How Vyvanse (Lisdexamfetamine) Helps with Binge Eating Disorder
Lisdexamfetamine is the only FDA-approved medication specifically for moderate-to-severe binge eating disorder and works through its amphetamine-based mechanism to reduce both the frequency of binge eating episodes and the obsessive-compulsive features that drive the disorder. 1, 2
Mechanism of Action and Clinical Effects
Lisdexamfetamine is a prodrug of dextroamphetamine that exerts its therapeutic effects through multiple pathways 3:
Reduces binge eating frequency: The medication significantly decreases the number of binge eating days per week, with clinical trials showing reductions of approximately 4 binge days per week compared to baseline 2, 4
Addresses obsessive-compulsive features: Lisdexamfetamine reduces binge eating-related obsessions and compulsions as measured by the Yale-Brown Obsessive Compulsive Scale Modified for Binge Eating (Y-BOCS-BE), with mean reductions of approximately 6.5 points 5, 6
Suppresses appetite and food cravings: The amphetamine mechanism reduces appetite and the intense urges that characterize binge eating episodes 2, 5
Promotes weight loss: As a secondary benefit, patients typically lose 4-5 kg during treatment, which is clinically meaningful for those with comorbid obesity 4
Evidence of Efficacy
The FDA approval was based on robust clinical trial data 2:
Binge cessation rates: 50% of patients on 70 mg/day achieved 4-week binge cessation compared to 21.3% on placebo 4
Sustained effect: Long-term studies up to 52 weeks demonstrate maintained efficacy, with only 9% of patients experiencing treatment failure compared to 75% on placebo during withdrawal phases 2, 3
Dose-response relationship: The 50 mg/day and 70 mg/day doses show statistically significant superiority over placebo, while 30 mg/day does not 2, 4
Clinical Application
Lisdexamfetamine should be the first-line pharmacologic choice when medication is indicated for moderate-to-severe binge eating disorder, particularly when psychotherapy alone has been inadequate or when patients prefer medication. 1
Dosing follows a titration protocol starting at 30 mg/day for 1 week, then 50 mg/day, with potential increase to 70 mg/day as tolerated and clinically indicated 7, 2
The medication demonstrates effects within 3-4 weeks, with optimal response by 11-12 weeks 2, 4
Treatment should be considered especially when weight management is a concurrent goal, as the medication addresses both binge eating behavior and obesity 1, 8
Important Caveats
Cardiovascular monitoring is essential: As a sympathomimetic agent, lisdexamfetamine increases heart rate and blood pressure and should be avoided in patients with cardiovascular disease 1
Common side effects: Dry mouth (most common), headache, insomnia, and gastrointestinal upset occur more frequently than placebo but are typically mild to moderate in intensity 3, 5
Abuse potential: As a Schedule II controlled substance containing amphetamine, careful patient selection and monitoring for misuse is required 2
Discontinuation if ineffective: If patients do not achieve at least 5% weight loss or meaningful reduction in binge eating by 12 weeks, alternative treatments should be considered 1