Converting from Adderall 30 mg BID to Dyanavel XR
Do not substitute Adderall for Dyanavel XR on a milligram-per-milligram basis due to different amphetamine salt compositions and differing pharmacokinetic profiles. 1
Critical Dosing Principle
When switching from other amphetamine products to Dyanavel XR, you must discontinue the current treatment and titrate Dyanavel XR from the beginning using the standard titration schedule. 1 This is explicitly stated in the FDA labeling and represents a critical safety consideration that cannot be bypassed.
Why Direct Conversion is Contraindicated
- Adderall contains a specific mixture of amphetamine salts (dextroamphetamine sulfate, dextro- and levoamphetamine sulfate, dextroamphetamine aspartate, levoamphetamine aspartate, and dextroamphetamine saccharate) that differs from Dyanavel XR's composition 1
- The pharmacokinetic profiles between these formulations are substantially different, meaning they are absorbed, distributed, and eliminated at different rates 1
- Your patient is currently taking 60 mg total daily dose of Adderall (30 mg twice daily), which is a high dose that cannot be directly translated to Dyanavel XR
Recommended Conversion Protocol
Start Dyanavel XR at 2.5 mg or 5 mg once daily in the morning after discontinuing Adderall. 1
Titration Schedule
- Week 1: Begin with 2.5 mg or 5 mg once daily in the morning 1
- Subsequent weeks: Increase in increments of 2.5 mg to 10 mg every 4 to 7 days based on clinical response 1
- Maximum dose: 20 mg once daily 1
Critical Limitation
The maximum recommended dose of Dyanavel XR is only 20 mg once daily, which is substantially lower than your patient's current 60 mg total daily Adderall dose. 1 This represents a significant therapeutic challenge, as Dyanavel XR may not provide equivalent symptom control at its maximum approved dose.
Important Clinical Considerations
- Expect potential symptom breakthrough: Given that your patient requires 60 mg daily of Adderall, the 20 mg maximum of Dyanavel XR may be insufficient for adequate ADHD control 1
- Monitor cardiovascular parameters: Amphetamines increase systolic blood pressure by approximately 1.93 mmHg and diastolic blood pressure by 1.84 mmHg, with heart rate increases of 3.71 beats per minute 2
- Assess for withdrawal symptoms: Abrupt discontinuation of the higher Adderall dose may cause temporary worsening of ADHD symptoms during the transition period 1
Alternative Consideration
Given the substantial dose discrepancy, consider whether Dyanavel XR is the appropriate choice for this patient. If the patient requires 60 mg daily of immediate-release amphetamine formulation, switching to a different extended-release amphetamine product with a higher maximum dose (such as Adderall XR, which can be dosed up to 40 mg daily in adolescents) may be more clinically appropriate 3.
Common Pitfalls to Avoid
- Never attempt a direct milligram-per-milligram conversion between different amphetamine formulations 1
- Do not start at a higher dose to compensate for the patient's current high Adderall dose—this increases risk of adverse effects including cardiovascular complications 4, 2
- Avoid rushing the titration schedule—allow at least 4 to 7 days between dose increases to properly assess response 1