Effective Vyvanse Dosage for Binge Eating Disorder
For adults with moderate to severe binge eating disorder, the effective dosage of lisdexamfetamine (Vyvanse) is 50-70 mg once daily, which is the FDA-approved target dose range that demonstrates robust efficacy in reducing binge eating behaviors. 1, 2
Dosing Protocol
Starting Dose and Titration
- Begin with 30 mg once daily in the morning (with or without food), as this is the recommended starting dose 1
- Titrate in 20 mg increments at approximately weekly intervals to reach the target therapeutic range 1
- Target dose is 50-70 mg once daily, which represents the effective range demonstrated in pivotal trials 1, 3
- Maximum dose is 70 mg once daily 1
Administration Options
- The capsule can be swallowed whole, or opened and mixed with yogurt, water, or orange juice and consumed immediately 4, 1
- Avoid afternoon dosing due to insomnia risk 1
Evidence for Efficacy
Dose-Response Relationship
- The 50 mg and 70 mg daily doses showed statistically significant reductions in binge eating days per week compared to placebo, while the 30 mg dose did not demonstrate efficacy 3
- Effect sizes for the 50-70 mg range were highly robust (0.83-0.97) in Phase III trials 5
- Four-week binge eating cessation rates were 42.2% for 50 mg and 50.0% for 70 mg, compared to only 21.3% for placebo 3
Clinical Outcomes
- The Number Needed to Treat (NNT) for response is 3, and for remission is 4, indicating strong therapeutic benefit 5
- Mean reduction in binge eating days per week was approximately 4 days for both 50 mg and 70 mg doses 3
Monitoring Requirements
Initial Assessment Period
- Assess efficacy and safety monthly for the first 3 months, then at least every 3 months thereafter 4, 6
- Discontinue if binge eating does not improve 1
Safety Monitoring
- Monitor cardiovascular parameters, as lisdexamfetamine is contraindicated in patients with cardiovascular disease 4
- Track weight changes; mean weight loss of 4.3-4.9 kg was observed in treatment groups 3
- Most common adverse events include dry mouth (NNH=4), decreased appetite (NNH=11), insomnia (NNH=11), and headache (NNH=19) 5
Special Populations
Renal Impairment Adjustments
- Severe renal impairment (GFR 15-30 mL/min/1.73 m²): maximum 50 mg daily 1
- End-stage renal disease (GFR <15 mL/min/1.73 m²): maximum 30 mg daily 1
Critical Contraindications
- Absolute contraindications include: known hypersensitivity to amphetamine products, current MAOI use or within 14 days of stopping MAOIs, and cardiovascular disease 1, 4
- High potential for abuse and misuse; assess each patient's risk before prescribing 1
Treatment Context
When to Use Medication
- Lisdexamfetamine should be considered when patients prefer medication over psychotherapy, or have not responded adequately to eating disorder-focused cognitive-behavioral therapy (CBT) or interpersonal therapy 6
- It is particularly appropriate when weight management is also a treatment goal 7