What is Vysance (viloxazine)?

What is Vyvanse?

Vyvanse (lisdexamfetamine) is a long-acting prodrug stimulant medication approved for the treatment of ADHD that is converted to dextroamphetamine in the body. 1

Mechanism and Formulation

• Lisdexamfetamine is a prodrug that is enzymatically converted to dextroamphetamine after absorption, providing extended therapeutic effects throughout the day 1
• The medication works by increasing dopamine and norepinephrine activity in the brain, which helps improve attention, focus, and impulse control in patients with ADHD 1

Dosing

• Usual starting dose is 20-30 mg orally every morning 1
• Titrate by increasing 10 mg weekly to a maximum of 70 mg daily 1
• The once-daily dosing provides symptom control throughout the day without requiring multiple doses 1

Safety Profile in Special Populations

Pregnancy

• Limited published information exists specifically on lisdexamfetamine in pregnancy, but since it converts to dextroamphetamine, the amphetamine safety data applies 1
• Amphetamines overall do not appear to be associated with major congenital malformations, including cardiac malformations, or other significant adverse obstetrical or developmental outcomes 1
• Possible small increased risk for gastroschisis (adjusted OR 3.0; 95% CI 1.2-7.4), though the absolute risk remains very low given the rarity of this condition (0.05% population prevalence), and other studies have not confirmed this association 1
• Possible small increased risk for preeclampsia (adjusted RR 1.29; 95% CI 1.11-1.49) and preterm birth when stimulant use continues in the second half of pregnancy (adjusted RR 1.30; 95% CI 1.10-1.55), though these risks appear modest and other studies have not consistently found these associations 1

Breastfeeding

• No published studies exist specifically on lisdexamfetamine while breastfeeding, but amphetamine data is likely applicable 1
• Breastfeeding does not appear to adversely affect infants when amphetamines are used therapeutically 1
• Hale lactation risk category is L3 1
• Monitor infants carefully for irritability, insomnia, and feeding difficulty 1

Clinical Context

• Vyvanse is a psychostimulant medication, which represents first-line pharmacologic treatment for ADHD with response rates around 70% 2
• Stimulants show larger effect sizes than non-stimulants for ADHD core symptoms 3
• The prodrug formulation may offer some advantages in terms of abuse potential compared to immediate-release amphetamine formulations, as the conversion process is required for activation 1

Important Distinction from Viloxazine

Note that Vyvanse (lisdexamfetamine) is completely different from viloxazine (Qelbree), which is a non-stimulant serotonin-norepinephrine modulating agent recently approved for ADHD 4, 5. These are distinct medications with different mechanisms, side effect profiles, and clinical applications.