From the Guidelines
Withdrawal symptoms from lisdexamfetamine should be managed in a supportive environment, with symptomatic medication for relief of symptoms such as agitation, sleep disturbance, and close monitoring for depression or psychosis, as recommended by the World Health Organization 1.
Overview of Withdrawal Symptoms
Withdrawal symptoms from lisdexamfetamine can include:
- Fatigue
- Increased appetite
- Sleep disturbances
- Depression
- Anxiety
- Irritability
- Intense drug cravings These symptoms occur because the brain has adapted to the presence of the stimulant, which increases dopamine levels, and needs time to readjust to functioning without it.
Management of Withdrawal Symptoms
The management of withdrawal symptoms from lisdexamfetamine is crucial to prevent complications and minimize discomfort.
- Medical supervision is recommended, especially for those who have been taking high doses or have co-occurring mental health conditions.
- Tapering the medication gradually rather than stopping abruptly can help minimize withdrawal symptoms.
- Symptomatic medication may be used to relieve symptoms such as agitation, sleep disturbance, and other related issues.
- Close monitoring for depression or psychosis is necessary, and specialist advice should be sought if these conditions occur.
Factors Influencing Withdrawal Severity
The severity of withdrawal depends on factors like:
- Dosage
- Duration of use
- Individual physiology Withdrawal typically begins within 24-72 hours after the last dose and may last for several days to weeks.
Importance of Medical Supervision
Medical supervision during withdrawal is essential to ensure the patient's safety and comfort.
- A supportive environment can help alleviate symptoms and prevent complications.
- Regular monitoring and follow-up appointments can help identify potential issues early on and provide timely interventions.
- The use of symptomatic medication and other supportive measures can help manage withdrawal symptoms and improve the patient's quality of life.
From the FDA Drug Label
Withdrawal signs and symptoms after abrupt discontinuation or dose reduction following prolonged use of CNS stimulants including lisdexamfetamine dimesylate capsules include dysphoric mood; depression; fatigue; vivid, unpleasant dreams; insomnia or hypersomnia; increased appetite; and psychomotor retardation or agitation. The withdrawal symptoms of someone under the influence of Lisdexamphetamine may include:
- Dysphoric mood
- Depression
- Fatigue
- Vivid, unpleasant dreams
- Insomnia or hypersomnia
- Increased appetite
- Psychomotor retardation or agitation 2
From the Research
Withdrawal Symptoms of Lisdexamphetamine
- The study 3 assessed amphetamine withdrawal symptoms after treatment cessation in adults with binge-eating disorder treated with lisdexamfetamine dimesylate for up to 38 weeks, and found that abrupt lisdexamfetamine termination was not associated with amphetamine withdrawal symptoms at the exposure durations and therapeutic doses analyzed.
- Another study 4 used a tapering dose of lisdexamfetamine for the treatment of acute methamphetamine withdrawal, and found that the treatment was safe and feasible, with no treatment-related serious adverse events, and withdrawal severity and craving reduced through the admission.
- A review of pharmacokinetic/pharmacodynamic, animal, clinical, and pharmaco-epidemiological studies 5 found that the potential for abuse of lisdexamfetamine was limited by its prodrug property, and that epidemiological studies found that abuse rates of lisdexamfetamine were substantially lower than those of immediate-release dexamphetamine.
- However, it is worth noting that the study 5 also found that some authors reported similar Cmax for lisdexamfetamine and dexamphetamine, and reinforcing properties with a dose-dependent effect, suggesting that lisdexamfetamine abuse is possible.
- A study on the clinical management of withdrawal from benzodiazepine anxiolytic and hypnotic medications 6 is not directly relevant to lisdexamfetamine withdrawal symptoms, but highlights the importance of careful attention to underlying medical conditions, medication consolidation and gradual dosage reduction, and accompanying psychological interventions in managing withdrawal symptoms.
Symptoms and Treatment
- The Amphetamine Cessation Symptom Assessment (ACSA) was used to assess withdrawal experiences in the study 3, and found that mean ACSA aggregate scores for lisdexamfetamine were lower than those for placebo on the day of the last dose and on day 7 after the last dose.
- The study 4 used a tapering dose of lisdexamfetamine, commencing at 250 mg once daily, reducing by 50 mg per day to 50 mg on Day 5, and found that this regimen was safe and feasible for the treatment of acute methamphetamine withdrawal.
- The review 5 found that the pharmacokinetic parameters of lisdexamfetamine, including a longer Tmax and a decreased Cmax, were associated with a diminished feeling of euphoria, and a decreased potential for abuse.