Vyvanse with Adderall Booster Dosing for a 19-Year-Old with ADHD
For a 19-year-old with ADHD, start Vyvanse at 30 mg once daily in the morning, titrate by 10-20 mg weekly to an optimal dose of 50-70 mg daily (maximum 70 mg), and if breakthrough symptoms occur in late afternoon/evening despite optimal Vyvanse dosing, consider adding a low-dose immediate-release Adderall booster of 5-10 mg in the early afternoon. 1, 2, 3, 4
Initial Vyvanse Dosing and Titration
Begin with 30 mg of Vyvanse once daily in the morning, which is the standard FDA-approved starting dose across all age groups including young adults 1, 3, 4
Titrate the dose by 10 mg increments at approximately weekly intervals based on clinical response and tolerability, assessing both efficacy and side effects before each increase 1, 2, 3
The therapeutic target range is 50-70 mg daily, with the maximum approved dose being 70 mg once daily 3, 4
Maintain weekly contact (by telephone if needed) during initial titration, which typically requires 2-4 weeks to reach optimal dosing 3
Monitoring During Titration
Use standardized ADHD rating scales (ADHD-RS-IV) to objectively assess response before each dose increase, obtaining ratings from the patient and ideally from significant others or workplace/academic contacts 1, 2, 3
Monitor vital signs including blood pressure, pulse, height, and weight at each visit, as stimulants can affect cardiovascular parameters and appetite 1, 2
Systematically assess for specific side effects including insomnia, decreased appetite, headaches, weight loss, increased blood pressure/pulse, and irritability 2, 3
When to Consider an Adderall Booster
The concept of adding an immediate-release stimulant "booster" is not explicitly addressed in FDA labeling or major guidelines, but in clinical practice this approach may be considered when:
The patient achieves good symptom control during most of the day on optimized Vyvanse (typically 50-70 mg) but experiences breakthrough symptoms in late afternoon/evening 4, 5
Vyvanse provides coverage for approximately 13 hours post-dose based on clinical trial data, so symptoms emerging beyond this window may warrant additional coverage 5
Booster Dosing Strategy (Clinical Practice Approach)
If a booster is deemed necessary, start with immediate-release Adderall 5 mg in the early afternoon (typically around 2-3 PM, at least 6 hours after the morning Vyvanse dose)
The booster dose should generally be no more than 25-30% of the total daily amphetamine equivalent to avoid excessive stimulation and sleep disturbance
Monitor carefully for increased side effects, particularly insomnia, anxiety, appetite suppression, and cardiovascular effects, as the combined amphetamine load increases 2, 4
Important Caveats and Pitfalls
Starting at too high a dose leads to unnecessary side effects and decreased medication adherence - always begin at 30 mg even though the patient is 19 years old 3
Lisdexamfetamine (Vyvanse) is a prodrug with lower abuse potential compared to immediate-release amphetamines, which is particularly relevant for young adults 1, 6
If adequate symptom control is not achieved at 70 mg Vyvanse alone, consider alternative treatments or adding non-stimulant medications (such as atomoxetine or guanfacine) before adding a stimulant booster 2, 3
Weight loss is a common side effect requiring regular monitoring, especially in young adults 3, 7
Schedule follow-up appointments at least monthly after stabilization to assess ongoing efficacy, side effects, and growth parameters 2, 3
Alternative to Booster Strategy
Before adding a booster, ensure the Vyvanse dose is truly optimized - many patients respond well to 70 mg once daily without needing additional medication 4, 8
Consider whether the patient is taking Vyvanse early enough in the morning (ideally upon waking) to maximize duration of effect 1
Evaluate whether non-pharmacological interventions (structured routines, organizational strategies) might address late-day symptoms without additional medication 2