What is the recommended dosage of Vyvanse (lisdexamfetamine) for Attention Deficit Hyperactivity Disorder (ADHD) and binge eating disorder?

Vyvanse (Lisdexamfetamine) Dosing

ADHD Dosing

Start Vyvanse at 30 mg once daily in the morning for both adults and children 6 years and older, then titrate in 10-20 mg increments at weekly intervals up to a maximum of 70 mg daily. 1

Starting and Titration Protocol

• Initial dose: 30 mg once daily in the morning (with or without food) 1
• Titration schedule: Increase by 10-20 mg increments at approximately weekly intervals 1
• Maximum dose: 70 mg once daily 1
• Timing: Administer in early morning to avoid insomnia; avoid afternoon doses 1

Special Pediatric Considerations

• For children weighing less than 20 kg (45 lb), omit the 15 mg dose step in titration 2
• Children under 25 kg generally should not receive single doses greater than 15 mg of dextroamphetamine equivalents 3
• Continue titration until optimal symptom control is achieved without adverse effects 4

Renal Impairment Adjustments

• 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

Binge Eating Disorder Dosing (Adults Only)

Start at 30 mg once daily, then titrate in 20 mg increments weekly to reach the target dose of 50-70 mg daily, with a maximum of 70 mg. 1

BED-Specific Protocol

• Initial dose: 30 mg once daily 1
• Titration: Increase by 20 mg at weekly intervals 1
• Target dose: 50-70 mg daily 1, 5
• Maximum dose: 70 mg once daily 1
• Discontinuation: Stop if binge eating does not improve 1

The 50 mg and 70 mg doses demonstrated superior efficacy compared to placebo, with 42.2% and 50.0% of patients achieving 4-week binge eating cessation respectively, versus 21.3% with placebo 5.

Administration Methods

Vyvanse can be taken in two ways 1:

1. Swallow capsule whole
2. Open capsule and mix contents with yogurt, water, or orange juice:
   • Break apart any compacted powder with a spoon
   • Mix until completely dispersed
   • Consume entire mixture immediately (do not store)
   • One capsule = one dose (never divide a single dose) 1

Monitoring Requirements

Initial Assessment (Before Starting)

• Cardiac history and physical examination to assess for cardiac disease 1
• Family history of sudden death or ventricular arrhythmia 1
• Baseline blood pressure, pulse, height, and weight 3
• Screen for motor/verbal tics or Tourette's syndrome 1

Ongoing Monitoring

• Vital signs: Blood pressure and pulse at each visit 3, 4
• Growth parameters: Height and weight at each visit 4
• Symptom assessment: Use standardized ADHD rating scales from parents and teachers for children; self-ratings for adolescents and adults 3, 2
• Follow-up frequency: Weekly contact during titration phase (2-4 weeks), then at least monthly until symptoms stabilized 3

Common Side Effects to Monitor

• Decreased appetite and weight loss 2, 5
• Sleep disturbances/insomnia 2
• Increased blood pressure and pulse 2
• Headaches 2
• Anxiety and social withdrawal 3

Critical Safety Considerations

• High abuse potential: Vyvanse is a Schedule II controlled substance with risk for misuse, abuse, and addiction 1
• Contraindications: Do not use with MAOIs or within 14 days of stopping MAOIs due to hypertensive crisis risk 1
• Prodrug advantage: Lisdexamfetamine requires enzymatic conversion to active d-amphetamine, providing lower abuse potential and longer duration of action (up to 14 hours) compared to immediate-release stimulants 2, 6
• Drug interactions: Acidifying agents (ascorbic acid) decrease blood levels; alkalinizing agents (sodium bicarbonate) increase blood levels—adjust dose accordingly 1