What is the normal dose of Vyvanse (lisdexamfetamine) for attention deficit hyperactivity disorder (ADHD)?

Normal Dose of Vyvanse for ADHD

Start Vyvanse at 30 mg once daily in the morning, then titrate by 10-20 mg weekly based on response and tolerability, with most patients achieving optimal control at 50-70 mg daily and a maximum dose of 70 mg. 1, 2

Starting Dose

• Begin with 30 mg once daily in the morning - this is the standard FDA-approved starting dose for both adults and children 6 years and older 2
• Take the medication early in the morning (around 0700 hours) with or without food to avoid insomnia 2
• The capsule can be swallowed whole or opened and mixed with yogurt, water, or orange juice if swallowing is difficult 2

Titration Protocol

• Increase the dose in 10 mg or 20 mg increments at approximately weekly intervals until optimal symptom control is achieved 1, 2
• Maintain weekly contact (by telephone if needed) during initial titration to assess clinical response and tolerability before each dose increase 1
• Use standardized ADHD rating scales from patients and significant others to objectively track response before each dose adjustment 1, 3
• Titration typically requires 2-4 weeks to reach optimal dosing 1

Target Maintenance Dose Range

• The therapeutic dose range is 30-70 mg daily, with 50-70 mg representing the most common maintenance doses in clinical practice 1
• The maximum FDA-approved daily dose is 70 mg 1, 2
• Most patients achieve adequate symptom control within this range when properly titrated 4, 5

Monitoring Requirements

• Systematically assess for side effects at each visit by asking specific questions about insomnia, decreased appetite, headaches, and weight loss 1
• Monitor blood pressure, pulse, height, and weight at each visit, as stimulants can affect growth and cardiovascular parameters 3
• After stabilization on an optimal dose, schedule follow-up appointments at least monthly to assess ongoing efficacy and side effects 1

Special Dosing Considerations

• For severe renal impairment (GFR 15-30 mL/min/1.73 m²): maximum dose should not exceed 50 mg daily 2
• For end-stage renal disease (GFR <15 mL/min/1.73 m²): maximum recommended dose is 30 mg daily 2
• Agents that alter urinary pH can impact blood levels - acidifying agents decrease levels while alkalinizing agents increase levels, requiring dose adjustments 2

Critical Pitfalls to Avoid

• Starting at too high a dose leads to unnecessary side effects and decreased medication adherence - always begin at 30 mg 1
• Failing to systematically assess both benefits and side effects during titration - use standardized rating scales consistently 1
• Not allowing sufficient time (approximately one week) between dose increases to properly evaluate response 1
• Giving afternoon doses - this increases the risk of insomnia; morning administration is essential 2

When Maximum Dose Is Insufficient

• If adequate symptom control is not achieved at 70 mg daily, consider alternative treatments or adding non-stimulant medications rather than exceeding the maximum dose 1
• More is not necessarily better - if the maximum recommended dose doesn't help, a change in medication or addition of psychosocial interventions may be required 6