What is the role of Vyvanse (lisdexamfetamine) in treating 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 should be considered when patients prefer medication over psychotherapy, have not responded adequately to psychotherapy alone, or have comorbid obesity. 1, 2

Indication and Place in Therapy

• Lisdexamfetamine is specifically indicated for moderate to severe binge eating disorder in adults, not for weight loss purposes 2
• Psychotherapy, particularly cognitive-behavioral therapy (CBT), is recommended as first-line treatment for BED 1
• Lisdexamfetamine should be considered as a treatment option when:
  • Patients prefer medication over psychotherapy 1
  • Patients have not responded adequately to psychotherapy alone 1
  • Patients have comorbid obesity 1

Dosing Protocol

• Initial dose: 30 mg taken orally every morning 2
• Titration schedule: Increase by 20 mg weekly 2
• Recommended dose range: 50-70 mg per day 2
• Maximum dose: 70 mg per day 2
• Dose adjustments:
  • Severe renal impairment: Maximum 50 mg/day 2
  • End-stage renal disease: Maximum 30 mg/day 2

Efficacy

• Significantly reduces binge eating days per week compared to placebo 3
• Increases binge eating abstinence with a relative risk of 2.61 compared to placebo 4
• Reduces binge-eating related obsessions and compulsions (mean difference -6.50 compared to placebo) 4
• Markedly reduces the risk of BED relapse in long-term treatment (up to 52 weeks) 3
• Produces weight reduction in patients with BED 4

Safety and Adverse Effects

• Boxed warning: High potential for abuse, misuse, and addiction 2
• Most common adverse effects (occurring in ≥5% and at least twice the rate of placebo):
  • Dry mouth (27.2%) 5
  • Headache (13.2%) 5
  • Insomnia (12.4%) 5
  • Upper respiratory tract infection (11.4%) 5
  • Other common effects: decreased appetite, anxiety, dizziness, irritability, nausea, abdominal pain, and vomiting 2
• Cardiovascular effects:
  • Increased blood pressure and heart rate 2
  • Contraindicated in patients with serious cardiac disease 2
  • Regular monitoring of vital signs is necessary 2
• Psychiatric effects:
  • May worsen or trigger psychiatric symptoms 2
  • Screen for risk factors for manic episodes before initiating 2
• Weight effects:
  • Produces weight loss in adults with BED 4, 5
  • Mean weight change of -7.04 kg observed in 12-month extension study 5

Important Precautions

• Assess for cardiac disease before initiating treatment 2
• Contraindicated with MAO inhibitors or within 14 days of last MAO inhibitor dose 2
• Monitor for signs of abuse or dependence throughout treatment 2
• Assess for tics or Tourette's syndrome before and during treatment 2
• Monitor growth in pediatric patients (though not indicated for BED in pediatrics) 2
• Watch for peripheral vasculopathy including Raynaud's phenomenon 2
• Risk of serotonin syndrome when combined with serotonergic agents 2

Clinical Pearls and Pitfalls

• Lisdexamfetamine is not indicated or recommended for weight loss, despite its effects on weight 2
• Regular reassessment of the need for continued treatment is recommended 2
• Medication should be stored securely due to abuse potential 2
• Treatment effects are typically not assessed beyond the end of treatment in most studies 4
• Most research has been conducted in overweight or obese white women aged 20-40 years, potentially limiting generalizability 4