Recommended Starting Dose of Vyvanse (Lisdexamfetamine) for ADHD
The recommended starting dose of Vyvanse (lisdexamfetamine) for ADHD is 30 mg once daily in the morning for both adults and pediatric patients 6 years and older. 1
Dosing Protocol
- Begin with 30 mg once daily in the morning, which can be taken with or without food, but avoid afternoon doses due to potential insomnia 1
- Titrate the dose in increments of 10 mg or 20 mg at approximately weekly intervals based on clinical response and tolerability 2, 1
- Maximum recommended dose is 70 mg once daily for both adults and children 1
- For children weighing less than 25 kg, exercise additional caution during dose titration 3
Administration Options
- Vyvanse capsules can be swallowed whole 1
- Alternatively, capsules can be opened and the entire contents mixed with yogurt, water, or orange juice and consumed immediately 1
- The medication should be taken in the morning to avoid sleep disturbances 1
Monitoring During Titration
- Assess clinical response and tolerability before each dose increase to minimize side effects 2
- Maintain weekly contact by telephone during initial titration and dose adjustments 2
- Typical titration period requires 2-4 weeks to reach optimal dosing 2
- After stabilization, schedule follow-up appointments at least monthly 2
Side Effect Management
- Systematically assess for common side effects including decreased appetite, insomnia, headaches, and weight loss 2
- Monitor vital signs including blood pressure, pulse, height, and weight regularly 3
- Weight should be checked at each visit as weight loss is a common side effect 2
Special Considerations
- For patients with severe renal impairment (GFR 15 to <30 mL/min/1.73 m²), maximum dosage should not exceed 50 mg once daily 1
- For patients with end-stage renal disease (GFR <15 mL/min/1.73 m²), maximum recommended dosage is 30 mg once daily 1
- Lisdexamfetamine has a high potential for abuse and misuse; proper storage and disposal should be discussed with patients and families 1
Common 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 considering the prodrug formulation's longer duration of action (up to 13 hours), which may affect timing of administration 4
- Inadequate monitoring of vital signs and weight during treatment 3
Lisdexamfetamine's prodrug design provides a gradual release of active d-amphetamine with a duration of activity of approximately 12-13 hours, allowing for once-daily dosing with efficacy maintained throughout the day 4, 5.