Why does Vyvanse (lisdexamfetamine) wear off too quickly?

Managing Vyvanse Wearing Off Too Quickly

If Vyvanse (lisdexamfetamine) is wearing off too early in the day, the most effective strategy is to optimize the current dose first by titrating upward in 10-20 mg increments weekly up to the maximum of 70 mg daily, as this extends duration of effect, and if symptoms still break through before the end of the day despite optimal dosing, consider switching to Adderall XR or adding a short-acting stimulant booster in the late afternoon. 1

Understanding Vyvanse's Duration of Action

Vyvanse is specifically designed as a long-acting prodrug that provides extended symptom control throughout the day:

• Vyvanse demonstrates efficacy from 1.5 hours post-dose through 13 hours in children and up to 14 hours in adults, making it one of the longest-acting ADHD stimulants available 2, 3, 4
• The medication reaches peak plasma concentration (Tmax) for the active metabolite dextroamphetamine at approximately 3.5-4.4 hours post-dose, with a half-life of 8.6-9.5 hours in children and 10-11.3 hours in adults 5
• The prodrug design provides consistent plasma concentrations throughout the day with low inter-subject (<25%) and intra-subject (<8%) variability, which theoretically should minimize "wearing off" effects 5

Dose Optimization Strategy

Before considering medication changes, ensure the patient is on an adequate dose:

• Start with 20-30 mg daily and titrate upward by 10 mg weekly increments to a maximum of 70 mg daily 6
• Higher doses within the therapeutic range provide longer duration of effect and more robust symptom control 7, 4
• Many patients reporting early "wearing off" are simply underdosed and will respond to dose escalation 1

Timing and Food Considerations

Optimize administration timing to maximize coverage:

• Administer Vyvanse in the early morning (upon waking) to ensure coverage extends through the entire day and evening 6
• Food delays Tmax by approximately 1 hour but does not significantly affect overall exposure (AUC and Cmax), so taking with or without food is acceptable based on patient preference 5
• Taking the medication too late in the morning will shift the entire duration curve later, potentially causing insomnia while leaving morning hours uncovered 6

When Dose Optimization Fails

If symptoms break through in late afternoon/evening despite optimal Vyvanse dosing (70 mg):

Option 1: Add Short-Acting Stimulant Booster

• Add immediate-release dextroamphetamine 5-10 mg or methylphenidate 5-10 mg in the late afternoon (around 3-4 PM) to bridge the gap until evening 6, 1
• This provides targeted coverage for the specific time period when Vyvanse effects diminish
• Monitor for insomnia, as late-day dosing can interfere with sleep 6

Option 2: Switch to Adderall XR

• Consider switching to Adderall XR using approximate dose conversion: 30 mg Vyvanse ≈ 10 mg Adderall; 50 mg Vyvanse ≈ 15-20 mg Adderall; 70 mg Vyvanse ≈ 20-30 mg Adderall 1
• Adderall XR has a different release profile (immediate release of 50% followed by delayed release of remaining 50%) that may provide better coverage for some patients 1
• Direct switch with no washout period is appropriate, as both are amphetamine-based stimulants with similar mechanisms and short half-lives 1

Option 3: Consider Methylphenidate-Based Alternatives

• If amphetamine side effects are problematic or duration remains inadequate, switch to methylphenidate-based long-acting formulations (Concerta, Focalin XR) which have different mechanisms and pharmacokinetic profiles 6, 1

Common Pitfalls to Avoid

Do not assume "wearing off" is inevitable or untreatable—many patients reporting this phenomenon are simply underdosed or taking medication too late in the morning 1, 2

Avoid adding multiple short-acting boosters throughout the day, as this defeats the purpose of long-acting formulations and increases pill burden, side effects, and potential for misuse 1

Do not switch medications prematurely before optimizing the current regimen to maximum therapeutic dose 1

Monitoring During Adjustments

Track specific parameters during dose optimization or medication changes:

• ADHD symptom control throughout the entire day, noting specific times when symptoms return 1, 2
• Common stimulant side effects including decreased appetite, insomnia, irritability, headache, and cardiovascular effects (blood pressure and heart rate) 1, 2, 8
• Sleep quality and timing, as late-day symptom coverage must be balanced against insomnia risk 6, 2