Vyvanse (Lisdexamfetamine) Dosing and Usage
ADHD Treatment
For ADHD, start lisdexamfetamine at 30 mg once daily in the morning, titrate by 10-20 mg weekly 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 (adults and children ≥6 years) 1
- Titration: 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 in US: Lisdexamfetamine is approved as first-line therapy in the United States 2
- Second-line in Europe: In many European countries, it is approved as second-line therapy after methylphenidate 2
- After methylphenidate failure: If no benefit is observed after adequate methylphenidate treatment, lisdexamfetamine should be preferred as the next option over non-stimulants 2
Key Advantages for ADHD
- Large effect sizes for reducing ADHD core symptoms 2
- Rapid onset of treatment effects 2
- Extended duration: Demonstrates efficacy at 14 hours post-dose in adults 3
- Lower abuse potential: May be preferred in adolescents due to prodrug formulation making extraction more difficult 4
Binge Eating Disorder Treatment
For moderate to severe binge eating disorder in adults, start lisdexamfetamine at 30 mg once daily, titrate by 20 mg weekly to the target dose of 50-70 mg daily (maximum 70 mg). 1
Dosing Algorithm for BED
- Starting dose: 30 mg once daily 1
- Titration: Increase by 20 mg increments at approximately weekly intervals 1
- Target dose: 50-70 mg once daily 1
- Maximum dose: 70 mg once daily 1
Position in BED Treatment Algorithm
- Not first-line: The American Psychiatric Association recommends eating disorder-focused cognitive-behavioral therapy or interpersonal therapy as first-line treatment 2
- Second-line pharmacotherapy: Lisdexamfetamine is suggested for adults who prefer medication or have not responded to psychotherapy alone 2
- Only FDA-approved medication: Lisdexamfetamine is currently the only drug approved in the USA for moderate to severe BED 5, 6
Efficacy Data for BED
- 50-70 mg doses effective: Both doses significantly reduced binge eating days per week compared to placebo at week 11 7
- 30 mg ineffective: The 30 mg dose did not show significant benefit over placebo 7
- Cessation rates: 50 mg achieved 42.2% four-week binge cessation; 70 mg achieved 50.0% versus 21.3% with placebo 7
- Weight loss: Mean weight reduction of 4.9 kg with both 50 mg and 70 mg doses 7
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
- Do not divide doses: Never take less than one full capsule per day; a single dose should not be divided 1
Pretreatment Screening Requirements
Before initiating lisdexamfetamine, assess for cardiac disease with careful history, family history of sudden death or ventricular arrhythmia, and physical examination. 1
- Cardiac assessment: Perform careful history, family history of sudden death/ventricular arrhythmia, and physical exam 1
- Tic disorders: Evaluate family history and clinically assess for motor/verbal tics or Tourette's syndrome 1
Monitoring Parameters
Monitor pulse, blood pressure, weight, and height (in children) throughout treatment. 2
- Cardiovascular: Pulse and blood pressure 2
- Growth: Height and weight, particularly important in pediatric patients 2
- Psychiatric: Monitor for signs of abuse, misuse, and addiction throughout treatment 1
Critical Safety Warnings
Lisdexamfetamine has high potential for abuse and misuse, which can lead to substance use disorder and addiction; misuse can result in overdose and death. 1
Key Safety Concerns
- Controlled substance: Schedule II with abuse potential 2, 1
- Cardiovascular risks: Can increase blood pressure and pulse 2
- Not for weight loss: Not indicated or recommended for weight loss; use of sympathomimetics for weight loss has been associated with serious cardiovascular adverse events 1
- Common adverse effects: Decreased appetite, sleep disturbances, headaches, dry mouth, insomnia 2, 5
Pregnancy Considerations
- Crosses placenta: Amphetamines cross the placental barrier 4
- Possible risks: Small increased risk for gastroschisis (aOR 3.0) and preeclampsia (aRR 1.29) 4
- Preterm birth: Continued use in second half of pregnancy may increase preterm birth risk (aRR 1.30) 4
- Infant monitoring: Monitor newborns for irritability, insomnia, and feeding difficulties 4
Special Populations
Pediatric ADHD
- Age ≥6 years: Same dosing as adults (start 30 mg, max 70 mg) 1
- Age <6 years: Not recommended; younger children experience more long-term weight loss 1