From the Guidelines
Yes, a urine drug screen (UDS) is typically required for Vyvanse (lisdexamfetamine) prescriptions. Since Vyvanse is a Schedule II controlled substance used to treat ADHD and binge eating disorder, healthcare providers often require periodic drug testing to monitor compliance and ensure the medication is being used as prescribed 1. These tests help verify that you are taking the medication (Vyvanse will show up as amphetamine in your system) and not using other unauthorized substances. The frequency of testing varies by provider—some may require testing before starting treatment, while others may conduct random or scheduled tests throughout your treatment.
Key Considerations
- The American Society of Clinical Oncology clinical practice guideline recommends urine drug screening as part of universal precautions in chronic cancer pain management, which can be applied to other conditions where controlled substances are prescribed 1.
- The Centers for Disease Control and Prevention (CDC) also suggests using urine drug testing before starting opioid therapy and considering it at least annually to assess for prescribed medications as well as other controlled prescription drugs and illicit drugs 1.
- This monitoring is part of responsible prescribing practices for controlled substances and helps prevent misuse or diversion.
- If you're prescribed Vyvanse, your doctor should explain their specific drug testing requirements, which may depend on your medical history, state regulations, and insurance requirements.
Benefits of UDS
- Helps verify compliance with the prescribed medication
- Detects unauthorized substance use
- Prevents misuse or diversion of controlled substances
- Supports responsible prescribing practices
Important Notes
- The clinical evidence review did not find studies evaluating the effectiveness of urine drug screening for risk mitigation during opioid prescribing for pain 1.
- Urine drug testing results can be subject to misinterpretation and might sometimes be associated with practices that might harm patients.
- Routine use of urine drug tests with standardized policies at the practice or clinic level might destigmatize their use.
From the FDA Drug Label
2 DOSAGE AND ADMINISTRATION
2.1 Pretreatment Screening Prior to treating patients with lisdexamfetamine dimesylate capsules, assess: for the presence of cardiac disease (i.e., perform a careful history, family history of sudden death or ventricular arrhythmia, and physical exam) the family history and clinically evaluate patients for motor or verbal tics or Tourette's syndrome before initiating lisdexamfetamine dimesylate capsules
No specific mention of a UDS (Urine Drug Screen) is made in the provided drug label for Vyvanse (lisdexamfetamine).
- The label does discuss the importance of assessing patients for certain medical conditions before initiating treatment.
- However, it does not explicitly state that a UDS is required.
- Clinical judgment should be used to determine if a UDS is necessary on a case-by-case basis 2.
From the Research
Urine Drug Screens (UDS) for Vyvanse
- Vyvanse, also known as lisdexamfetamine, is a prodrug that is hydrolyzed to its active form d-amphetamine in the blood following oral administration 3.
- The use of Vyvanse may lead to false-positive results for amphetamine and methamphetamine in urine drug screens (UDS) due to its mechanism of action and the limitations of immunoassay tests 4.
- However, the potential for abuse of lisdexamfetamine is considered to be lower than that of immediate-release dexamphetamine due to its prodrug property and pharmacokinetic parameters, such as a longer time to maximum concentration (Tmax) and a decreased maximum concentration (Cmax) 5, 6.
- Urine drug testing is an essential component of monitoring patients who are receiving long-term stimulant therapy, including Vyvanse, and family physicians should be familiar with the characteristics and capabilities of screening and confirmatory drug tests 7.
- It is recommended to confirm the results of immunoassay tests with additional analytical methods, such as gas chromatography-mass spectrometry, to avoid adverse consequences for patients due to false-positive results 4, 7.