Vyvanse Dose Escalation After 30mg
The next dose after 30mg Vyvanse is 40mg once daily in the morning, achieved by increasing in 10mg increments at approximately weekly intervals, with the option to increase by 20mg if more rapid titration is needed. 1
Standard Dose Titration Protocol
- Start with 40mg as the next step after 30mg, following the FDA-approved dosing schedule that allows for 10mg or 20mg increments at weekly intervals 1
- The maximum recommended dose is 70mg once daily for ADHD treatment 1
- All doses should be administered once daily in the morning with or without food to avoid insomnia 1
Rationale for This Approach
The FDA label explicitly states that "dosage may be adjusted in increments of 10mg or 20mg at approximately weekly intervals" for ADHD treatment 1. Since your patient is doing well but lacking full-day coverage, a 10mg increase to 40mg represents the most conservative and evidence-based next step. This allows you to:
- Assess response incrementally while minimizing side effects 1
- Maintain the extended duration of effect that characterizes lisdexamfetamine, which has demonstrated efficacy from 1.5 hours through 13 hours post-dose in pediatric studies 2
- Optimize coverage since the prodrug mechanism provides consistent effect throughout the day once adequate dosing is achieved 3, 4
Duration of Effect Considerations
- Lisdexamfetamine demonstrates efficacy beginning at 1.5 hours post-dose and maintains effect through 13 hours in school-aged children 2
- In adults, efficacy has been demonstrated at 14 hours post-dose, making it suitable for managing symptoms that extend late into the day 4
- The drug reaches steady-state by day 5 of consistent dosing, with peak concentrations occurring at a median of 3 hours post-dose 5
Monitoring After Dose Increase
- Evaluate response after 1 week at the new 40mg dose before considering further increases 1
- If 40mg provides insufficient all-day coverage, increase to 50mg (another 10mg increment) or 60mg (20mg increment) at the next weekly interval 1
- Common side effects to monitor include decreased appetite, insomnia, headache, and irritability, though these are typically mild to moderate 2, 3
Alternative Titration Strategy
If more rapid symptom control is needed and the patient tolerates 30mg well without side effects, you may increase by 20mg to 50mg at the next weekly interval 1. However, the 10mg increment to 40mg is generally preferred for a 24-year-old who is already responding partially, as it minimizes the risk of overshoot and allows for finer dose optimization.