What is the starting dose of Vyvanse (lisdexamfetamine) for Attention Deficit Hyperactivity Disorder (ADHD)?

Starting Dose of Vyvanse (Lisdexamfetamine) for ADHD

The recommended starting dose of Vyvanse (lisdexamfetamine) for ADHD is 30 mg once daily in the morning, with dosage adjustments in increments of 10 mg or 20 mg at approximately weekly intervals up to a maximum recommended dosage of 70 mg once daily. 1

Initial Dosing Protocol

• Vyvanse (lisdexamfetamine) should be initiated at 30 mg once daily in the morning for patients with ADHD 1
• Administer Vyvanse orally in the morning with or without food; avoid afternoon doses because of the potential for insomnia 1
• Vyvanse may be taken as a whole capsule or opened and mixed with yogurt, water, or orange juice, but the entire mixture should be consumed immediately 1
• Dosage titration should occur gradually, with increases of 10-20 mg at approximately weekly intervals based on response and tolerability 1

Dose Titration and Monitoring

• Assess clinical response and tolerability before each dose increase to minimize side effects 2
• During initial titration and dose adjustments, weekly contact can be maintained by telephone 2
• The titration phase typically requires 2-4 weeks to reach optimal dosing 2
• After stabilization, follow-up appointments should be scheduled at least monthly 2
• Systematically assess for side effects by asking specific questions about known stimulant side effects such as insomnia, anorexia, headaches, and weight loss 2

Maximum Dosing

• The maximum recommended daily dose of Vyvanse is 70 mg once daily 1
• If adequate symptom control is not achieved at the maximum dose, consider alternative treatments or adding non-stimulant medications 2
• For patients with severe renal impairment, the maximum dose should not exceed 50 mg once daily 1

Common Side Effects and Management

• The most common side effects include decreased appetite (47%), insomnia (27%), headache (17%), irritability (16%), and upper abdominal pain (16%) 3
• Monitor weight regularly as weight loss is a common side effect of stimulant medications 2
• Side effects are typically mild to moderate in intensity and often transient in nature 4
• Lisdexamfetamine has demonstrated efficacy for up to 13 hours post-dose in children and 14 hours in adults 4

Special Considerations

• Assess for cardiac disease before initiating treatment by taking a careful history, family history of sudden death or ventricular arrhythmia, and physical examination 1
• Evaluate for motor or verbal tics or Tourette's syndrome before starting Vyvanse 1
• Agents that alter urinary pH can impact urinary excretion and alter blood levels of amphetamine; acidifying agents decrease blood levels while alkalinizing agents increase blood levels 1
• Vyvanse is contraindicated in patients taking monoamine oxidase inhibitors (MAOIs) or within 14 days of stopping MAOIs 1

Pitfalls to Avoid

• Starting at too high a dose can lead to unnecessary side effects and decreased medication adherence 2
• Failure to systematically assess both benefits and side effects during titration 2
• Not allowing sufficient time (at least one week) between dose increases to evaluate response 1
• Overlooking the importance of morning administration to minimize sleep disturbances 1

Vyvanse has demonstrated robust clinical efficacy with dose-dependent improvements in the core symptoms of ADHD, with a duration of action that continues throughout the day, making it an effective long-acting stimulant option for managing ADHD symptoms 4, 5.