Recommended Starting Dose of Chewable Lisdexamfetamine for Pediatric ADHD
The recommended starting dose of chewable lisdexamfetamine for pediatric patients with ADHD is 30 mg once daily in the morning, with dosage adjustments in increments of 10 mg or 20 mg at approximately weekly intervals based on clinical response and tolerability. 1
Initial Dosing and Administration
- The FDA-approved starting dose for lisdexamfetamine in children 6 years and older with ADHD is 30 mg once daily taken in the morning 1
- Chewable lisdexamfetamine tablets can be substituted for capsules on a unit per unit/mg per mg basis (for example, 30 mg capsule for 30 mg chewable tablet) 1
- Lisdexamfetamine should be taken in the morning with or without food; afternoon doses should be avoided due to potential insomnia 1
- A single dose should not be divided; patients should take at least one complete tablet daily 1
Titration Protocol
- After starting at 30 mg daily, dosage may be adjusted in increments of 10 mg or 20 mg at approximately weekly intervals 1
- Titration should continue until optimal symptom control is achieved without adverse effects 2
- The maximum recommended dosage is 70 mg once daily 1
- Efficacy can typically be observed by the first week of treatment 3
Special Considerations
- Before initiating treatment, assess for cardiac disease (perform careful history, family history of sudden death or ventricular arrhythmia, and physical examination) 1
- Evaluate for history of motor or verbal tics or Tourette's syndrome before starting treatment 1
- For patients with severe renal impairment, the maximum dosage should not exceed 50 mg once daily 1
- For patients with end-stage renal disease, the maximum recommended dosage is 30 mg once daily 1
Monitoring During Treatment
- Monitor for common side effects, which include decreased appetite (39%), insomnia (19%), upper abdominal pain (12%), headache (12%), irritability (10%), and weight decrease (9%) 3
- Regularly assess height, weight, pulse, and blood pressure during treatment 2
- Use standardized ADHD rating scales to evaluate treatment response 2
- Growth attenuation may occur with stimulant treatment, particularly in children on higher doses 4
Duration of Effect
- Lisdexamfetamine provides symptom control throughout the day, with effects lasting up to 6 PM after morning dosing 3, 5
- The prodrug nature of lisdexamfetamine provides a gradual release of the active d-amphetamine molecule through rate-limited hydrolysis, contributing to its extended duration of action 3
Important Cautions
- Lisdexamfetamine has a high potential for abuse and misuse; assess each patient's risk before prescribing 1
- Avoid use in patients with known structural cardiac abnormalities, cardiomyopathy, serious cardiac arrhythmia, or other serious cardiac disease 1
- Lisdexamfetamine is not indicated for children younger than 6 years of age 1
- Lisdexamfetamine is not recommended for weight loss; use of sympathomimetic drugs for weight loss has been associated with serious cardiovascular adverse events 1