What is the recommended starting dose of Vyvanse (lisdexamfetamine) for a stimulant-naive patient?

Starting Dose of Vyvanse in Stimulant-Naive Patients

The recommended starting dose of Vyvanse (lisdexamfetamine) for stimulant-naive patients is 30 mg once daily in the morning, regardless of whether the indication is ADHD or binge eating disorder. 1

Dosing Protocol

Initial Dosing

• Start at 30 mg once daily in the morning for both adults and pediatric patients 6 years and older 1
• Administer with or without food 1
• Avoid afternoon doses due to potential for insomnia 1

Titration Schedule

• Increase in increments of 10 mg or 20 mg at approximately weekly intervals 1
• Maximum recommended dose is 70 mg once daily 1, 2
• For ADHD: titrate up to 70 mg based on clinical response 1
• For binge eating disorder: target dose is 50-70 mg daily, with 20 mg increments during titration 1, 3

Administration Options

The medication can be given in two ways 1:

• Swallow capsule whole, or
• Open capsule and mix entire contents with yogurt, water, or orange juice; consume immediately and do not store 1

Special Populations

Renal Impairment

• Severe renal impairment (GFR 15-30 mL/min/1.73 m²): maximum 50 mg daily 1
• End-stage renal disease (GFR <15 mL/min/1.73 m²): maximum 30 mg daily 1

Clinical Considerations

Pretreatment Assessment

Before initiating therapy, assess for 1:

• Cardiac disease (careful history, family history of sudden death or ventricular arrhythmia, physical exam)
• Family history and clinical evaluation for motor/verbal tics or Tourette's syndrome

Pharmacokinetic Profile

• Lisdexamfetamine is a prodrug that remains inactive until enzymatically converted to d-amphetamine, predominantly by red blood cells 2
• At steady state with 70 mg dosing, d-amphetamine achieves peak concentration (Cmax) at median 3.0 hours 4
• Steady-state concentration is reached by day 5 of daily dosing 4
• The prodrug formulation provides extended effect lasting up to 14 hours post-dose in adults 2

Common Pitfalls to Avoid

• Do not divide a single dose - the entire capsule content must be taken as one dose 1
• Do not start higher than 30 mg even in larger adults, as this is the FDA-approved starting dose for all patients 1
• Do not administer in the afternoon to minimize insomnia risk 1

Expected Tolerability

• Most treatment-emergent adverse events are mild to moderate 3
• Common side effects include dry mouth, headache, and insomnia 3
• Tolerability profile is similar to that observed in ADHD patients across indications 3