Starting Dose of Vyvanse (Lisdexamfetamine)
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 ADHD
- For adults and pediatric patients 6 years and older with ADHD, start with 30 mg once daily in the morning 1
- Dose may be adjusted in increments of 10 mg or 20 mg at approximately weekly intervals 1
- Maximum recommended dosage is 70 mg once daily 1
- Titration should be based on clinical response and presence of side effects 2
- Continue titration until symptoms have resolved and impairment has been diminished 2
Dosing for Binge Eating Disorder
- For adults with moderate to severe binge eating disorder, start with 30 mg once daily 1
- Titrate in increments of 20 mg at approximately weekly intervals 1
- Target dose 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
- Lisdexamfetamine is currently the only FDA-approved medication for binge eating disorder in adults 3
Administration Guidelines
- Take orally in the morning with or without food 1
- Avoid afternoon doses because of the potential for insomnia 1
- Can be administered by swallowing the capsule whole or by opening the capsule and mixing contents with yogurt, water, or orange juice 1
- Do not take less than one capsule per day; a single dose should not be divided 1
Special Populations and Considerations
- For patients with severe renal impairment (GFR 15 to <30 mL/min/1.73 m²), maximum dosage should not exceed 50 mg once daily 1
- For patients with end-stage renal disease (GFR <15 mL/min/1.73 m²), maximum recommended dosage is 30 mg once daily 1
- 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
Monitoring Recommendations
- Monitor for side effects including decreased appetite, sleep disturbances, increased blood pressure/pulse, and headaches 2
- For children with ADHD, obtain rating scales from teachers and parents 2
- For adults, collect symptom and side-effect ratings from the patient and significant others 2
- Monitor vital signs including blood pressure, pulse, height, and weight 2
- Be aware that lisdexamfetamine has a high potential for abuse and misuse 2, 1
Important Precautions
- Prior to treatment, assess for cardiac disease through careful history, family history of sudden death or ventricular arrhythmia, and physical examination 1
- Evaluate family history and clinically assess for motor or verbal tics or Tourette's syndrome before initiating treatment 1
- Be aware that lisdexamfetamine's prodrug formulation provides a longer duration of action (approximately 12 hours) compared to immediate-release stimulants 2, 4
- Lisdexamfetamine is not indicated or recommended for weight loss 1