What is the recommended dose of Vyvanse (lisdexamfetamine) for an 11-year-old with Attention Deficit Hyperactivity Disorder (ADHD)?

Vyvanse Dosing for an 11-Year-Old with ADHD

For an 11-year-old with ADHD, start Vyvanse at 30 mg once daily in the morning, then titrate by 10-20 mg weekly based on response and tolerability, with a typical therapeutic range of 30-70 mg/day.

Initial Dosing

• Begin with 30 mg once daily in the morning 1, 2, 3
• This starting dose has been validated in multiple clinical trials for children aged 6-12 years and provides an appropriate balance between efficacy and tolerability 1, 2

Titration Strategy

• Increase the dose by 10-20 mg at weekly intervals to allow adequate time to assess both therapeutic response and side effects 1, 2
• Available dose strengths are 30 mg, 50 mg, and 70 mg 1, 4
• The typical therapeutic range is 30-70 mg/day for school-aged children 1, 2, 4
• Weekly contact during the initial titration phase is essential, which typically requires 2-4 weeks to reach optimal dosing 5

Response Assessment

• Efficacy begins as early as 1.5 hours post-dose and maintains through 13 hours, providing full-day symptom control including homework time 1
• Use standardized ADHD rating scales (ADHD-RS-IV) and obtain reports from both parents and teachers to objectively measure response 2, 4
• Clinical response is defined as "much improved" or "very much improved" on Clinical Global Impressions scales 4
• The median time to first clinical response is approximately 12 days, with 81.7% of patients responding by week 9 4

Monitoring Requirements

• Weigh the patient at each visit to objectively measure appetite suppression effects 5
• Monitor blood pressure, pulse rate, and heart rate at each visit, as stimulants typically cause small increases (mean increases of approximately 3-4 bpm in pulse and minimal changes in blood pressure) 4
• Schedule follow-up appointments at least monthly until symptoms are stabilized 5

Common Side Effects

• The most frequent adverse events include decreased appetite (47%), insomnia (27%), headache (17%), irritability (16%), and upper abdominal pain (16%) during initial dose optimization 1, 2
• These side effects are typically mild to moderate and consistent with amphetamine products 3
• Side effect frequency decreases substantially after the optimization phase 1
• Mean weight loss of approximately 1.3 kg can be expected during treatment 4

Critical Pitfalls to Avoid

• Never start at doses higher than 30 mg, as this leads to unnecessary side effects and decreased medication adherence 5
• Do not increase doses more frequently than weekly, as insufficient time between adjustments prevents accurate assessment of response 5
• Avoid attributing all irritability to the medication without considering behavioral or environmental factors, and assess whether irritability occurs during medication wear-off (suggesting need for dose adjustment) versus throughout the day (suggesting possible excessive dosing) 6
• Do not rely solely on subjective impressions—systematic monitoring using standardized rating scales is necessary to quantify both benefits and side effects 5, 6
• Recognize that untreated ADHD symptoms themselves can cause irritability, which may actually improve with appropriate stimulant treatment 6

Special Considerations

• Lisdexamfetamine is a prodrug that is therapeutically inactive until enzymatically hydrolyzed in the gastrointestinal tract to release active dextroamphetamine 7, 3
• This prodrug formulation provides reduced abuse potential compared to immediate-release amphetamines, as it does not produce high dextroamphetamine levels when injected or snorted 7, 3
• The medication provides consistent efficacy from 1.5 hours through 13 hours post-dose, eliminating the need for school-based dosing 1