Is it appropriate to increase the dose of Vyvanse (lisdexamfetamine) in a patient who has been taking 30mg for one week and is requesting a dose increase?

Dose Increase After One Week of Vyvanse 30mg

It is generally too early to increase the dose of Vyvanse after only one week of treatment, as proper titration protocols recommend weekly dose adjustments with adequate time to assess therapeutic response and tolerability. 1, 2

Recommended Titration Protocol

Standard dosing guidelines specify that Vyvanse should be started at 20-30 mg once daily in the morning, with dose increases of 10 mg at weekly intervals up to a maximum of 70 mg daily. 3, 2

• The FDA label for lisdexamfetamine indicates that patients should be initiated on 30 mg for the first week of treatment, with subsequent titration occurring weekly as clinically indicated 2
• The American Academy of Child and Adolescent Psychiatry recommends gradual dose increases by 5-10 mg increments at weekly intervals 1
• One week represents the minimum interval before considering dose adjustment, not the optimal timeframe for determining therapeutic adequacy 2

Clinical Considerations for This Patient

At one week, you are at the earliest possible decision point—a dose increase to 40 mg could be considered if there is absolutely no therapeutic response and the medication is well-tolerated, but waiting another week at 30 mg is the more conservative and evidence-based approach. 1, 2

• Clinical trials demonstrate that lisdexamfetamine produces measurable improvements in ADHD symptoms within the first week, but full therapeutic assessment typically requires 2-4 weeks 4, 5
• The patient's request for dose increase does not necessarily indicate inadequate dosing—patient education about realistic timelines for symptom improvement is essential 5
• If the 30 mg dose is producing partial benefit with good tolerability, increasing to 40 mg at the two-week mark is appropriate 1, 2

Monitoring Requirements Before Dose Escalation

Before increasing the dose, you must systematically assess both therapeutic response and adverse effects. 1, 6

• Blood pressure and heart rate should be checked, as cardiovascular effects increase with higher amphetamine doses 1, 6
• Sleep quality must be evaluated—insomnia is a common dose-limiting side effect 6, 7
• Appetite and weight should be monitored at each visit to assess for appetite suppression 1, 6
• Mood changes, irritability, and anxiety should be assessed, as these increase at higher doses 6

Maximum Dosing Considerations

The maximum recommended total daily amphetamine dose is 40 mg according to the American Academy of Child and Adolescent Psychiatry, though clinical practice sometimes extends to 50-70 mg for lisdexamfetamine specifically. 1, 2

• The FDA-approved maximum dose for Vyvanse is 70 mg daily 2
• However, exceeding recommended doses does not necessarily provide additional therapeutic benefit—"if the top recommended dose does not help, more is not necessarily better" 1
• If symptom control is not achieved at maximum recommended doses, consider switching to an alternative stimulant medication rather than continuing dose escalation 1, 6

Common Pitfalls to Avoid

Do not escalate doses too rapidly based solely on patient request without objective assessment of symptom improvement and side effect profile. 1, 2

• Patient-reported "lack of effect" at one week may reflect unrealistic expectations about immediate symptom resolution rather than true medication failure 5
• Approximately 90% of patients respond when both amphetamine and methylphenidate classes are tried—premature dose escalation may miss the opportunity to optimize the current medication 6
• Rapid dose escalation increases the risk of cardiovascular effects, tolerance, and dependence 1