Vyvanse Starting Dose for Binge Eating Disorder
The recommended starting dose of Vyvanse (lisdexamfetamine) for adults with moderate to severe binge eating disorder is 30 mg once daily in the morning, with titration in 20 mg increments at approximately weekly intervals to reach the target dose of 50-70 mg daily. 1
Initial Dosing Protocol
- Start at 30 mg once daily in the morning (with or without food), as specified in the FDA label for BED treatment 1
- This 30 mg starting dose applies specifically to BED treatment and differs from the titration approach used for ADHD 1
- Avoid afternoon doses due to potential for insomnia 1
Titration Schedule
- Increase dose in 20 mg increments at approximately weekly intervals to achieve the recommended target dose 1
- The target therapeutic dose range is 50-70 mg once daily 1, 2
- Maximum recommended dose is 70 mg once daily 1
- Studies demonstrate that both 50 mg and 70 mg doses show significant efficacy compared to placebo, while 30 mg does not 2
Evidence Supporting This Dosing
The FDA approval was based on pivotal trials showing:
- 50 mg and 70 mg doses significantly reduced binge eating days per week compared to placebo (P=.008 and P<.001, respectively) 2
- The 30 mg dose did not demonstrate significant efficacy (P=.88) 2
- 4-week binge eating cessation rates were 42.2% for 50 mg and 50.0% for 70 mg, compared to 21.3% for placebo 2
- Mean reduction in binge eating days was 4.1 days per week for both 50 mg and 70 mg doses 2
Administration Options
Lisdexamfetamine can be administered in two ways 1:
- Swallow capsule whole, or
- Open capsule and mix entire contents with yogurt, water, or orange juice; consume immediately (do not store)
- Never divide a single dose; always take at least one full capsule per day 1
Dose Adjustments for Special Populations
Severe renal impairment (GFR 15-30 mL/min/1.73 m²):
- Maximum dose should not exceed 50 mg once daily 1
End-stage renal disease (GFR <15 mL/min/1.73 m²):
- Maximum recommended dose is 30 mg once daily 1
Monitoring Requirements
- Assess efficacy and safety monthly for the first 3 months, then at least every 3 months 3, 4
- Discontinue if ≤5% weight loss at 12 weeks or if binge eating does not improve 1, 4
- Monitor vital signs including blood pressure and pulse regularly, as lisdexamfetamine increases both 2, 5
- Baseline cardiovascular assessment is required before initiating treatment 1
Predictors of Response
Patients with higher baseline motor and non-planning impulsivity and greater loss of control over eating scores experience the greatest reduction in binge eating frequency with lisdexamfetamine treatment 6. This suggests that patients presenting with more impulsive features may derive particular benefit from this medication.
Safety Considerations
The most common treatment-emergent adverse events include 7, 5:
- Dry mouth (27.2% in long-term studies)
- Headache (13.2%)
- Insomnia (12.4%)
- Most adverse events are mild to moderate in intensity 7
Critical contraindications 1:
- Known hypersensitivity to amphetamine products
- Current MAOI use or within 14 days of stopping MAOIs
- Cardiovascular disease (sympathomimetic agents should be avoided) 8, 4
Duration of Treatment
Long-term safety data support use up to 12 months, with mean weight loss of approximately 7 kg maintained over this period 5. The medication demonstrates sustained efficacy in reducing binge eating episodes when continued beyond the initial 12-week acute treatment phase 7.