Side Effects of Vyvanse (Lisdexamfetamine)
Vyvanse causes common side effects including decreased appetite, insomnia, dry mouth, increased blood pressure and heart rate, headaches, and gastrointestinal symptoms, with most adverse events being mild to moderate in severity. 1
Most Common Side Effects
Cardiovascular Effects
- Increased blood pressure and heart rate occur consistently with Vyvanse treatment and require regular monitoring throughout therapy 2
- These cardiovascular changes are statistically significant but typically small at the group level, though may be clinically relevant in patients with pre-existing cardiovascular disease 2
- Sudden death has been reported in patients with heart defects or serious heart disease, though causality remains uncertain 1
Appetite and Weight Effects
- Decreased appetite is among the most frequent side effects, reported in 8% of adults with binge eating disorder (vs 2% placebo) 1
- Weight loss occurs in a dose-dependent manner: in pediatric patients ages 6-12, mean weight loss after 4 weeks was -0.9, -1.9, and -2.5 pounds for 30mg, 50mg, and 70mg doses respectively 1
- In adults with ADHD, weight loss after 4 weeks ranged from 2.8 to 4.3 pounds depending on dose 1
- Growth rate slowing occurs in consistently medicated pediatric patients, with an age- and sex-normalized mean change in weight percentile of -13.4 over one year 1
Sleep Disturbances
- Insomnia is reported in 20% of adults with binge eating disorder taking Vyvanse (vs 8% placebo) 1
- Sleep disturbances are among the most frequently cited adverse effects across all age groups 2
Gastrointestinal Effects
- Dry mouth is the most common side effect in adults with binge eating disorder, occurring in 36% (vs 7% placebo) 1
- Stomach pain, abdominal discomfort, constipation (6% vs 1% placebo), and diarrhea (4% vs 2% placebo) are reported 2, 1
Neuropsychiatric Effects
- Headaches occur frequently across all patient populations 2
- Irritability and jitteriness are common, with "feeling jittery" reported in 6% of adults (vs 1% placebo) 1
- Anxiety occurs in 5-6% of adult patients (vs 0-1% placebo) 3, 1
Serious but Rare Side Effects
Psychiatric Complications
- New or worsening psychiatric symptoms including psychosis, mania, bipolar illness, and aggression can occur 1
- Motor and verbal tics may emerge or worsen during treatment 1
- Depression and suicidality require monitoring, though recent evidence suggests stimulants may actually decrease suicidal risk in ADHD patients 2
Cardiovascular Events
- Serious cardiovascular events including sudden death have been reported, though a causal relationship remains uncertain given the millions of patients treated 2
- Cardiomyopathy and chest pain are listed as postmarketing adverse reactions 1
Other Serious Reactions
- Serotonin syndrome can occur, particularly when combined with other serotonergic medications (SSRIs, SNRIs, MAOIs, triptans) 3, 1
- Peripheral vasculopathy including Raynaud's phenomenon 1
- Anaphylactic reactions, angioedema, and Stevens-Johnson Syndrome (postmarketing reports) 1
- Eosinophilic hepatitis, rhabdomyolysis, and intestinal ischemia (rare postmarketing reports) 1
Monitoring Requirements
Regular monitoring should include: 2
- Height and weight at each visit
- Blood pressure and heart rate throughout treatment
- Assessment for psychiatric adverse reactions including new or worsening anxiety, particularly in the first 24-48 hours after dosage changes 3
Clinical Context
The tolerability profile of Vyvanse is consistent with other stimulant medications, with most treatment-emergent adverse events being mild to moderate in intensity and often transient 4, 5. In clinical trials, only 4-10% of children experienced moderate side effects, and discontinuation rates due to adverse events were low (5.1% vs 2.4% placebo in binge eating disorder trials) 2, 1. The prodrug formulation provides gradual release of active d-amphetamine, which may contribute to its tolerability profile 6, 5.