Vyvanse Titration Schedule for ADHD
Starting Dose and Titration Protocol
Begin Vyvanse at 30 mg once daily in the morning, then increase by 10-20 mg at weekly intervals until optimal symptom control is achieved, with a typical maintenance dose of 50-70 mg daily and a maximum of 70 mg/day. 1, 2, 3
Specific Titration Algorithm
Standard Weekly Titration
- Week 1: Start 30 mg every morning 2, 3
- Week 2 onward: Increase by 10 mg increments at approximately weekly intervals 1
- Alternative approach: Some clinicians use 20 mg weekly increments for faster titration 1, 2
- Target range: 30-70 mg daily, with most patients requiring 50-70 mg for optimal maintenance 2
- Maximum dose: 70 mg per day 2, 3
Special Population Adjustments
- Children <20 kg (45 lb): Omit the 15 mg dose and corresponding week in the titration schedule 4
- Severe renal impairment: Maximum dose is 50 mg/day 3
- End-stage renal disease: Maximum dose is 30 mg/day 3
Monitoring Requirements During Titration
Weekly Assessment Protocol
- Contact frequency: Maintain weekly telephone contact during initial titration and dose adjustments 2
- Rating scales: Obtain standardized ADHD rating scales (such as ADHD-RS-IV) from both parents and teachers before each dose increase 1, 4
- Vital signs: Assess blood pressure, pulse, height, and weight at each visit 1, 4
- Time to optimal dosing: Typically requires 2-4 weeks to reach optimal dosing 2
Systematic Side Effect Assessment
Ask specific questions about known stimulant side effects at each contact 2:
- Insomnia
- Decreased appetite and weight loss
- Headaches
- Increased blood pressure and pulse
- Anxiety or irritability
Alternative Titration Strategy
Forced titration approach: Some clinicians use a structured protocol where the child receives all dose levels (30 mg, 50 mg, 70 mg) for one week each, with rating scales collected at each dose to identify the optimal level 1. This approach allows for systematic comparison of responses across doses.
Administration Timing
- Administer in early morning to provide coverage throughout the school day and minimize sleep disturbances 1
- Duration of action: Lisdexamfetamine provides symptom control for 13 hours in children and 14 hours in adults 5, 6
Post-Stabilization Monitoring
- Follow-up frequency: Schedule appointments at least monthly after stabilization 2
- Ongoing assessment: Continue monitoring efficacy, side effects, and growth parameters (height, weight, blood pressure, pulse) 2
- Dose adjustments: Remain vigilant for need to adjust doses due to changes in symptomatology, psychosocial situation, or normal development 2
Critical Pitfalls to Avoid
- Starting too high: Beginning at doses above 30 mg can lead to unnecessary side effects and decreased medication adherence 2
- Inadequate monitoring: Failure to systematically assess both benefits and side effects during titration compromises treatment optimization 2
- Insufficient trial duration: Each dose level should be maintained for approximately one week to adequately assess response 1, 2
When Maximum Dose Is Inadequate
If adequate symptom control is not achieved at 70 mg daily: Consider alternative treatments or adding non-stimulant medications 2. Lisdexamfetamine should be the preferred next stimulant option if no desired benefit is observed after adequate treatment with methylphenidate 2.