Starting Dose of Vyvanse for ADHD
The recommended starting dose of Vyvanse (lisdexamfetamine) is 30 mg once daily in the morning for both adults and children 6 years and older with ADHD. 1, 2, 3
Initial Dosing Protocol
- Start at 30 mg once daily in the morning with or without food 3
- Avoid afternoon dosing due to potential for insomnia 3
- The medication can be swallowed whole or the capsule contents can be mixed with yogurt, water, or orange juice and consumed immediately 3
Dose Titration Schedule
- Increase by 10 mg or 20 mg increments at approximately weekly intervals based on clinical response and tolerability 2, 3
- The maximum recommended dose is 70 mg daily 2, 3
- Most patients achieve optimal symptom control at maintenance doses of 50-70 mg daily after titration 2
Monitoring During Titration
Assess both therapeutic response and side effects before each dose increase to minimize adverse effects and optimize adherence 2:
- Obtain ADHD rating scales from teachers and parents (for children) or from the patient and significant others (for adults) 2
- Monitor vital signs including blood pressure, pulse, height, and weight at baseline and with each dose adjustment 2
- Systematically ask about specific stimulant side effects: insomnia, decreased appetite, headaches, and weight loss 2
- Maintain weekly contact (by telephone is acceptable) during initial titration, which typically requires 2-4 weeks to reach optimal dosing 2
Special Populations
For patients with severe renal impairment (GFR 15 to <30 mL/min/1.73 m²), the maximum dose should not exceed 50 mg daily 3
For patients with end-stage renal disease (GFR <15 mL/min/1.73 m²), the maximum recommended dose is 30 mg daily 3
Critical Pitfalls to Avoid
- Do not start at doses lower than 30 mg - the FDA-approved starting dose is 30 mg, not the 20 mg mentioned in some older amphetamine protocols 3
- Do not start at higher doses (such as 50 mg or 70 mg) as this leads to unnecessary side effects and decreased medication adherence 2
- Do not increase doses more frequently than weekly - allow at least one week between adjustments to properly evaluate response 2
- Do not fail to systematically assess both benefits and side effects using standardized rating scales at each dose adjustment 2
- Do not administer in the afternoon or evening as this causes insomnia 3
When Maximum Dose Fails
If adequate symptom control is not achieved at 70 mg daily, do not increase further - instead, switch to an alternative stimulant (such as methylphenidate) or consider adding non-stimulant medications 2