Management of Fatigue After Starting Vyvanse 10 mg
The 10 mg dose of Vyvanse is below the recommended therapeutic starting dose and is likely insufficient to provide clinical benefit, resulting in paradoxical fatigue rather than the expected stimulant effect; increase to the standard starting dose of 20-30 mg taken in the early morning. 1, 2, 3
Immediate Dosing Adjustment
- Increase to 20-30 mg as the appropriate starting dose, as the FDA-approved initial dosing for lisdexamfetamine is 20-30 mg once daily in the morning, not 10 mg 2, 3
- The 10 mg dose represents a subtherapeutic level that may cause fatigue due to insufficient dopamine and norepinephrine enhancement without reaching the threshold for therapeutic stimulant effects 1
- Titrate weekly in 10 mg increments up to a maximum of 70 mg/day based on clinical response 1, 2, 3
Timing Optimization
- Administer the medication immediately upon waking in the early morning to minimize sleep disruption and subsequent daytime fatigue 1
- Avoid administration after noon, as late-day dosing significantly increases sleep problems which can manifest as next-day exhaustion 1
- Lisdexamfetamine has a duration of action extending 13-14 hours, so early morning dosing is critical 4, 5
Common Pitfalls to Avoid
- Do not continue subtherapeutic dosing: The 10 mg dose is not a standard therapeutic dose and will not provide adequate symptom control 2, 3
- Avoid high caffeine intake (>300 mg/day) during titration, as this can potentiate cardiovascular effects and worsen rebound fatigue 1
- Do not skip medication breaks entirely: Daily use without occasional breaks can lead to dopamine/norepinephrine depletion and tolerance, causing paradoxical exhaustion 1
Monitoring During Dose Adjustment
- Regularly assess for signs of exhaustion including fatigue, irritability, and sleep disturbances during the titration phase 1
- Monitor cardiovascular parameters (blood pressure and heart rate) at each dose adjustment 1
- Evaluate response at each weekly increment to identify the lowest effective dose that maintains adequate functioning 1
Alternative Considerations if Fatigue Persists
- If persistent fatigue develops despite optimization to 20-30 mg with proper timing, consider switching to alternative treatments such as methylphenidate, atomoxetine, or guanfacine 1
- The mechanism of lisdexamfetamine-induced exhaustion involves depletion of catecholamine reserves when dosing is inadequate or timing is suboptimal 1