What is the recommended starting dose of Vyvanse (lisdexamfetamine) for a 12-year-old female?

Vyvanse Starting Dose for a 12-Year-Old Female

The recommended starting dose of Vyvanse (lisdexamfetamine) for a 12-year-old female is 30 mg once daily in the morning. 1

Initial Dosing Strategy

• Start with 30 mg orally once daily in the morning as the standard initial dose for pediatric patients, including 12-year-old females 1
• An alternative starting dose of 20 mg may be considered for patients who may be more sensitive to stimulant medications or have concerns about tolerability 1
• The medication should be administered in the morning to minimize potential sleep disturbances 1

Titration Protocol

• Increase the dose by 10 mg or 20 mg increments at approximately weekly intervals based on clinical response and tolerability 2
• The maximum approved daily dose is 70 mg 1
• Weekly dose adjustments allow adequate time to assess therapeutic response and identify any emerging side effects 2

Monitoring Requirements

During the initial titration phase (first 2-4 weeks):

• Monitor vital signs including blood pressure and pulse at each visit 2
• Track height and weight regularly, as stimulants can affect growth 2
• Assess target ADHD symptoms through parent and teacher reports 1
• Weekly telephone contact can be maintained during dose adjustments 1

Common side effects to assess systematically:

• Decreased appetite (most common) 2, 3
• Insomnia 2, 3
• Headache 2, 3
• Irritability 3
• Upper abdominal pain 3

Clinical Pearls

• Lisdexamfetamine demonstrates efficacy from 1.5 hours through 13 hours post-dose in school-aged children 3
• The prodrug formulation provides a more gradual release of active d-amphetamine, potentially reducing abuse liability compared to immediate-release formulations 4
• If the maximum recommended dose (70 mg) does not provide adequate symptom control, consider switching to a different medication class rather than exceeding the maximum dose 1
• Monthly follow-up appointments are appropriate once symptoms are stabilized on a maintenance dose 1

Important Caveats

• More frequent appointments are warranted if side effects emerge, comorbid psychiatric conditions are present, or adherence concerns arise 1
• The longer duration of action compared to immediate-release stimulants means appetite suppression and sleep effects may be more pronounced—counsel families accordingly 1
• Obtain baseline cardiovascular assessment before initiating treatment, particularly if there is any personal or family history of cardiac conditions 2