Vyvanse Starting Dose for ADHD
The starting dose of Vyvanse (lisdexamfetamine) is 30 mg once daily in the morning for both adults and children 6 years and older with ADHD. 1
Initial Dosing Protocol
- Start at 30 mg once daily administered in the early morning, with or without food 1
- Avoid afternoon dosing due to insomnia risk 1
- The medication can be swallowed whole or the capsule contents can be mixed with yogurt, water, or orange juice and consumed immediately 1
Titration Strategy
Increase the dose by 10 mg or 20 mg increments at approximately weekly intervals until optimal symptom control is achieved, up to a maximum of 70 mg once daily 1, 2
The American Academy of Pediatrics recommends:
- Using standardized ADHD rating scales (such as ADHD-RS-IV) from both parents and teachers before each dose increase to objectively guide titration 2
- Some clinicians employ a "forced titration" approach where patients receive all dose levels (30 mg, 50 mg, 70 mg) for one week each with rating scales collected at each dose 2
Monitoring Requirements
At each visit, assess:
- Blood pressure and pulse 2, 3
- Height and weight (stimulants can affect growth parameters) 2, 3
- ADHD symptom ratings from multiple informants 3
- Side effects including decreased appetite, insomnia, increased cardiovascular parameters, and headaches 3
Special Dosing Considerations
For patients with renal impairment:
- Severe renal impairment (GFR 15 to <30 mL/min/1.73 m²): maximum dose 50 mg daily 1
- End-stage renal disease (GFR <15 mL/min/1.73 m²): maximum dose 30 mg daily 1
For small children:
- Exercise caution in children weighing less than 25 kg 3
- For children weighing less than 20 kg (45 lb), omit the 15 mg dose step in titration 3
Pretreatment Screening
Before initiating Vyvanse, assess for:
- Cardiac disease through careful history, family history of sudden death or ventricular arrhythmia, and physical examination 1
- Family history and clinical evaluation for motor or verbal tics or Tourette's syndrome 1
Key Clinical Pearls
- Lisdexamfetamine is a prodrug converted to dextroamphetamine after ingestion, providing lower abuse potential compared to other amphetamines 2
- Duration of effect extends approximately 12-13 hours, with efficacy demonstrated from 1.5 hours through 13 hours post-dose 4, 5
- Do not divide a single dose; always administer at least one full capsule or chewable tablet per day 1
- The prodrug formulation provides rate-limited enzymatic biotransformation allowing once-daily dosing 6