From the Guidelines
A patient should undergo a thorough medical evaluation before restarting Vyvanse after a 10-month break to assess any changes in their health status and medication needs. This evaluation is crucial due to the potential for misuse of Vyvanse, a controlled substance, and the possibility of changes in the patient's health status during the hiatus 1. The evaluation should include a comprehensive assessment of current health status, including vital signs with special attention to blood pressure and heart rate, as Vyvanse can affect cardiovascular function. A medical history review is essential to identify any new conditions or medications that might interact with Vyvanse. Laboratory tests may be necessary, particularly to check liver function, as Vyvanse is metabolized by the liver. For patients with cardiovascular risk factors, an ECG might be recommended. Additionally, a psychiatric evaluation should assess current ADHD symptoms and any co-occurring mental health conditions.
Key Considerations
- Comprehensive assessment of current health status
- Medical history review to identify new conditions or medications
- Laboratory tests, including liver function
- Psychiatric evaluation to assess ADHD symptoms and co-occurring mental health conditions
- Consideration of cardiovascular risk factors and potential need for ECG The prescribing physician will determine the appropriate starting dose, which might be lower than the previous dose to minimize side effects as the body readjusts to the medication. According to the most recent evidence, lisdexamfetamine, the active ingredient in Vyvanse, has a large effect size for reducing ADHD core symptoms, but it is a controlled substance with potential for misuse 1. Therefore, a thorough evaluation is necessary to ensure the safe and effective use of Vyvanse.
From the FDA Drug Label
Prior to initiating lisdexamfetamine dimesylate capsules, screen patients for risk factors for developing a manic episode. Monitor all lisdexamfetamine dimesylate capsules-treated patients for potential tachycardia and hypertension. Careful observation for digital changes is necessary during lisdexamfetamine dimesylate treatment.
Yes, a patient may require further evaluation prior to restarting Vyvanse (lisdexamfetamine) after a 10-month hiatus, as the drug label recommends screening for risk factors and monitoring for potential adverse reactions prior to initiating treatment 2. It is essential to assess the patient's current medical status, including any changes in cardiac disease, psychiatric symptoms, or other conditions that may interact with lisdexamfetamine treatment.
- Evaluate the patient's cardiac status, as lisdexamfetamine may increase blood pressure and heart rate.
- Assess the patient's psychiatric history, including any new or worsening symptoms of psychosis, mania, or bipolar disorder.
- Monitor the patient's growth and development, particularly in pediatric patients.
- Check for any signs or symptoms of peripheral vasculopathy, including Raynaud's phenomenon.
- Review the patient's medication list for potential interactions with serotonergic agents or other drugs that may increase the risk of serotonin syndrome.
From the Research
Patient Evaluation Prior to Restarting Vyvanse
To determine if a patient requires further evaluation prior to restarting Vyvanse (lisdexamfetamine) after a 10-month hiatus, consider the following points:
- The patient's medical history and any changes that may have occurred during the hiatus
- The patient's previous response to Vyvanse and any adverse events that may have occurred
- The presence of any new medical conditions or medications that may interact with Vyvanse
Considerations for Restarting Vyvanse
Some key points to consider when restarting Vyvanse include:
- The pharmacological properties of lisdexamfetamine, which is a prodrug that is hydrolyzed to its active form d-amphetamine in the blood following oral administration 3
- The potential for adverse events, such as decreased appetite, insomnia, abdominal pain, and irritability, which are common with stimulant medications 4
- The importance of monitoring the patient's response to Vyvanse and adjusting the dose as needed to minimize adverse events and optimize efficacy 5
Clinical Evidence
Clinical studies have demonstrated the efficacy and safety of lisdexamfetamine in the treatment of attention-deficit/hyperactivity disorder (ADHD) in adults and children 6, 4, 5
- A study published in 2023 found that lisdexamfetamine was effective in treating ADHD in a patient with stimulant use disorder, with significant improvements in focus, concentration, and organization of thoughts 6
- Another study published in 2017 found that lisdexamfetamine was effective in reducing binge eating days per week in adults with moderate to severe binge eating disorder 7
Evaluation Prior to Restarting Vyvanse
Based on the available evidence, it is recommended that patients undergo a thorough evaluation prior to restarting Vyvanse, including:
- A review of their medical history and any changes that may have occurred during the hiatus
- An assessment of their current symptoms and any new medical conditions or medications that may interact with Vyvanse
- Monitoring of their response to Vyvanse and adjustment of the dose as needed to minimize adverse events and optimize efficacy 3, 4, 5