What patient education and monitoring are required for individuals taking Vyvanse (lisdexamfetamine)?

Vyvanse Patient Education and Monitoring Requirements

Patients taking Vyvanse (lisdexamfetamine) require comprehensive education about abuse risks, cardiovascular symptoms, and psychiatric side effects, along with systematic monitoring of blood pressure, heart rate, growth (in pediatric patients), and adherence throughout treatment. 1

Essential Patient Education

Abuse, Misuse, and Addiction Risks

• Educate patients and families that Vyvanse has high potential for abuse and misuse, which can lead to substance use disorder, overdose, and death. 1
• Instruct patients to store Vyvanse in a safe, preferably locked location and never share medication with others. 1
• Provide clear instructions on proper disposal of unused medication to prevent diversion. 1
• Emphasize that the first treatment regimen has the best chance for long-term success, reinforcing the importance of adherence. 2

Cardiovascular Warning Signs

• Instruct patients to contact their healthcare provider immediately if they develop exertional chest pain, unexplained syncope, or other symptoms suggestive of cardiac disease. 1
• Inform patients that Vyvanse can cause elevations in blood pressure and heart rate. 1

Psychiatric Symptoms

• Advise patients that Vyvanse may cause psychotic or manic symptoms even without prior psychiatric history. 1
• Patients should report any new or worsening behavioral changes, hallucinations, or mood disturbances immediately. 1

Peripheral Vasculopathy (Raynaud's Phenomenon)

• Educate patients about signs of circulation problems: fingers or toes may feel numb, cool, painful, or change color from pale to blue to red. 1
• Instruct patients to report any new numbness, pain, skin color changes, or temperature sensitivity in digits. 1
• Patients must call immediately if unexplained wounds appear on fingers or toes. 1

Growth Suppression (Pediatric Patients)

• Inform families that Vyvanse may cause slowing of growth and weight loss in children. 1
• Explain that growth monitoring will be part of routine care. 1

Dosing Instructions

• Starting dose: 20-30 mg every morning, titrated by 10-20 mg weekly to target dose of 50-70 mg daily (maximum 70 mg/day). 2, 1
• Instruct patients on what to do if doses are missed to prevent non-adherence complications. 2
• Emphasize the importance of taking medication as prescribed without self-adjustment. 2

Required Monitoring Parameters

Cardiovascular Monitoring

• Monitor blood pressure and pulse at baseline and regularly throughout treatment. 1
• Assess for presence of cardiac disease prior to initiating treatment. 1

Growth Monitoring (Pediatric Patients)

• Closely monitor height and weight in pediatric patients throughout treatment. 1
• Pediatric patients not growing or gaining weight as expected may need treatment interruption. 1

Psychiatric Status Monitoring

• Screen patients for risk factors for developing manic episodes prior to initiating treatment. 1
• Monitor for emergence of psychotic symptoms, mania, aggression, or behavioral changes during treatment. 1
• If new psychotic or manic symptoms occur, consider discontinuing Vyvanse. 1

Adherence Monitoring

• Establish a clinical monitoring schedule with regular review of medication adherence and concomitant medications. 2
• Non-adherence is a major preventable cause of treatment failure and increases risk of relapse. 2
• Patient self-reporting of suboptimal adherence is a strong predictor and should be taken seriously. 2

Renal Function Monitoring (When Applicable)

• In patients with renal impairment: maximum dose is 50 mg/day for severe renal impairment and 30 mg/day for end-stage renal disease. 1

Adverse Event Monitoring

• Monitor for common side effects including dry mouth, headache, insomnia, decreased appetite, and irritability. 3, 4
• Most adverse events are mild to moderate in severity. 3, 5
• Assess for signs of peripheral vasculopathy through careful observation for digital changes. 1

Ongoing Patient Support

Continuous Education

• Patient education should be continuous throughout the course of treatment, not just at initiation. 2
• Repeat teaching at intervals of 6 months or less to maintain adherence. 2
• Emphasize expected positive results (improved symptoms, well-being) rather than negative outcomes to prevent excessive anxiety. 2

Monitoring Frequency

• More frequent visits should be considered for high-risk patients based on age, comorbidities, and concomitant treatments. 2
• Regular contact (at least monthly) is needed to adequately monitor symptom course, side effects, and compliance. 2

Concomitant Medication Review

• Patients should report immediately when new medications are prescribed, particularly those that may interact with Vyvanse. 2
• Review all concomitant medications at each visit to assess for drug interactions. 2