What baseline assessments and follow‑up monitoring should be performed for a patient initiating Vyvanse (lisdexamfetamine) therapy?

Monitoring of Patients on Vyvanse (Lisdexamfetamine)

Baseline Assessment Before Initiating Vyvanse

Before starting Vyvanse, obtain a comprehensive medical history, baseline vital signs (blood pressure and pulse), height, weight, and screen for cardiovascular risk factors. 1, 2

Cardiovascular Screening

• Measure baseline blood pressure and pulse to establish a reference point for monitoring cardiovascular effects 1, 2
• Obtain detailed cardiac history including syncope, chest pain, palpitations, exercise intolerance, and family history of premature cardiovascular death, arrhythmias, or structural heart disease 1
• Avoid use in patients with known structural cardiac abnormalities, cardiomyopathy, serious cardiac arrhythmia, coronary artery disease, or other serious cardiac disease 2
• Confirm absence of symptomatic cardiovascular disease or uncontrolled hypertension before initiating therapy 2

Growth Parameters

• Record baseline height and weight to monitor for growth suppression, particularly in pediatric patients 1, 2
• Calculate baseline body mass index (BMI) for ongoing comparison 1

Psychiatric Screening

• Screen patients for risk factors for developing a manic episode before initiating Vyvanse 2
• Assess family history and clinically evaluate patients for tics or Tourette's syndrome 2
• Screen adolescents and adults for substance-use risk, as stimulants carry abuse potential 1, 3

Documentation of Prior Treatments

• Document all previous ADHD treatments including medication names, dosages, duration, response, side effects, and adherence 1
• Review previous records to ensure the proposed intervention is the next logical treatment step 1

Laboratory Testing

• No routine laboratory testing is required before starting Vyvanse unless indicated by specific medical conditions 1
• Pregnancy testing in female adolescents and adults should be considered given the potential fetal risks 1

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Follow-Up Monitoring During Treatment

Cardiovascular Monitoring

• Monitor blood pressure and pulse at each visit during dose titration to detect emerging cardiovascular effects 1, 2
• During maintenance therapy in adults, check blood pressure and pulse quarterly 1
• In children and adolescents, perform annual vital sign assessment as part of routine physical examination 1

Growth Monitoring in Pediatric Patients

• Measure height and weight at every visit to track growth trajectory 1, 2
• Monitor body mass index monthly for the first 3 months, then quarterly 1
• Pediatric patients not growing or gaining height or weight as expected may need to have their treatment interrupted 2
• Chronic stimulant use can suppress growth by approximately 1–2 cm from predicted adult height, particularly at higher doses 1

Symptom and Side Effect Monitoring

• Obtain weekly symptom ratings during dose adjustment using standardized ADHD rating scales 1
• At each monthly visit, question patients regarding possible adverse effects including appetite changes, sleep disturbances, headache, irritability, and mood changes 1, 2
• The most common adverse reactions (≥5% incidence and at least twice placebo rate) include decreased appetite, insomnia, dry mouth, headache, upper abdominal pain, irritability, nausea, dizziness, and anxiety 2

Psychiatric Monitoring

• Regularly monitor patients for the emergence or worsening of tics or Tourette's syndrome 2
• If new psychotic or manic symptoms occur, consider discontinuing Vyvanse 2
• Monitor for signs of peripheral vasculopathy, including Raynaud's phenomenon, with careful observation for digital changes 2
• Screen for serotonin syndrome risk, particularly when co-administered with serotonergic agents 2

Substance Abuse Monitoring

• Implement urine drug screening in patients with substance abuse history to ensure compliance and detect any return to substance use 3
• Monitor prescription-refill requests for signs of misuse or diversion 3

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Monitoring Schedule

Titration Phase (First 4–8 Weeks)

• Weekly contact for symptom assessment and adverse effect monitoring 1
• Blood pressure and pulse at each dose adjustment 1, 2
• Height and weight measurement in pediatric patients 1

Maintenance Phase

• Monthly visits until symptom control stabilizes 1
• Quarterly visits once stable, with blood pressure and pulse checks 1
• Annual comprehensive physical examination including vital signs, height, and weight 1

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Common Pitfalls to Avoid

• Do not assume the current dose is adequate without systematic assessment—approximately 70% of patients respond optimally when proper titration protocols are followed 1, 3
• Do not ignore sleep disturbances or appetite suppression—these are manageable with dose timing adjustments or nutritional counseling 1, 2
• Do not overlook cardiovascular monitoring in adults—small but statistically significant increases in pulse and blood pressure occur with stimulant use 4
• Do not continue treatment without addressing growth concerns in pediatric patients—treatment interruption may be necessary if growth is not progressing as expected 2
• Do not combine Vyvanse with MAO inhibitors or start within 14 days of MAO inhibitor discontinuation due to risk of hypertensive crisis 2