What is the recommended dosage and usage of Vyvanse (lisdexamfetamine) for treating Attention Deficit Hyperactivity Disorder (ADHD) and binge eating disorder?

Vyvanse (Lisdexamfetamine) Dosing and Usage

ADHD Treatment

For ADHD in patients 6 years and older, start lisdexamfetamine at 30 mg once daily in the morning, titrate by 10-20 mg weekly intervals to a maximum of 70 mg daily based on response and tolerability. 1

Dosing Algorithm for ADHD

• Starting dose: 30 mg once daily in the morning 1
• Titration schedule: Increase by 10-20 mg increments at approximately weekly intervals 1
• Maximum dose: 70 mg once daily 1
• Timing: Take in the morning with or without food; avoid afternoon doses due to insomnia risk 1

Position in ADHD Treatment Algorithm

• First-line status varies by region: Lisdexamfetamine is approved as first-line therapy in the United States but as second-line therapy in many European countries 2
• When methylphenidate fails: If no benefit after adequate methylphenidate trial, lisdexamfetamine should be preferred as the next option over non-stimulants 2
• Adolescent considerations: Lisdexamfetamine may be preferred over other stimulants in adolescents due to lower abuse potential from its prodrug formulation 3

Expected Response Timeline

• Rapid onset: Treatment effects begin quickly, unlike non-stimulants which require 6-12 weeks 2
• Duration of action: Efficacy demonstrated at 14 hours post-dose in adults, providing all-day symptom control 4

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Binge Eating Disorder Treatment

For moderate to severe binge eating disorder in adults, start lisdexamfetamine at 30 mg daily, titrate by 20 mg weekly to reach the target dose of 50-70 mg daily (maximum 70 mg). 1

Dosing Algorithm for BED

• Starting dose: 30 mg once daily 1
• Titration schedule: Increase by 20 mg increments at approximately weekly intervals 1
• Target dose: 50-70 mg daily 1
• Maximum dose: 70 mg once daily 1

Position in BED Treatment Algorithm

• Not first-line: Psychotherapy (cognitive-behavioral therapy or interpersonal therapy) should be offered first 2
• When to use medication: Consider lisdexamfetamine for adults who prefer medication or have not responded to psychotherapy alone 2
• Only FDA-approved option: Lisdexamfetamine is currently the only drug approved for BED treatment 5, 6

Efficacy Data

• 50-70 mg doses effective: Both 50 mg and 70 mg daily significantly reduced binge eating days per week compared to placebo, while 30 mg did not 7
• Cessation rates: 42.2% achieved 4-week binge cessation with 50 mg and 50.0% with 70 mg, compared to 21.3% with placebo 7
• Long-term benefit: Marked reduction in BED relapse risk maintained up to 52 weeks 5

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Administration Methods

Lisdexamfetamine can be swallowed whole or the capsule contents can be mixed with yogurt, water, or orange juice and consumed immediately. 1

• Whole capsule: Swallow intact 1
• Mixed administration: Open capsule, empty entire contents into yogurt, water, or orange juice; mix until dispersed; consume immediately without storing 1
• Breaking powder: If contents include compacted powder, use a spoon to break it apart 1
• Do not divide doses: Never take less than one full capsule per day; single dose should not be divided 1

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Monitoring Requirements

Cardiovascular Monitoring

• Pre-treatment screening: Assess for cardiac disease with careful history, family history of sudden death or ventricular arrhythmia, and physical exam before initiating 1
• Ongoing monitoring: Monitor blood pressure and pulse regularly during treatment 2

Growth and Weight Monitoring

• Height and weight: Monitor regularly, especially in pediatric patients 2
• Weight loss expected: Mean weight loss of 4.3-4.9 kg observed in BED trials 7
• Pediatric caution: Patients younger than 6 years experienced more long-term weight loss than older patients 1

Psychiatric Monitoring

• Tic assessment: Evaluate family history and clinically assess for motor/verbal tics or Tourette's syndrome before starting 1
• Abuse risk: Assess each patient's risk for abuse, misuse, and addiction before prescribing and monitor frequently throughout treatment 1

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Critical Safety Warnings

Abuse and Addiction Risk

• High abuse potential: Lisdexamfetamine is a Schedule II controlled substance with high potential for abuse, misuse, and addiction 1
• Overdose risk: Misuse can result in overdose and death, especially with higher doses or unapproved administration methods 1
• Patient education: Educate patients and families about abuse risks, proper storage, and disposal of unused medication 1

Common Adverse Effects

• Most frequent: Dry mouth, headache, insomnia, decreased appetite 2, 5
• Cardiovascular: Increased blood pressure and pulse 2
• Sleep disturbances: Avoid afternoon dosing to minimize insomnia 1
• Generally well-tolerated: Most treatment-emergent adverse events are mild to moderate intensity 5

Contraindications and Precautions

• Not for weight loss: Lisdexamfetamine is not indicated or recommended for weight loss; use of sympathomimetics for weight loss has been associated with serious cardiovascular adverse events 1
• Cardiac disease: Contraindicated in patients with serious cardiac conditions 1

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Special Populations

Pregnancy Considerations

• Placental transfer: Amphetamines cross the placental barrier 3
• Malformation risk: No association with major congenital malformations or cardiac malformations 3
• Small increased risks: Possible increased risk for gastroschisis (adjusted OR 3.0) and preeclampsia (adjusted RR 1.29) 3
• Preterm birth: Continued use in second half of pregnancy may increase preterm birth risk (adjusted RR 1.30) 3
• Neonatal monitoring: Monitor infants for irritability, insomnia, and feeding difficulties if mother took amphetamines during pregnancy 3