What is the starting dose of Vyvanse (lisdexamfetamine) for adults and pediatric patients with Attention Deficit Hyperactivity Disorder (ADHD) and binge eating disorder?

Starting Dose of Vyvanse (Lisdexamfetamine) for ADHD and Binge Eating Disorder

The recommended starting dose of Vyvanse (lisdexamfetamine) is 30 mg once daily in the morning for both adults and pediatric patients 6 years and older with ADHD, and 30 mg once daily for adults with binge eating disorder. 1

Dosing for Attention Deficit Hyperactivity Disorder (ADHD)

Initial Dosing

• Start with 30 mg once daily in the morning for both adults and pediatric patients 6 years and older 1
• Administer orally in the morning with or without food 1
• Avoid afternoon doses due to potential for insomnia 1

Titration

• Dose may be adjusted in increments of 10 mg or 20 mg at approximately weekly intervals 1
• Titrate based on clinical response and presence of side effects 2
• Continue titration until symptoms have resolved and impairment has been diminished 2
• Different target symptoms may require different doses, so prioritize which symptoms are to be chosen as a basis for titration 2

Maximum Dosage

• Maximum recommended dosage is 70 mg once daily 1
• For adults, maximum daily doses may reach up to 65 mg for methylphenidate or 40 mg for dextroamphetamine/amphetamine 2

Dosing for Binge Eating Disorder (Adults Only)

Initial Dosing

• Start with 30 mg once daily in the morning 1
• Administer orally in the morning with or without food 1

Titration

• Titrate in increments of 20 mg at approximately weekly intervals 1
• Target dose range is 50 mg to 70 mg once daily 1
• Maximum recommended dosage is 70 mg once daily 1
• Discontinue if binge eating does not improve 1

Special Populations

Renal Impairment

• For severe renal impairment (GFR 15 to <30 mL/min/1.73 m²): maximum dose should not exceed 50 mg once daily 1
• For end-stage renal disease (GFR <15 mL/min/1.73 m²): maximum dose is 30 mg once daily 1

Small Children

• Exercise caution when titrating doses in children weighing less than 25 kg 2
• For children weighing less than 45 lb (20 kg), omit the 15 mg dose and week in the titration schedule 2

Administration Options

• Swallow capsules whole, or 1
• Open capsules and mix entire contents with yogurt, water, or orange juice 1
• If the contents include compacted powder, break apart with a spoon 1
• Mix until completely dispersed and consume immediately 1
• Do not store the mixture 1

Monitoring During Titration

• Obtain rating scales from teachers and parents for children with ADHD 2
• For adults, collect symptom and side-effect ratings from the patient and significant others 2
• Monitor for side effects including decreased appetite, sleep disturbances, increased blood pressure/pulse, and headaches 2
• Monitor vital signs including blood pressure, pulse, height, and weight 2

Common Pitfalls and Caveats

• Avoid prescribing to patients taking MAO inhibitors or within 14 days of stopping MAOIs due to risk of hypertensive crisis 1
• Screen for cardiac disease before initiating treatment 1
• Evaluate for motor or verbal tics or Tourette's syndrome before starting 1
• Be aware of the potential for abuse and misuse; lisdexamfetamine has a high potential for abuse 1
• Do not use for weight loss; it is not indicated or recommended for this purpose 1
• The drug is a controlled substance with potential for rebound of symptoms when effect wears off 2

Lisdexamfetamine has demonstrated efficacy at 14 hours post-dose in adults and may be used as a long-acting stimulant for managing ADHD symptoms that extend late into the day 3. Its prodrug formulation provides a longer duration of action compared to immediate-release stimulants, which may improve compliance, especially in adolescents who may benefit from the privacy of not having to take medication at school 2.