What is the recommended dosage and usage of Vyvanse (lisdexamfetamine) for treating Attention Deficit Hyperactivity Disorder (ADHD) and binge eating disorder?

Vyvanse (Lisdexamfetamine) Dosing and Usage

For ADHD, start Vyvanse at 30 mg once daily in the morning and titrate by 10-20 mg weekly to a maximum of 70 mg daily; for binge eating disorder, start at 30 mg and titrate by 20 mg weekly to a target of 50-70 mg daily. 1

ADHD Treatment

Initial Dosing and Titration

• Start at 30 mg once daily in the morning with or without food 1
• Titrate in increments of 10 mg or 20 mg at approximately weekly intervals 1
• Maximum recommended dose is 70 mg once daily 1
• Avoid afternoon doses due to insomnia risk 1

Administration Options

• Swallow capsules whole, OR 1
• Open capsules and mix entire contents with yogurt, water, or orange juice; consume immediately without storing 1
• Do not divide a single dose—take at least one full capsule daily 1

Monitoring During Titration

• Maintain weekly contact (by telephone is acceptable) during initial titration and dose adjustments, which typically requires 2-4 weeks to reach optimal dosing 2
• After stabilization, schedule follow-up appointments at least monthly to assess efficacy, side effects, and growth parameters including height, weight, blood pressure, and pulse 2
• Systematically assess for specific stimulant side effects: insomnia, anorexia, headaches, and weight loss 2

Duration of Action

• Vyvanse provides 13-14 hours of symptom control, significantly longer than other stimulants 3
• This extended duration improves medication adherence and reduces stigma from in-school dosing 3

Binge Eating Disorder Treatment

Dosing Protocol

• Start at 30 mg once daily in the morning 1
• Titrate in increments of 20 mg at approximately weekly intervals 1
• Target dose is 50-70 mg daily 1
• Maximum dose is 70 mg daily 1

Treatment Context

• The American Psychiatric Association suggests lisdexamfetamine for adults with binge eating disorder who prefer medication or have not responded to psychotherapy alone 4
• Psychotherapy (cognitive-behavioral therapy or interpersonal therapy) should be offered first-line, with lisdexamfetamine as adjunctive or alternative treatment 4
• Lisdexamfetamine is the only FDA-approved medication for moderate to severe binge eating disorder 1, 5

Efficacy Evidence

• The 50 mg and 70 mg doses demonstrated significant reductions in binge eating days per week compared to placebo (mean decrease of 4.1 days/week vs 3.3 days/week for placebo) 6
• 4-week binge eating cessation rates were 42.2% for 50 mg, 50.0% for 70 mg, versus 21.3% for placebo 6
• Weight loss occurred with treatment: mean decreases of 4.9 kg for both 50 mg and 70 mg doses versus 0.1 kg for placebo 6

Pretreatment Screening

Cardiac Assessment

• Perform careful history and family history of sudden death or ventricular arrhythmia 1
• Complete physical examination focusing on cardiac disease 1

Neuropsychiatric Assessment

• Evaluate family history and clinically assess for motor or verbal tics or Tourette's syndrome before initiating treatment 1

Common Side Effects and Management

Most Frequent Adverse Events

• Dry mouth, headache, and insomnia are the most common treatment-emergent adverse events 5
• Most adverse events are mild to moderate in intensity 5
• Adverse events infrequently lead to discontinuation 5

Weight and Appetite

• Monitor weight regularly as weight loss is a common side effect 2
• In binge eating disorder trials, mean weight loss was approximately 4.9 kg at therapeutic doses 6

Critical Safety Warnings

Abuse Potential

• Vyvanse has high potential for abuse and misuse, which can lead to substance use disorder and addiction 1
• Assess each patient's risk for abuse, misuse, and addiction before prescribing 1
• Reassess risk throughout treatment and monitor frequently for signs of abuse 1
• Misuse can result in overdose and death, especially with higher doses or unapproved administration methods (snorting, injection) 1

Cardiovascular Risks

• Obtain electrocardiogram in patients taking medications known to prolong QTc intervals 4
• Monitor blood pressure and heart rate at each visit 2

Special Populations

Pregnancy and Lactation

• Limited published information exists on lisdexamfetamine use in pregnancy 4
• Lisdexamfetamine is a prodrug converted to dextroamphetamine; amphetamines overall do not appear associated with major congenital malformations 4
• Possible small increased risk for gastroschisis (aOR 3.0), preeclampsia (aRR 1.29), and preterm birth (aRR 1.30) when used in second half of pregnancy 4
• Lactation category L3; monitor infants carefully for irritability, insomnia, and feeding difficulty if breastfeeding 4

Pediatric Considerations

• Approved for children 6 years and older with ADHD 1
• Pediatric patients younger than 6 years experienced more long-term weight loss than older patients 1

When to Consider Alternatives

Inadequate Response

• If adequate symptom control is not achieved at maximum 70 mg dose, consider alternative treatments or adding non-stimulant medications 2
• For ADHD, methylphenidate extended-release represents a reasonable alternative if lisdexamfetamine duration is inadequate or side effects are problematic 3

Insomnia Management

• If insomnia persists despite morning-only dosing, consider switching to methylphenidate extended-release, which causes less sleep disruption than amphetamines 3
• Alternatively, treat insomnia separately with cognitive behavioral therapy or short-term hypnotics rather than abandoning effective ADHD treatment 3