From the Guidelines
Vyvanse (lisdexamfetamine) and sertraline can generally be taken together, but this combination should be monitored by a healthcare provider due to potential interactions, particularly the risk of serotonin syndrome, as noted in the 2020 clinical practice guideline for the assessment and treatment of children and adolescents with anxiety disorders 1. When considering the combination of these medications, it's essential to be aware of the potential for increased risk of serotonin syndrome, a condition that can be serious and even life-threatening. This risk is a primary concern when combining any serotonergic medications, including SSRIs like sertraline and stimulants like Vyvanse. Some key points to consider when taking Vyvanse and sertraline together include:
- Monitoring for symptoms of serotonin syndrome, especially in the first 24 to 48 hours after dosage changes, as advised in the guideline 1.
- Starting with a low dose and gradually increasing it to minimize the risk of adverse effects, a strategy that aligns with the guideline's recommendation for conservative medication trials 1.
- Being cautious in patients with heart conditions, as both medications can affect blood pressure and heart rate, potentially amplifying these effects.
- Informing all healthcare providers about all medications being taken, including over-the-counter drugs and supplements, to avoid potential interactions. It's also worth noting that while the 2002 practice parameter for the use of stimulant medications mentions various contraindications, including concomitant use of MAO inhibitors, psychosis, glaucoma, existing liver disorder, and drug dependence 2, these do not directly apply to the combination of Vyvanse and sertraline. However, the principle of cautious prescribing and monitoring, especially in complex cases or when multiple medications are involved, remains crucial. Given the potential risks and the importance of monitoring, it is recommended that patients taking Vyvanse and sertraline together be closely supervised by a healthcare provider, with regular assessments for signs of serotonin syndrome, changes in blood pressure and heart rate, and other potential side effects, as guided by the most recent and highest quality evidence available 1.
From the Research
Contraindications with Vyvanse and Sertraline
- There are no direct studies on the contraindications of Vyvanse (lisdexamfetamine) and sertraline.
- However, studies have shown that sertraline is a selective serotonin reuptake inhibitor (SSRI) that is safe and well-tolerated in numerous patient populations, including those with psychiatric and/or medical comorbidities 3.
- Another study found that SSRIs, including sertraline, have a good tolerability profile and low fatal toxicity 4.
- A study on the risk of switch in mood polarity to hypomania or mania in patients with bipolar depression during acute and continuation trials of venlafaxine, sertraline, and bupropion as adjuncts to mood stabilizers found that sertraline was associated with a lower risk of threshold switches compared to venlafaxine 5.
- A meta-analysis on the efficacy, acceptability, and tolerability of lisdexamfetamine (Vyvanse) in the treatment of attention-deficit hyperactivity disorder (ADHD) in adults found that Vyvanse had a high effect size in reducing ADHD symptoms 6.
- Although there are no direct studies on the contraindications of Vyvanse and sertraline, it is essential to monitor patients for potential interactions, such as serotonin syndrome, when combining these medications 7.