What is the recommended dosing for Vyvanse (lisdexamfetamine) in a 10-year-old child with Attention Deficit Hyperactivity Disorder (ADHD)?

Vyvanse (Lisdexamfetamine) Dosing for a 10-Year-Old with ADHD

Start with 30 mg once daily in the morning, then increase by 10-20 mg at weekly intervals based on response, with a maximum dose of 70 mg/day. 1

Initial Dosing Protocol

• Begin with 30 mg orally once daily in the morning as the standard starting dose for school-aged children 1
• Administer the medication in the early morning to provide coverage throughout the school day 2
• The medication can be taken with or without food 1

Titration Schedule

• Increase the dose by 10 mg increments at approximately weekly intervals until optimal symptom control is achieved 2, 3
• Some clinicians may use 20 mg increments during titration, particularly if response is inadequate 3
• The maximum recommended daily dose is 70 mg/day 1
• Continue titration until ADHD symptoms are adequately controlled without significant adverse effects 3

Monitoring During Dose Adjustment

• Use standardized ADHD rating scales (such as ADHD-RS-IV) from both parents and teachers before each dose increase to objectively assess response 2, 3
• Assess blood pressure, pulse, height, and weight at each visit, as stimulants can affect growth and cardiovascular parameters 2, 4
• Systematically evaluate for common side effects including decreased appetite, insomnia, irritability, headache, and upper abdominal pain 5
• Rating scales should be obtained through phone contact between visits if needed to guide titration decisions 2

Duration of Effect

• Lisdexamfetamine provides symptom control from 1.5 hours post-dose through 13 hours, making it suitable for once-daily dosing that covers the entire school day and homework time 5
• This extended duration eliminates the need for midday dosing at school, which is a practical advantage over shorter-acting stimulants 5

Clinical Considerations for This Age Group

• A 10-year-old falls within the well-studied pediatric age range (6-12 years) where lisdexamfetamine has demonstrated robust efficacy 1, 5
• Growth monitoring is particularly important as stimulants can cause growth attenuation, especially with higher doses or longer treatment duration 6
• The prodrug formulation of lisdexamfetamine (converted to dextroamphetamine after ingestion) provides lower abuse potential compared to other amphetamines, which becomes increasingly relevant as children approach adolescence 2

Alternative Dosing Strategy: Forced Titration

• Some clinicians use a "forced titration" approach where the child receives all dose levels (30 mg, 50 mg, 70 mg) for one week each, with rating scales collected at each dose 2
• At the follow-up visit, all rating scales are reviewed together with side effect reports, and the dose producing the most benefit with fewest side effects is selected 2
• This approach can be more efficient than gradual titration but requires careful monitoring 2

Common Pitfalls to Avoid

• Do not stop at the starting dose of 30 mg without assessing for further improvement - many children require 50-70 mg for optimal response 1
• Do not increase doses more frequently than weekly intervals to allow adequate time to assess response and side effects 3
• Do not skip cardiovascular monitoring - measure blood pressure and pulse regularly, especially at higher doses 4
• Do not ignore appetite suppression - this can lead to significant weight loss and growth attenuation over time 6

When to Consider Maximum Doses

• If symptoms persist at 70 mg/day (the FDA-approved maximum), reassess the diagnosis, evaluate for comorbid conditions, and consider adding behavioral therapy rather than exceeding the recommended dose 1
• While some retrospective data suggests that exceeding recommended doses may be done safely in select cases, this should only occur with clear documentation that lower doses were inadequate and higher doses produce no significant side effects 6