Can you take Vyvanse (lisdexamfetamine) with Celebrex (celecoxib) and Flexeril (cyclobenzaprine)?

Concomitant Use of Vyvanse with Celebrex and Flexeril

Taking Vyvanse (lisdexamfetamine) with Celebrex (celecoxib) and Flexeril (cyclobenzaprine) should be avoided due to potential serious drug interactions, particularly the risk of serotonin syndrome with cyclobenzaprine and increased cardiovascular risks when combining stimulants with NSAIDs.

Potential Interactions and Risks

Vyvanse (Lisdexamfetamine)

• Vyvanse is a prodrug that converts to dextroamphetamine, a central nervous system stimulant used for ADHD treatment 1
• It works by inhibiting dopamine and norepinephrine transporters and promoting neurotransmitter release 1
• Can increase blood pressure and heart rate, which may compound cardiovascular risks when combined with NSAIDs 2

Celebrex (Celecoxib)

• Celecoxib is a COX-2 selective NSAID that carries cardiovascular risks including increased risk of myocardial infarction, stroke, and heart failure 2
• The American Heart Association has issued warnings about cardiovascular events with COX-2 inhibitors 2
• Celecoxib can cause renal toxicity through inhibition of prostaglandin synthesis 3

Flexeril (Cyclobenzaprine)

• Cyclobenzaprine is a muscle relaxant that has been associated with serotonin syndrome when combined with other serotonergic medications 4
• Has a chemical structure similar to tricyclic antidepressants and may affect serotonin levels 4

Specific Interaction Concerns

Cardiovascular Risks

• Both Vyvanse (as a stimulant) and Celebrex can independently increase cardiovascular risks 2, 1
• Combining these medications may potentially compound these risks, leading to:
  • Increased blood pressure 2, 3
  • Higher risk of cardiovascular events 2
  • Worsening of existing hypertension 3

Serotonin Syndrome Risk

• Cyclobenzaprine (Flexeril) has been reported to precipitate serotonin syndrome when combined with serotonergic medications 4
• Amphetamines like the active metabolite of Vyvanse can affect serotonin levels, potentially increasing this risk 1
• Symptoms of serotonin syndrome include agitation, hallucinations, rapid heart rate, fever, excessive sweating, shivering, tremor, muscle stiffness, coordination problems, and gastrointestinal symptoms 4

Renal Concerns

• Both Celebrex and Vyvanse can affect kidney function 3
• Celebrex can cause volume-dependent renal failure and other renal complications 3
• The combination may increase the risk of renal adverse effects 3

Recommendations

Alternative Approaches

• Consider alternative pain management options instead of combining these medications 3, 5
• For pain management:
  • Acetaminophen may be a safer alternative for pain relief than Celebrex when taking Vyvanse 5
  • Non-pharmacological approaches such as physical therapy for muscle spasms 5
  • If NSAID therapy is necessary, consider using the lowest effective dose for the shortest duration 2, 5

If These Medications Must Be Used

• Close monitoring for:
  • Signs of serotonin syndrome (confusion, agitation, muscle rigidity, fever, sweating, tremor) 4
  • Cardiovascular effects (blood pressure, heart rate) 2, 3
  • Renal function 3
  • Gastrointestinal symptoms 3, 5

Special Considerations

• Elderly patients are at particularly high risk for adverse effects from these medications 5
• Patients with pre-existing cardiovascular disease should especially avoid this combination 2, 3, 5
• Patients with renal impairment are at higher risk for complications 3

Conclusion

The combination of Vyvanse with both Celebrex and Flexeril carries significant risks, particularly cardiovascular concerns and potential serotonin syndrome. Alternative treatment approaches should be strongly considered, and if these medications must be used together, close monitoring is essential.