Can Metoprolol and Vyvanse Be Taken Together?
Yes, metoprolol and Vyvanse (lisdexamfetamine) can be taken together, but this combination requires careful monitoring due to opposing cardiovascular effects and potential for complications.
Rationale for Combined Use
The combination is sometimes necessary because:
- Beta-blockers like metoprolol are recommended for specific cardiovascular indications including post-myocardial infarction, heart failure with reduced ejection fraction, angina, and heart rate control 1
- Amphetamines like Vyvanse increase sympathetic tone, causing tachycardia and hypertension, which metoprolol can help counteract 1
- Metoprolol does not have significant drug-drug interactions with stimulants through cytochrome P450 pathways, unlike interactions seen with certain antidepressants 2, 3
Key Monitoring Parameters
When combining these medications, monitor closely for:
- Blood pressure changes: Vyvanse increases BP while metoprolol lowers it; the net effect is unpredictable and patient-specific 1
- Heart rate: Check for both excessive tachycardia (inadequate beta-blockade) or bradycardia (excessive beta-blockade) 4
- Target resting heart rate of 50-60 bpm unless limiting side effects occur 4
- Monitor at 1-2 week intervals during any dose adjustments of either medication 4
Dosing Considerations
Start conservatively and titrate carefully:
- Initial metoprolol dosing: 25-50 mg twice daily (tartrate) or 50-200 mg once daily (succinate) 4
- Titrate metoprolol in 25-50 mg increments every 1-2 weeks until adequate heart rate control is achieved 4
- Maximum doses: Metoprolol tartrate 200 mg twice daily (400 mg total) or metoprolol succinate 400 mg once daily 4
Contraindications to Monitor
Before escalating metoprolol doses, check for absolute contraindications:
- AV block greater than first degree 4
- SA node dysfunction 4
- Decompensated heart failure 4
- Severe hypotension 4
- Active asthma or severe reactive airway disease 4
Common Pitfalls to Avoid
Underdosing metoprolol: Starting at 25 mg and stopping there is inadequate for most patients requiring rate control; most need higher doses 4
Premature discontinuation: Hypotension often improves with time and does not necessarily require stopping therapy 4
Ignoring symptoms of excessive beta-blockade: Watch for dizziness, fatigue, syncope, shortness of breath, or worsening heart failure symptoms 5
Not considering alternative agents: If metoprolol alone fails to control Vyvanse-induced tachycardia, consider adding ivabradine (7.5 mg twice daily) which has shown superior heart rate reduction in refractory cases 4
Clinical Bottom Line
This combination is pharmacologically sound but requires individualized dose titration and vigilant monitoring. The opposing cardiovascular effects mean you cannot predict the net result without empirical observation. Start with standard metoprolol dosing, monitor closely, and titrate to effect while watching for signs of excessive beta-blockade 4, 5.