Starting Dose of Vyvanse for Adults with ADHD
The recommended starting dose of Vyvanse (lisdexamfetamine) for adults is 30 mg once daily in the morning. 1
Initial Dosing Protocol
- Start with 30 mg once daily in the morning, taken with or without food 2, 3, 1
- This 30 mg starting dose is standard across all age groups (adults and children ≥6 years) and represents the FDA-approved initial dose 1
- Avoid afternoon dosing due to insomnia risk 1
Titration Schedule
- Increase by 10 mg or 20 mg increments at approximately weekly intervals based on clinical response and tolerability 3, 1
- The typical titration period requires 2-4 weeks to reach optimal dosing 2, 3
- Maximum approved dose is 70 mg daily 2, 1
Target Maintenance Dose
- Most patients achieve optimal response at 50-70 mg daily, which represents the most common maintenance dose range in clinical practice 2, 3
- The therapeutic dose range spans 30-70 mg daily 2, 3
Critical Pre-Treatment Assessment
Before initiating Vyvanse, you must:
- Obtain baseline vital signs: blood pressure, pulse, height, and weight in the context of a physical examination 3
- Screen for cardiac disease: perform careful personal and family history of sudden death or ventricular arrhythmia, plus physical exam 1
- Screen for substance abuse symptoms, particularly in adolescents and young adults 3
- Assess for tics or Tourette's syndrome through family history and clinical evaluation 1
Monitoring During Titration
- Maintain weekly contact (by telephone if needed) during initial titration and dose adjustments 2
- Collect ADHD rating scales from the patient and significant others before each dose increase 2, 3
- Systematically assess for specific side effects at each contact: insomnia, decreased appetite, headaches, and weight loss 2, 3
- Monitor blood pressure and pulse at each dose adjustment 3
- Use standardized ADHD rating scales (such as ADHD-RS-IV) to objectively track response 3, 4
Common Pitfalls to Avoid
- Starting at too high a dose leads to unnecessary side effects and decreased medication adherence 2, 3
- Failing to systematically assess both benefits and side effects during titration results in suboptimal dosing 2, 3
- Continuing to escalate dose when symptom control plateaus—instead, switch medications or add non-stimulant options 3
- Real-world data suggests clinicians often underdose stimulants (mean 35.8 mg methylphenidate in one study), not exploiting the full therapeutic potential 5
Special Considerations for Adults
- Lisdexamfetamine has lower abuse potential compared to immediate-release amphetamines due to its prodrug formulation, making it particularly appropriate for patients at risk for diversion 3, 6
- The prodrug remains pharmacologically inactive until enzymatic conversion (predominantly by red blood cells) to d-amphetamine 6, 7
- Efficacy extends up to 14 hours post-dose in adults, providing coverage late into the day 6
Renal Impairment Adjustments
- Severe renal impairment (GFR 15-29 mL/min/1.73 m²): maximum dose 50 mg daily 1
- End-stage renal disease (GFR <15 mL/min/1.73 m²): maximum dose 30 mg daily 1
Administration Options
Vyvanse can be administered by:
- Swallowing capsules whole, OR
- Opening capsules and mixing entire contents with yogurt, water, or orange juice; consume immediately and do not store 1