Starting Dose for Vyvanse (Lisdexamfetamine) in Adults
The recommended starting dose of Vyvanse for adults is 30 mg once daily in the morning. 1
Initial Dosing Protocol
- Start at 30 mg once daily taken in the morning with or without food 1
- Avoid afternoon doses due to insomnia risk 1
- The capsule can be swallowed whole or opened and mixed with yogurt, water, or orange juice if needed 1
Dose Titration Strategy
- Increase in increments of 10 mg or 20 mg at approximately weekly intervals based on clinical response 1
- The maximum recommended dose is 70 mg once daily 1
- For binge eating disorder specifically, titrate in 20 mg increments weekly to reach a target of 50-70 mg daily 1
Special Dosing Considerations
Renal Impairment
- Severe renal impairment (GFR 15-30 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
Drug Interactions Affecting Dose
- Acidifying agents (e.g., ascorbic acid) decrease amphetamine blood levels and may require dose adjustment upward 1
- Alkalinizing agents (e.g., sodium bicarbonate) increase amphetamine blood levels and may require dose reduction 1
Pretreatment Requirements
Before initiating Vyvanse, you must assess for:
- Cardiac disease through careful history, family history of sudden death or ventricular arrhythmia, and physical examination 1
- Motor or verbal tics or Tourette's syndrome through family history and clinical evaluation 1
Monitoring Parameters
- Blood pressure and pulse should be checked quarterly in adults on stimulants 2
- Monitor for common adverse effects including dry mouth, headache, insomnia, and decreased appetite 3
Clinical Pearls
- Lisdexamfetamine is a prodrug that remains inactive until enzymatically converted to d-amphetamine, primarily by red blood cells 4, 5
- Duration of effect is approximately 12-13 hours, supporting once-daily dosing 6, 4, 7
- The prodrug design provides rate-limited conversion, which may reduce abuse potential compared to immediate-release amphetamines 5, 7
- Do not divide a single capsule or chewable tablet—the minimum dose is one full unit 1
Common Pitfalls to Avoid
- Do not start higher than 30 mg even if the patient has prior stimulant experience—this is the FDA-approved starting dose for all adults 1
- Do not use in patients taking MAOIs or within 14 days of stopping MAOIs due to hypertensive crisis risk 1
- Do not exceed 70 mg daily—if ineffective at maximum dose, consider switching medications rather than exceeding recommended limits 2