What is the role of Vyvanse (lisdexamfetamine) in the treatment of binge eating disorder in adults?

Vyvanse (Lisdexamfetamine) for Binge Eating Disorder

Lisdexamfetamine (Vyvanse) is the only FDA-approved medication for moderate to severe binge eating disorder (BED) in adults and has demonstrated significant efficacy in reducing binge eating episodes. 1

Clinical Overview and Indication

• BED is characterized by recurrent episodes of consuming large amounts of food at least once weekly for 3 months, accompanied by a sense of loss of control, without compensatory behaviors seen in bulimia nervosa 2
• Lisdexamfetamine is specifically indicated for moderate to severe BED in adults, not for weight loss purposes 1
• BED affects individuals of all genders and is associated with the development of obesity 2

Efficacy in Binge Eating Disorder

• Lisdexamfetamine significantly reduces binge eating days per week compared to placebo in clinical trials 3
• The medication increases binge eating abstinence with a relative risk of 2.61 (95% CI, 2.04 to 3.33) compared to placebo 4
• Long-term studies (up to 52 weeks) show sustained efficacy and significantly reduced risk of BED relapse compared to placebo 3, 5
• Lisdexamfetamine also reduces binge-eating-related obsessions and compulsions (mean difference -6.50 [95% CI, -8.82 to -4.18]) 4

Dosing and Administration

• Initial dose: 30 mg once daily in the morning 1
• Titration: Increase by 20 mg weekly 1
• Recommended dose range: 50-70 mg once daily 1
• Maximum dose: 70 mg per day 1
• Dose adjustments needed for patients with renal impairment:
  • Severe renal impairment: Maximum 50 mg/day 1
  • End-stage renal disease: Maximum 30 mg/day 1

Safety and Adverse Effects

• Common adverse effects (occurring in ≥5% of patients and at least twice the rate of placebo) include: 1, 5
  • Dry mouth (27.2%)
  • Headache (13.2%)
  • Insomnia (12.4%)
  • Decreased appetite
  • Anxiety
  • Nausea
  • Upper abdominal pain
• Cardiovascular effects include increased blood pressure and heart rate, requiring regular monitoring 1
• Weight loss is a common effect, with mean weight reduction of 7.04 kg over 52 weeks in long-term studies 5
• Most adverse events are mild to moderate in intensity and infrequently lead to discontinuation 3, 5

Important Warnings and Precautions

• Boxed Warning: High potential for abuse, misuse, and addiction 1
• Contraindicated in patients: 1
  • With known hypersensitivity to amphetamine products
  • Taking MAO inhibitors or within 14 days of stopping MAO inhibitors
  • Being treated with linezolid or intravenous methylene blue
• Not indicated for weight loss, despite causing weight reduction 1
• Caution in patients with serious cardiac disease, including structural abnormalities, cardiomyopathy, arrhythmias, or coronary artery disease 1
• Risk of psychiatric adverse reactions including new or worsening psychosis, mania, or bipolar symptoms 1
• May cause peripheral vasculopathy, including Raynaud's phenomenon 1
• Risk of serotonin syndrome when combined with serotonergic medications 1

Place in Therapy

• Psychotherapy, particularly cognitive-behavioral therapy (CBT), is recommended as first-line treatment for BED 6
• Lisdexamfetamine should be considered when: 6
  • Patients prefer medication over psychotherapy
  • Patients have not responded adequately to psychotherapy alone
  • BED is accompanied by comorbid obesity
• Other medication options with evidence for BED (though not FDA-approved) include topiramate and naltrexone/bupropion 6

Special Considerations

• Lisdexamfetamine is a Schedule II controlled substance due to its high potential for abuse 1
• Store in a safe place and properly dispose of unused medication 1
• Not indicated for pediatric BED patients 1
• Requires assessment of cardiac risk factors before initiation 1
• Regular monitoring of vital signs, growth (in pediatric ADHD patients), and psychiatric symptoms is essential 1