What is the maximum recommended dose of Vyvanse (lisdexamfetamine) for Attention Deficit Hyperactivity Disorder (ADHD) in adults and children?

Maximum Dose of Vyvanse for ADHD

The maximum approved dose of Vyvanse (lisdexamfetamine) for ADHD is 70 mg once daily in both adults and children 6 years and older. 1

Standard Dosing Parameters

Starting and Titration:

• Begin with 30 mg once daily in the morning for both adults and pediatric patients 6 years and older 2, 1
• Increase in increments of 10 mg or 20 mg at approximately weekly intervals 2, 1
• The therapeutic range is 30-70 mg daily, with 50-70 mg representing the most common maintenance doses 2

Maximum Dose Modifications

Renal Impairment Adjustments:

• Severe renal impairment (GFR 15 to <30 mL/min/1.73 m²): Maximum dose is 50 mg once daily 1
• End-stage renal disease (GFR <15 mL/min/1.73 m²): Maximum dose is 30 mg once daily 1

These renal adjustments are critical because lisdexamfetamine and its active metabolite are renally excreted, and failure to adjust dosing can lead to accumulation and increased adverse effects 1.

Titration Monitoring

Assessment During Dose Escalation:

• Maintain weekly contact (by telephone if needed) during initial titration, which typically requires 2-4 weeks to reach optimal dosing 2
• Use standardized ADHD rating scales from parents and teachers (for children) or from the patient and significant others (for adults) before each dose increase 2, 3
• Systematically assess for specific stimulant side effects including insomnia, anorexia, headaches, and weight loss 2
• Monitor blood pressure, pulse, height, and weight at each visit 3

When Maximum Dose Is Insufficient

Alternative Strategies:

• If adequate symptom control is not achieved at 70 mg daily, consider switching to alternative medications or adding non-stimulant medications rather than exceeding the maximum dose 2, 3
• Lisdexamfetamine should be the preferred next stimulant option if methylphenidate fails to provide adequate benefit 3

Critical Safety Considerations

Cardiovascular and Growth Monitoring:

• Assess for presence of cardiac disease before initiating treatment through careful history, family history of sudden death or ventricular arrhythmia, and physical examination 1
• Continue regular cardiovascular monitoring (blood pressure, pulse) and growth parameters at each visit throughout treatment 2, 3
• In long-term studies, mean increases in pulse rate (7.0 bpm), systolic blood pressure (3.4 mmHg), and diastolic blood pressure (3.2 mmHg) were observed 4

Common Pitfalls to Avoid:

• Starting at too high a dose leads to unnecessary side effects and decreased medication adherence 2
• Failure to systematically assess both benefits and side effects during titration 2
• The most common adverse events occur in the first 4-12 weeks and include decreased appetite (49.4%), weight decrease (18.2%), and insomnia (13.1%) 4

Administration Timing

Optimal Dosing Schedule:

• Administer in the early morning to provide coverage throughout the day and avoid afternoon doses due to potential for insomnia 3, 1
• Duration of effect is approximately 12-13 hours, with efficacy maintained from 1.5 hours through 13 hours post-dose 5, 6