Can Vyvanse (lisdexamfetamine) help with eating disorders, particularly in patients with a history of binge eating disorder?

Can Vyvanse Help with Eating Disorders?

Yes, Vyvanse (lisdexamfetamine) 50-70 mg/day is FDA-approved and effective specifically for moderate to severe binge eating disorder in adults, but it is absolutely contraindicated in patients with a history of anorexia nervosa or bulimia nervosa due to seizure risk. 1, 2

Specific Indication: Binge Eating Disorder Only

Lisdexamfetamine is the only FDA-approved medication for treating moderate to severe binge eating disorder (BED) in adults. 1 The American Psychiatric Association suggests that adults with BED who prefer medication or have not responded to psychotherapy alone be treated with either an antidepressant or lisdexamfetamine. 3, 4

Treatment Algorithm for Binge Eating Disorder

• First-line treatment: Initiate eating disorder-focused cognitive-behavioral therapy (CBT) or interpersonal therapy as the primary treatment modality. 3, 4

• Add medication at 6 weeks: If psychotherapy shows minimal or no response by 6 weeks of treatment, add lisdexamfetamine 50-70 mg/day or an antidepressant (particularly SSRIs). 3, 2

• Alternative approach: Lisdexamfetamine can be prescribed initially for patients who prefer medication or as combination therapy from the start. 2

• Dosing schedule: Start at 30 mg once daily in the morning, then titrate in increments of 20 mg at approximately weekly intervals to achieve the target dose of 50-70 mg daily (maximum 70 mg/day). 1

Absolute Contraindications - Critical Safety Concerns

A history of anorexia nervosa or bulimia nervosa is an absolute contraindication for lisdexamfetamine due to seizure risk. 2 This is a critical safety issue that cannot be overlooked—do not prescribe Vyvanse to patients with current or past restrictive eating disorders or purging behaviors.

Additional Contraindications

• Substance abuse history: A history of drug abuse or dependence is a relative contraindication requiring careful assessment, as lisdexamfetamine is a Schedule II controlled substance with high abuse potential. 2, 1

• Cardiovascular disease: Patients with serious heart disease, heart defects, or uncontrolled hypertension should not receive lisdexamfetamine due to risk of sudden cardiac death. 1

• MAOI use: Do not prescribe if the patient is taking or has stopped taking a monoamine oxidase inhibitor (MAOI) within the last 14 days. 1

Evidence of Efficacy in Binge Eating Disorder

The approval of lisdexamfetamine for BED was based on robust clinical trial data demonstrating significant reductions in binge eating behaviors. 5, 6

• Short-term efficacy: Two pivotal 12-week phase III studies showed significantly greater reduction in binge eating days per week with lisdexamfetamine 50-70 mg/day compared to placebo. 5

• Specific outcomes at 11 weeks: The 50 mg/day and 70 mg/day doses reduced binge eating days by approximately 4.1 days per week (from baseline), compared to 3.3 days with placebo. 6

• Cessation rates: 4-week binge eating cessation was achieved in 42.2% of patients on 50 mg/day and 50.0% on 70 mg/day, compared to only 21.3% with placebo. 6

• Long-term data: Studies up to 52 weeks, including a 26-week randomized withdrawal phase, showed that lisdexamfetamine markedly reduced the risk of BED relapse relative to placebo. 5

Required Pre-Treatment Screening

Before prescribing lisdexamfetamine, conduct comprehensive screening to identify contraindications and risk factors. 2, 1

Cardiac Assessment

• Perform careful history and family history of sudden death or ventricular arrhythmia. 1
• Complete physical examination with vital signs including resting heart rate, blood pressure, and orthostatic measurements. 1
• Obtain electrocardiogram if there is any history of cardiac disease or risk factors. 1

Psychiatric and Substance Use Screening

• Screen for history of substance abuse, as this increases risk of misuse and addiction. 2, 1
• Assess for psychiatric conditions, especially psychosis and bipolar disorder, as stimulants can precipitate manic episodes. 2, 1
• Evaluate family history and clinically assess for motor or verbal tics or Tourette's syndrome. 1

Eating Disorder History

• Document any history of anorexia nervosa or bulimia nervosa—these are absolute contraindications. 2
• Quantify baseline binge eating frequency (days per week). 2
• Measure baseline weight and BMI. 2

Special Population Considerations

Bipolar Disorder

For bipolar patients with binge eating disorder, ensure mood stabilization is achieved before adding lisdexamfetamine, as stimulants can precipitate manic episodes. 2 This requires coordination with psychiatric care and may necessitate initiating or optimizing mood stabilizers first.

Pregnancy and Breastfeeding

• Lisdexamfetamine may harm the unborn baby; discuss risks and benefits if the patient is pregnant or planning pregnancy. 1
• Lisdexamfetamine passes into breast milk; patients should not breastfeed during treatment. 1

Monitoring During Treatment

Ongoing Safety Monitoring

• Reassess each patient's risk of abuse, misuse, and addiction throughout treatment. 1
• Monitor blood pressure and heart rate regularly. 1
• Watch for new or worsening psychiatric symptoms, including psychosis, mania, or suicidality. 1
• Track binge eating frequency to assess treatment response. 2

Common Adverse Effects

The tolerability profile is similar to that observed in ADHD patients, with most treatment-emergent adverse events being mild or moderate. 5

• Most common side effects: Dry mouth, headache, and insomnia. 5
• Weight changes: Mean weight loss of approximately 4.3-4.9 kg was observed in treatment groups compared to 0.1 kg loss with placebo. 6
• Discontinuation rates: Adverse events infrequently led to study drug discontinuation. 5

What Vyvanse Does NOT Treat

Lisdexamfetamine is not indicated or recommended for anorexia nervosa, bulimia nervosa, or weight loss. 1 The American Psychiatric Association guidelines specify different treatments for these conditions:

Anorexia Nervosa

• Adults should receive eating disorder-focused psychotherapy that normalizes eating behaviors, restores weight, and addresses psychological aspects. 3
• Adolescents should receive family-based treatment. 3
• No FDA-approved medications exist for anorexia nervosa. 7, 8

Bulimia Nervosa

• Adults should receive eating disorder-focused cognitive-behavioral therapy combined with fluoxetine 60 mg daily (the only FDA-approved medication for bulimia). 3, 7, 8
• Adolescents should receive family-based treatment. 3

Critical Pitfalls to Avoid

• Never prescribe lisdexamfetamine to patients with current or past anorexia nervosa or bulimia nervosa—this is an absolute contraindication due to seizure risk. 2

• Do not use lisdexamfetamine for weight loss—it is not indicated for obesity, and use of sympathomimetic drugs for weight loss has been associated with serious cardiovascular adverse events. 1

• Do not minimize substance abuse history—lisdexamfetamine has high potential for abuse, misuse, and addiction, which can lead to overdose and death. 1

• Do not prescribe without cardiac screening—sudden death has occurred in patients with heart defects or serious heart disease. 1

• Do not ignore psychiatric comorbidities—stimulants can precipitate or worsen psychosis, mania, and other psychiatric conditions. 2, 1