Are stimulants, such as Vyvanse (lisdexamfetamine), prescribed for appetite control in individuals with binge eating disorder?

Stimulants for Appetite Control in Binge Eating Disorder

Yes, lisdexamfetamine (Vyvanse) is specifically prescribed and FDA-approved for moderate to severe binge eating disorder in adults, and the American Psychiatric Association suggests it as a treatment option when psychotherapy alone is insufficient. 1, 2

Primary Indication and Mechanism

Lisdexamfetamine is the only FDA-approved medication for treating moderate to severe binge eating disorder (BED) in adults. 2 The drug works by reducing the core psychopathologies of BED—impulsivity, compulsivity, and perseveration—while increasing cognitive control over eating through augmentation of noradrenergic and dopaminergic neurotransmission. 3, 4

Clinical Guideline Recommendations

The American Psychiatric Association suggests (2C rating) that adults with binge eating disorder who prefer medication or have not responded to psychotherapy alone be treated with either an antidepressant medication or lisdexamfetamine. 1 This recommendation positions lisdexamfetamine as a second-line option after eating disorder-focused cognitive-behavioral therapy or interpersonal therapy, which are first-line treatments (1C rating). 1

Dosing and Efficacy

• Starting dose: 30 mg every morning 2
• Titration: Increase by 20 mg weekly 2
• Target dose: 50-70 mg per day 2
• Maximum dose: 70 mg per day 2

Clinical trials demonstrate that lisdexamfetamine 50-70 mg/day significantly reduces binge eating days per week compared to placebo over 12 weeks, with sustained efficacy up to 52 weeks. 5, 4 The drug markedly reduces the risk of BED relapse when continued long-term. 5

Critical Safety Considerations and Contraindications

Absolute Contraindications

Lisdexamfetamine is NOT indicated for weight loss or appetite suppression in general obesity. 2 The FDA label explicitly states: "Use of other sympathomimetic drugs for weight loss has been associated with serious cardiovascular adverse events. The safety and effectiveness of lisdexamfetamine dimesylate capsules for the treatment of obesity have not been established." 2

High-Risk Populations to Avoid

• Patients with known structural cardiac abnormalities, cardiomyopathy, serious cardiac arrhythmia, coronary artery disease, or other serious cardiac disease 2
• Patients with uncontrolled hypertension 1
• Patients with hyperthyroidism, glaucoma, anxiety, or insomnia 1
• Patients with history of drug abuse (stimulants have high potential for abuse and misuse) 2
• Patients taking MAO inhibitors or within 14 days of last MAO inhibitor dose 2

Monitoring Requirements

• Assess for presence of cardiac disease before initiating treatment 2
• Monitor blood pressure and pulse regularly 2
• Screen for risk factors for developing manic episodes before starting 2
• Monitor for signs of abuse, misuse, and addiction throughout treatment 2
• In pediatric patients, closely monitor growth (height and weight), though this is less relevant for adult BED 2

Common Adverse Effects

The most common treatment-emergent adverse events (≥5% incidence) include dry mouth, headache, insomnia, decreased appetite, anxiety, dizziness, nausea, and irritability. 2, 5 Most adverse events are mild to moderate in intensity and infrequently lead to discontinuation. 5

Important Clinical Distinctions

This question specifically asks about "sensory seeking compulsive binge eater/overeater"—it is crucial to distinguish true binge eating disorder from general overeating or obesity. BED requires recurrent episodes of binge eating (eating larger amounts than normal within 2 hours with loss of control) at least once weekly for 3 months, associated with eating rapidly, eating until uncomfortably full, eating when not hungry, eating alone due to embarrassment, and feeling distressed afterward—without compensatory purging behaviors. 1

Lisdexamfetamine is approved specifically for BED meeting DSM-5 criteria, not for:

• General appetite suppression 2
• Weight loss in obesity 2
• Overeating without loss of control 1
• Sensory-seeking behaviors unrelated to BED psychopathology

Renal Dosing Adjustments

• Severe renal impairment: Maximum dose 50 mg/day 2
• End-stage renal disease (ESRD): Maximum dose 30 mg/day 2

Alternative Pharmacological Options

If lisdexamfetamine is contraindicated or not tolerated, antidepressants (particularly SSRIs like fluoxetine 60 mg daily for bulimia nervosa) may be considered, though evidence is stronger for bulimia than BED. 1 Topiramate has shown efficacy in reducing binge eating but is not FDA-approved for this indication and has significant side effects. 6, 7