How can someone misuse Lisdexamfetamine (L-lysine-d-amphetamine), a central nervous system stimulant?

From the Guidelines

Lisdexamphetamine can be misused in several ways, including taking higher doses than prescribed, using it without a prescription, crushing and snorting it, or mixing it with other substances, which can lead to serious health consequences, including cardiovascular problems, psychosis, addiction, and even death, as reported in a study published in 2022 1.

Misuse Methods

Some common methods of misuse include:

• Taking higher doses than prescribed to experience euphoria or increase alertness
• Using it without a prescription to suppress appetite for weight loss or stay awake for extended periods
• Crushing and snorting it to enhance its effects
• Mixing it with other substances to achieve a stronger effect

Health Consequences

Misuse of lisdexamphetamine can lead to serious health consequences, including:

• Cardiovascular problems, such as increased blood pressure and heart rate, as noted in a study published in 2022 1
• Psychosis, including hallucinations and delusions
• Addiction, including physical dependence and withdrawal symptoms
• Death, due to overdose or other complications

Recommendations

It is essential to take lisdexamphetamine exactly as directed by a healthcare provider and never share it with others, as emphasized in a study published in 2002 1. Additionally, individuals prescribed lisdexamphetamine should be monitored closely for signs of misuse or addiction, and healthcare providers should educate patients on the risks and consequences of misuse.

Key Points

• Lisdexamphetamine is a Schedule II controlled substance due to its high potential for abuse
• Misuse can lead to serious health consequences, including cardiovascular problems, psychosis, addiction, and death
• It is essential to take lisdexamphetamine exactly as directed and never share it with others
• Healthcare providers should monitor patients closely for signs of misuse or addiction and educate them on the risks and consequences of misuse, as recommended in a study published in 2022 1.

From the FDA Drug Label

Lisdexamfetamine dimesylate capsules have a high potential for abuse and misuse. The use of lisdexamfetamine dimesylate capsules exposes individuals to the risks of abuse and misuse, which can lead to the development of a substance use disorder, including addiction Lisdexamfetamine dimesylate capsules can be diverted for non-medical use into illicit channels or distribution [see Drug Abuse and Dependence (9. 2)]. Misuse and abuse of CNS stimulants, including lisdexamfetamine dimesylate capsules, can result in overdose and death [see Overdosage (10)], and this risk is increased with higher doses or unapproved methods of administration, such as snorting or injection.

Lisdexamphetamine can be misused in several ways, including:

• Unapproved methods of administration: such as snorting or injection, which can increase the risk of overdose and death.
• Higher doses: taking more than the prescribed dose, which can lead to serious cardiovascular and CNS effects.
• Non-medical use: using the drug for recreational purposes or to achieve a desired psychological or physiological effect.
• Diversion: giving or selling the drug to someone else, which can lead to misuse and abuse.

It is essential to assess each patient's risk for abuse, misuse, and addiction before prescribing lisdexamfetamine dimesylate capsules and to monitor them frequently for signs and symptoms of abuse, misuse, and addiction 2.

From the Research

Misuse of Lisdexamphetamine

• Lisdexamfetamine is a prodrug that is converted to its active form, d-amphetamine, in the body, which may reduce its potential for abuse compared to immediate-release dexamphetamine 3.
• The pharmacokinetics of lisdexamfetamine suggest a reduced potential for abuse due to its rate-limited hydrolysis, which gradually releases pharmacologically active d-amphetamine 4.
• However, some studies have reported that lisdexamfetamine can still be abused, particularly at high doses, and that its potential for abuse is not entirely eliminated 3.
• Epidemiological studies have found that abuse rates of lisdexamfetamine are substantially lower than those of immediate-release dexamphetamine 3.

Factors Contributing to Misuse

• The delayed onset of effects and decreased Cmax of lisdexamfetamine compared to immediate-release dexamphetamine may contribute to its reduced potential for abuse 3.
• The prodrug property of lisdexamfetamine, which requires enzymatic conversion to its active form, may also reduce the risk of misuse 3.
• However, some authors have reported similar Cmax for lisdexamfetamine and dexamphetamine, and reinforcing properties with a dose-dependent effect, which may contribute to its potential for abuse 3.

Clinical Implications

• Lisdexamfetamine is approved for the treatment of attention-deficit/hyperactivity disorder (ADHD) in children and adults, and its efficacy in treating ADHD symptoms has been demonstrated in several studies 4, 5, 6.
• However, the potential for abuse of lisdexamfetamine should be considered when prescribing this medication, particularly in individuals with a history of substance abuse 3.
• Clinicians should monitor patients for signs of misuse or abuse, and adjust treatment plans accordingly 3.