What is the recommended starting dose of Vyvanse (lisdexamfetamine) for an adult?

Starting Dose of Vyvanse for Adults

The recommended starting dose of Vyvanse (lisdexamfetamine) for adults is 30 mg once daily in the morning, with titration in increments of 10 mg or 20 mg at approximately weekly intervals up to a maximum of 70 mg daily. 1

Dosing by Indication

ADHD Treatment

• Start at 30 mg once daily in the morning for all adults with ADHD 1
• Titrate upward in 10-20 mg increments at weekly intervals based on clinical response 1
• Maximum recommended dose is 70 mg daily 1
• The medication can be taken with or without food, but avoid afternoon dosing due to insomnia risk 1

Binge Eating Disorder (BED)

• Start at 30 mg once daily for adults with moderate to severe BED 1
• Titrate in 20 mg increments at weekly intervals to reach the target dose of 50-70 mg daily 1, 2
• Maximum dose remains 70 mg daily 1
• Discontinue if binge eating does not improve 1

Critical Dosing Modifications

Renal Impairment

• Severe renal impairment (GFR 15-29 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

Drug Interactions Affecting Dosing

• Acidifying agents (e.g., ascorbic acid) decrease amphetamine blood levels—may require dose increase 1
• Alkalinizing agents (e.g., sodium bicarbonate) increase amphetamine blood levels—may require dose reduction 1

Administration Considerations

Formulation Options

• Vyvanse is available only as oral capsules for once-daily administration 3
• Capsules can be swallowed whole OR opened and mixed with yogurt, water, or orange juice 1
• If mixing, consume the entire mixture immediately—do not store 1
• The prodrug design requires enzymatic conversion in red blood cells to active d-amphetamine 3, 4

Pharmacokinetic Profile

• Steady-state d-amphetamine concentrations are reached by day 5 of daily dosing 5
• Peak plasma concentration (Tmax) occurs at approximately 3 hours post-dose 5
• Duration of effect extends up to 14 hours post-dose in adults, providing full-day symptom control 4

Mandatory Pre-Treatment Screening

Before initiating Vyvanse, assess for:

• Cardiac disease: Obtain careful personal and family history of sudden death or ventricular arrhythmia, plus physical examination 1
• Tics or Tourette's syndrome: Evaluate family history and clinically assess for motor or verbal tics 1

Common Pitfalls to Avoid

• Do not divide doses: A single dose should not be split—take at least one full capsule daily 1
• Do not use with MAOIs: Contraindicated during MAOI therapy or within 14 days of stopping MAOIs due to hypertensive crisis risk 1
• Avoid in patients with known hypersensitivity: Anaphylaxis, Stevens-Johnson syndrome, angioedema, and urticaria have been reported 1
• Monitor for abuse potential: Lisdexamfetamine has high potential for abuse, misuse, and addiction despite its prodrug formulation 1

Expected Tolerability

The most common adverse events in adults include:

• Dry mouth, headache, and insomnia (most frequent) 2
• Decreased appetite and weight loss 6
• Upper abdominal pain, irritability, and nausea 6
• Most adverse events are mild to moderate in intensity and infrequently lead to discontinuation 2