Vyvanse (Lisdexamfetamine) Dosing for Adults
For adults with ADHD, start lisdexamfetamine at 30 mg once daily in the morning, then titrate in 10-20 mg increments at weekly intervals to a maximum of 70 mg daily. 1
Standard Dosing Protocol
- Starting dose: 30 mg once daily in the morning 1, 2
- Titration schedule: Increase by 10 mg or 20 mg increments at approximately weekly intervals 1
- Maximum recommended dose: 70 mg once daily 1, 2, 3
- Timing: Take in the morning with or without food; avoid afternoon doses due to insomnia risk 1
Administration Options
Lisdexamfetamine can be administered in two ways 1:
- Swallow capsule whole, or
- Open capsule and mix entire contents with yogurt, water, or orange juice. Use a spoon to break apart any compacted powder. Consume the entire mixture immediately—do not store. 1
Critical pitfall: Do not divide a single dose. Always take at least one full capsule per day. 1
Dosing for Binge Eating Disorder (Adults)
For moderate to severe binge eating disorder 1, 4:
- Starting dose: 30 mg once daily
- Titration: Increase by 20 mg at weekly intervals
- Target dose: 50-70 mg once daily
- Maximum dose: 70 mg once daily
- Discontinue if no improvement in binge eating occurs 1
Renal Impairment Adjustments
Dose reductions are mandatory in renal dysfunction 1:
- Severe renal impairment (GFR 15 to <30 mL/min/1.73 m²): Maximum 50 mg once daily
- End-stage renal disease (GFR <15 mL/min/1.73 m²): Maximum 30 mg once daily
Duration of Effect
Lisdexamfetamine provides extended symptom control 2, 3, 5:
- Adults: Efficacy demonstrated at 14 hours post-dose 2
- Children: Efficacy through 6 PM based on parent ratings 3
- This extended duration results from the prodrug's rate-limited enzymatic conversion to active d-amphetamine in red blood cells 6, 5
Drug Interactions Requiring Dose Adjustment
Urinary pH-altering agents significantly impact amphetamine blood levels 1:
- Acidifying agents (e.g., ascorbic acid): Decrease blood levels—may need to increase lisdexamfetamine dose
- Alkalinizing agents (e.g., sodium bicarbonate): Increase blood levels—may need to decrease lisdexamfetamine dose
Absolute contraindication: Do not use within 14 days of MAOIs (including linezolid or IV methylene blue) due to hypertensive crisis risk 1
Common Pitfalls to Avoid
- Never exceed 70 mg daily even if response is inadequate—instead, reassess diagnosis or switch to alternative medications 1
- Do not crush or open extended-release formulations of other amphetamines, though lisdexamfetamine capsules can be opened and mixed as described above 1
- Avoid late-day dosing to prevent insomnia 1
- Do not use for weight loss—lisdexamfetamine is not indicated for obesity, and sympathomimetic drugs for weight loss have been associated with serious cardiovascular events 1
Monitoring Requirements
While not explicitly detailed in the FDA label, the American Academy of Child and Adolescent Psychiatry recommends 7:
- Blood pressure and pulse: Check quarterly in adults on stimulants
- Efficacy assessment: Use standardized ADHD rating scales when possible
Tolerability Profile
The most common adverse events in clinical trials were 4, 3, 6:
- Dry mouth
- Headache
- Insomnia
- Decreased appetite
- Upper abdominal pain
- Irritability
- Weight loss
- Nausea
Most adverse events were mild to moderate in intensity and transient 3, 5. Treatment discontinuation due to adverse events was infrequent 4.
Abuse Potential Considerations
Lisdexamfetamine was specifically designed as a prodrug to reduce abuse potential 1, 6:
- Human abuse liability studies showed lower drug-liking scores compared with immediate-release d-amphetamine at equivalent doses 3
- The prodrug remains therapeutically inactive until enzymatically converted to d-amphetamine, primarily in red blood cells 6, 5
- This rate-limited conversion provides consistent plasma concentrations throughout the day 5
Warning: Misuse and abuse can still result in overdose and death, particularly with higher doses or unapproved administration methods (snorting, injection) 1