Standard Dosing of Vyvanse (Lisdexamfetamine) for ADHD

Start Vyvanse at 30 mg once daily in the morning, then increase by 10-20 mg increments at weekly intervals to a maximum of 70 mg daily. 1

Starting Dose

Begin with 30 mg once daily taken in the early morning (with or without food) for both adults and children aged 6 years and older 1
Morning administration is essential to prevent insomnia 1
Alternative starting approaches include 20-30 mg in some guideline recommendations, though the FDA label specifies 30 mg as the standard starting dose 2, 1

Increase the dose in increments of 10 mg or 20 mg at approximately weekly intervals based on symptom control and tolerability 1
Continue titration until optimal symptom control is achieved without intolerable side effects 3
Use standardized ADHD rating scales (such as ADHD-RS-IV) from patients, parents, or teachers before each dose increase to objectively guide titration decisions 3

The maximum recommended dose is 70 mg once daily for both adults and children 1
This represents the ceiling dose regardless of age or severity of symptoms 1

Vyvanse can be taken in two ways 1:

Swallow the capsule whole, or
Open the capsule and mix the entire contents with yogurt, water, or orange juice—consume the mixture immediately and do not store it 1
Do not divide a single dose; always take at least one full capsule per day 1

Renal impairment requires dose reduction 1:

Severe renal impairment (GFR 15 to <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

Before starting treatment 3, 1:

Assess for cardiac disease through careful history, family history of sudden death or ventricular arrhythmia, and physical examination 1
Evaluate for motor or verbal tics or Tourette's syndrome 1
Obtain baseline blood pressure, pulse, height, and weight 3

During titration and ongoing treatment 3:

Vyvanse provides efficacy throughout a full treatment day, with demonstrated effectiveness from 1.5 hours through 13 hours post-dose in pediatric studies 4
In adults, efficacy has been demonstrated up to 14 hours post-dose 5
This extended duration makes it suitable for managing ADHD symptoms that extend late into the day 5

Do not start at doses higher than 30 mg, as this leads to unnecessary side effects and decreased adherence 1
Do not take afternoon doses, as this significantly increases the risk of insomnia 1
Do not continue escalating the dose if symptom control plateaus at lower doses—consider switching medications or adding non-stimulant options instead 3
Do not use agents that alter urinary pH without dose adjustment, as acidifying agents (e.g., ascorbic acid) decrease blood levels while alkalinizing agents (e.g., sodium bicarbonate) increase blood levels 1

Lisdexamfetamine is a prodrug that remains inactive until enzymatic conversion (predominantly by red blood cells) to d-amphetamine and lysine 5
This prodrug formulation provides lower abuse potential compared to other amphetamines, which is particularly relevant for adolescents and adults with substance use concerns 3, 6
The medication follows linear pharmacokinetics at therapeutic doses (30-70 mg) 7