From the Guidelines
The risk of developing cardiomyopathy with Vyvanse (lisdexamfetamine) use is generally considered low, but patients with pre-existing cardiovascular conditions or risk factors should be closely monitored due to the potential for increased heart rate and blood pressure associated with stimulant medications. When considering the use of Vyvanse, it's essential to weigh the benefits against the potential cardiovascular risks, particularly in individuals with a history of heart conditions or those who are at higher risk for developing cardiomyopathy 1. The mechanism by which stimulants like Vyvanse could potentially contribute to cardiomyopathy involves the increase in catecholamines, which may affect cardiac muscle function and structure over time, especially at higher doses or with prolonged use. Key considerations for clinicians include:
- Conducting a thorough cardiovascular assessment before initiating Vyvanse, including measuring blood pressure and reviewing personal and family cardiac history.
- Regular monitoring of cardiovascular parameters, typically every 3-6 months, while the patient is on Vyvanse.
- Being aware of symptoms that could indicate cardiac complications, such as chest pain, shortness of breath, palpitations, or unusual fatigue, and advising patients to seek immediate medical attention if these occur.
- Recognizing that the standard dosing range of 20-70mg daily does not appear to significantly increase the risk of cardiomyopathy in otherwise healthy individuals when used as prescribed, based on the available evidence 1. It's also important to note that while the evidence suggests a low risk of cardiomyopathy with Vyvanse use, the potential for increased heart rate and blood pressure means that careful patient selection and ongoing monitoring are crucial to minimize cardiovascular risks.
From the FDA Drug Label
- 2 Risks to Patients with Serious Cardiac Disease Sudden death has been reported in patients with structural cardiac abnormalities or other serious cardiac disease who were treated with CNS stimulants at the recommended ADHD dosage Avoid lisdexamfetamine dimesylate capsules use in patients with known structural cardiac abnormalities, cardiomyopathy, serious cardiac arrhythmia, coronary artery disease, or other serious cardiac disease.
The risk of developing cardiomyopathy with Vyvanse (lisdexamfetamine) use is not directly stated in terms of incidence or probability. However, the label warns against using the drug in patients with known cardiomyopathy due to the risk of sudden death in patients with serious cardiac disease. This suggests that there may be an increased risk of adverse cardiac events, including potentially worsening or triggering cardiomyopathy, in susceptible individuals 2.
From the Research
Risk of Cardiomyopathy with Vyvanse (Lisdexamfetamine) Use
- The risk of developing cardiomyopathy with Vyvanse (lisdexamfetamine) use is not directly addressed in the provided studies 3, 4, 5, 6, 7.
- However, a study on the long-term risk of cardiovascular diseases associated with attention-deficit/hyperactivity disorder (ADHD) medication use found that longer cumulative duration of ADHD medication use was associated with an increased risk of cardiovascular disease (CVD), including hypertension and arterial disease 3.
- Another study on the pharmacological properties and clinical effects of lisdexamfetamine (Vyvanse) found that the drug is a prodrug that is hydrolyzed to its active form d-amphetamine in the blood, which can increase dopamine and noradrenaline concentrations in the synaptic cleft 4.
- There is no direct evidence in the provided studies to suggest a link between Vyvanse use and cardiomyopathy, but the increased risk of CVD associated with long-term ADHD medication use may be relevant to consider 3.
- Further research is needed to determine the specific risk of cardiomyopathy associated with Vyvanse use, as the current evidence does not provide a clear answer to this question.