What is the recommended starting dose of Vyvanse (lisdexamfetamine) for Attention Deficit Hyperactivity Disorder (ADHD)?

Vyvanse Starting Dose for ADHD

The recommended starting dose of Vyvanse (lisdexamfetamine) for ADHD is 30 mg once daily in the morning, taken with or without food. 1, 2

Initial Dosing Protocol

• Start all patients—both adults and children 6 years and older—at 30 mg once daily in the morning. 1, 2
• The medication can be taken with or without food, but avoid afternoon doses due to insomnia risk. 2
• Patients can either swallow the capsule whole or open it and mix the contents with yogurt, water, or orange juice for immediate consumption. 2

Titration Schedule

• Increase the dose by 10-20 mg increments at approximately weekly intervals based on clinical response and tolerability. 1, 2
• The typical maintenance dose range is 50-70 mg daily after titration. 1
• The maximum approved dose is 70 mg once daily. 1, 2

Monitoring During Titration

• Maintain weekly contact (by telephone or visit) during the initial 2-4 weeks of titration to assess both therapeutic response and side effects. 1

• At each contact, systematically assess for common stimulant side effects including:

  • Decreased appetite (most common at 47% during dose optimization) 3
  • Insomnia (27% during dose optimization) 3
  • Headaches, irritability, upper abdominal pain 3
  • Weight loss—monitor weight at each visit 1

• Obtain ADHD rating scales from teachers and parents for children, or from the patient and significant others for adults. 4

Special Dosing Considerations

Renal impairment requires dose adjustment:

• Severe renal impairment (GFR 15-29 mL/min/1.73 m²): maximum 50 mg daily 2
• End-stage renal disease (GFR <15 mL/min/1.73 m²): maximum 30 mg daily 2

Key Clinical Advantages

• Vyvanse demonstrates efficacy from 1.5 hours through 13 hours post-dose, providing full-day symptom control including homework time and evening activities. 3
• As a prodrug requiring enzymatic conversion to active d-amphetamine, it has lower abuse potential compared to immediate-release amphetamines, making it a reasonable option even in patients with substance use history. 5

Common Pitfalls to Avoid

• Do not start at doses higher than 30 mg—this leads to unnecessary side effects and decreased medication adherence. 1
• Do not split or divide capsules—a single intact dose should be given once daily. 2
• Do not fail to systematically assess both benefits and side effects at each titration step, as this can result in either under-dosing or excessive side effects. 1
• If maximum dose (70 mg) does not provide adequate symptom control, consider alternative treatments or adding non-stimulant medications rather than exceeding the maximum dose. 1

After Stabilization

• Once the optimal dose is established, schedule follow-up appointments at least monthly to monitor ongoing efficacy, side effects, and growth parameters (height, weight, blood pressure, pulse). 4, 1