Lisdexamfetamine and Vyvanse Are the Same Medication
Lisdexamfetamine and Vyvanse are identical—Vyvanse is simply the brand name for lisdexamfetamine dimesylate. There is no clinical difference between them; they refer to the same prodrug formulation 1.
Understanding the Medication
Lisdexamfetamine is a prodrug that requires metabolic conversion to become active:
- The medication consists of dextroamphetamine covalently bonded to the amino acid L-lysine 2, 3, 4
- After oral ingestion, red blood cells hydrolyze lisdexamfetamine to release the active component dextroamphetamine and L-lysine 1
- The parent compound (lisdexamfetamine) itself is therapeutically inactive and does not bind to dopamine or norepinephrine reuptake sites 1, 4
Pharmacokinetic Profile
The prodrug design creates a unique absorption pattern:
- Lisdexamfetamine reaches peak plasma concentration at approximately 1 hour post-dose 1
- Active dextroamphetamine reaches peak concentration at 3.5-4.4 hours post-dose, depending on formulation 1
- The plasma half-life of lisdexamfetamine is less than 1 hour, while dextroamphetamine has a half-life of 8.6-11.3 hours 1
- This rate-limited enzymatic conversion provides approximately 12 hours of therapeutic effect with once-daily dosing 5
Clinical Advantages of the Prodrug Design
The prodrug formulation offers reduced abuse potential compared to immediate-release amphetamines:
- The American Academy of Pediatrics suggests lisdexamfetamine may be preferred in adolescents due to lower abuse potential 2
- The medication is only activated after ingestion through metabolic hydrolysis, making extraction of the stimulant component more difficult 2
- Pharmacodynamic studies in adult stimulant abusers showed 50-100 mg doses of lisdexamfetamine had less likability than 40 mg immediate-release dextroamphetamine 4
Approved Indications
Lisdexamfetamine (Vyvanse) has two FDA-approved indications:
- Treatment of ADHD in adults and pediatric patients 6 years and older 1
- Treatment of moderate to severe binge eating disorder (BED) in adults 1, 6
Dosing Considerations
Standard dosing follows a titration schedule:
- Starting dose is 30 mg once daily in the morning for both ADHD and BED 1
- For ADHD: titrate in 10-20 mg increments at weekly intervals to maximum 70 mg daily 1
- For BED: titrate in 20 mg increments weekly to target dose of 50-70 mg daily 1
- The medication can be taken with or without food, though food delays time to peak concentration by approximately 1 hour without affecting overall exposure 1
Available Formulations
Multiple formulation options exist under the Vyvanse brand:
- Capsules available in 10,20,30,40,50,60, and 70 mg strengths 1
- Chewable tablets provide bioequivalent dextroamphetamine exposure to capsules on a mg-per-mg basis 1
- Capsules can be opened and contents mixed with yogurt, water, or orange juice if swallowing is difficult 1
Important Clinical Caveat
The terms are used interchangeably in clinical practice and medical literature:
- When prescribing, "lisdexamfetamine" refers to the generic name while "Vyvanse" is the brand name 6, 7
- Generic formulations of lisdexamfetamine dimesylate are now available and are therapeutically equivalent to brand-name Vyvanse 1
- All formulations—whether branded as Vyvanse or prescribed as generic lisdexamfetamine—contain the same active prodrug compound 1