; a single daily dose is recommended 1
Vyvanse represents an effective option for ADHD treatment in children 6 years and older with particular advantages for adolescents due to its reduced abuse potential and long duration of action, but it must be used with appropriate monitoring and as part of a comprehensive treatment approach.