What is the next step for an adult Attention Deficit Hyperactivity Disorder (ADHD) patient who is on Vyvanse (Lisdexamfetamine) 50 milligrams (mg) but no longer feels the medication is effective?

From the Guidelines

The next step for an adult ADHD patient who feels their Vyvanse 50 mg is no longer effective should be to schedule an appointment with their prescribing healthcare provider to discuss increasing the dose up to the maximum of 70 mg daily or switching to an alternative medication such as lisdexamfetamine, as recommended by the National Institute for Health and Care Excellence 1. When considering alternative medications, it's essential to evaluate the patient's individual needs, including the severity of symptoms, presence of comorbidities, and desired duration of symptom relief 1.

• The healthcare provider should assess whether the patient has developed tolerance to the current medication or if changes in life circumstances require different medication coverage.
• The patient should be prepared to describe specific symptoms that aren't being controlled, when the medication seems to wear off, and any side effects experienced.
• The healthcare provider will likely evaluate the patient's overall treatment plan, including diet, sleep patterns, and concurrent medications, to determine the best course of action.
• According to the study, lisdexamfetamine is preferred as the next option over non-stimulants if no desired benefit is observed after adequate treatment with methylphenidate 1.
• Medication adherence should also be regularly assessed, and potential issues in adherence openly discussed to increase medication adherence and improve treatment outcomes 1.

From the FDA Drug Label

DOSAGE AND ADMINISTRATION Indicated PopulationInitial DoseTitration ScheduleRecommended DoseMaximum Dose ADHD (Adults and pediatric patients 6 years and older) (2.2)30 mg every morning10 mg or 20 mg weekly30 mg to 70 mg per day70 mg per day

The next step for an adult ADHD patient who is on Vyvanse 50 mg but does not feel like the medication is effective anymore could be to increase the dose. According to the dosage and administration section of the drug label, the recommended dose for ADHD in adults is 30 mg to 70 mg per day, with a maximum dose of 70 mg per day. Therefore, the patient's dose could be increased by 10 mg or 20 mg weekly, up to a maximum of 70 mg per day, as treatment should be individualized 2.

From the Research

Next Steps for Adult ADHD Patient

• If an adult ADHD patient on Vyvanse 50 mg does not feel like the medication is effective anymore, the next step would be to consult their doctor to discuss alternative treatment options 3.
• The doctor may consider increasing the dosage, switching to a different medication, or adding behavioral interventions to the treatment plan 3, 4.
• Lisdexamfetamine, the active ingredient in Vyvanse, has been shown to be effective in reducing ADHD symptoms in adults, but other medications such as mixed amphetamine salts and methylphenidate may also be considered 4, 5.
• A systematic review and meta-analysis found that lisdexamfetamine had the largest effect size in reducing ADHD symptoms compared to other medications, but more research is needed to determine the best course of treatment for individual patients 4.

Considerations for Treatment

• When considering alternative treatment options, the doctor should take into account the patient's prior medical history, comorbid conditions, and individualized treatment needs 3.
• The patient's adherence to their current medication regimen should also be assessed, as poor adherence can impact the effectiveness of treatment 6.
• The doctor may also consider the potential for abuse and dependence when prescribing stimulant medications, and monitor the patient closely for any signs of misuse 7, 5.

Alternative Treatment Options

• Mixed amphetamine salts and methylphenidate are alternative medications that may be considered for adult ADHD patients who do not respond to Vyvanse 4, 5.
• Behavioral interventions, such as cognitive-behavioral therapy and lifestyle changes, may also be added to the treatment plan to help manage ADHD symptoms 3.
• The patient's response to treatment should be closely monitored, and adjustments made as needed to ensure optimal treatment outcomes 3, 4, 5.