Vyvanse (Lisdexamfetamine) Dosing and Usage
Primary Indications
Vyvanse is FDA-approved for two conditions: ADHD in patients 6 years and older, and moderate-to-severe binge eating disorder in adults. 1
ADHD Treatment
Starting Dose and Titration
- Start at 30 mg once daily in the morning for both adults and pediatric patients 6 years and older 1
- Titrate in increments of 10-20 mg at approximately weekly intervals 1
- Maximum dose: 70 mg once daily 1
Position in Treatment Algorithm
- In the United States, lisdexamfetamine is approved as first-line therapy for ADHD, while in many European countries it is second-line after methylphenidate 2
- If methylphenidate fails after adequate trial, lisdexamfetamine should be the next option over non-stimulants 2
- Lisdexamfetamine provides extended symptom control up to 14 hours post-dose, making it suitable for patients needing late-day coverage 3
Special Populations
- Adolescents with substance abuse concerns: Lisdexamfetamine has lower abuse potential than immediate-release stimulants because it requires enzymatic conversion in red blood cells to become active 2
- Avoid in children younger than 6 years due to increased risk of long-term weight loss 1
Binge Eating Disorder Treatment
Starting Dose and Titration
- Start at 30 mg once daily in the morning 1
- Titrate in increments of 20 mg at approximately weekly intervals 1
- Target dose: 50-70 mg once daily 1
- Maximum dose: 70 mg once daily 1
Position in Treatment Algorithm
- Psychotherapy (CBT or interpersonal therapy) is first-line treatment for BED 2
- The American Psychiatric Association suggests lisdexamfetamine for adults who prefer medication or have not responded to psychotherapy alone 2
- Lisdexamfetamine is the only FDA-approved medication specifically for moderate-to-severe BED 4, 1, 5
- Demonstrated efficacy in reducing binge eating days per week, with 50 mg and 70 mg doses showing significant improvement over placebo 6
- At 50-70 mg daily, 42-50% of patients achieved 4-week binge eating cessation compared to 21% with placebo 6
Administration Instructions
How to Take
Administration Options
- Swallow capsule whole, OR 1
- Open capsule and mix entire contents with yogurt, water, or orange juice; consume immediately (do not store) 1
- Do not divide doses—take at least one full capsule per day 1
Monitoring Requirements
Pre-Treatment Screening
- Assess for cardiac disease: Obtain careful history, family history of sudden death or ventricular arrhythmia, and perform physical exam 1
- Screen for tics or Tourette's syndrome in family history and clinical evaluation 1
- For adolescents with ADHD, assess for substance abuse symptoms before initiating treatment 2
Ongoing Monitoring (ADHD)
- Height and weight 2
- Pulse and blood pressure 2
- Monitor for signs of abuse, misuse, and addiction throughout treatment 1
Ongoing Monitoring (BED)
Adverse Effects Profile
Common Side Effects
- Dry mouth, headache, and insomnia are most common 5
- Decreased appetite 2
- Sleep disturbances 2
- Increased blood pressure and pulse 2
Serious Considerations
- Mean weight loss of 4.3-4.9 kg in BED trials (compared to 0.1 kg with placebo) 6
- High potential for abuse and misuse leading to substance use disorder 1
- Risk increases with higher doses or unapproved administration methods (snorting, injection) 1
- Most adverse events are mild to moderate in intensity 5
Critical Warnings
Boxed Warning
Lisdexamfetamine has high potential for abuse and misuse, which can lead to overdose and death. 1 Before prescribing:
- Assess each patient's risk for abuse, misuse, and addiction 1
- Educate patients and families about risks and proper storage/disposal 1
- Reassess abuse risk throughout treatment and monitor frequently for signs of misuse 1