What is the recommended tapering schedule for discontinuing Vyvanse (lisdexamfetamine) 30 mg daily?

Vyvanse Tapering Protocol

For Vyvanse 30 mg daily, reduce the dose by 10 mg weekly (approximately 33% of the original dose per week), which means decreasing to 20 mg for one week, then 10 mg for one week, before complete discontinuation. 1

Recommended Tapering Schedule

• Week 1: Reduce from 30 mg to 20 mg daily 1
• Week 2: Reduce from 20 mg to 10 mg daily 1
• Week 3: Discontinue completely 1

This approach follows the standard titration increments used when initiating Vyvanse, which increases by 10 mg weekly up to therapeutic doses. 1

Rationale for This Approach

• The 10 mg weekly reduction represents approximately a 33% decrease from the original dose in the first week, which is within the range of tapering recommendations for centrally-acting medications (10-50% reductions per week). 1
• Since lisdexamfetamine (Vyvanse) is a prodrug that converts to dextroamphetamine, general principles for tapering stimulant medications apply. 1
• The relatively short duration of this taper (2-3 weeks) is appropriate given the moderate dose of 30 mg daily and the pharmacological properties of stimulants, which typically do not require the prolonged tapers needed for medications like opioids or antidepressants. 1

Monitoring During Tapering

• Assess for withdrawal symptoms after each dose reduction, including fatigue, increased appetite, depression, irritability, and difficulty concentrating. 1
• Monitor for return of ADHD symptoms that may become more prominent as the medication is reduced. 1
• Schedule follow-up appointments at each dose reduction stage to assess tolerance and adjust the plan if needed. 1

Adjusting the Taper if Needed

• If withdrawal symptoms become severe, consider slowing the taper by extending the time between dose reductions to 2 weeks per step rather than 1 week. 1, 2
• For patients who have been taking Vyvanse for years (not just months), consider a slower taper of 10% per month rather than per week, which would mean reducing by 3 mg monthly. 1
• If significant symptoms emerge, temporarily return to the previous well-tolerated dose before attempting a slower taper. 1, 2

Special Considerations

• The taper rate should ultimately be determined by the patient's ability to tolerate it—tapers can be considered successful as long as the patient is making progress. 1
• Consider timing the final discontinuation when the patient has fewer life stressors or demands, as this may improve tolerability. 2
• Do not set arbitrary time limits for completing the taper; individualize based on patient response. 1, 2

Common Pitfalls to Avoid

• Avoid abrupt discontinuation, which increases the risk of withdrawal symptoms including severe fatigue, depression, and potential rebound ADHD symptoms. 1
• Do not use a rigid "one-size-fits-all" schedule—be prepared to adjust based on individual response and tolerance. 1
• Avoid dismissing patient concerns about withdrawal symptoms or functional decline during the taper, as these fears must be taken seriously and addressed. 1

Managing Withdrawal Symptoms

• Common stimulant withdrawal symptoms include fatigue, hypersomnia, increased appetite, depression, irritability, and difficulty concentrating. 1
• Provide adequate clinician time and support to address withdrawal distress. 1
• Consider adjunctive treatments to manage specific withdrawal symptoms as needed, though pharmacological interventions for stimulant withdrawal are limited. 1

Follow-up Recommendations

• Document the patient's response to guide future treatment decisions if ADHD symptoms require resumption of medication. 1
• If ADHD symptoms re-emerge significantly during tapering, consider pausing the taper at the current dose before continuing, or discuss whether ongoing treatment is needed. 1
• Ensure the patient understands that if medication needs to be restarted, it should begin at a lower dose than previously used, not at the full 30 mg. 1