From the Guidelines
Lisdexamfetamine is generally preferred over dexamphetamine for treating ADHD due to its smoother onset, longer duration of action, and lower abuse potential. According to the most recent and highest quality study 1, lisdexamfetamine offers several benefits, including a longer duration of action (10-14 hours) compared to immediate-release dexamphetamine (3-5 hours). This means patients typically need only one daily dose of lisdexamfetamine versus multiple doses of dexamphetamine throughout the day. The gradual conversion process of lisdexamfetamine reduces the "rush" and subsequent crash often experienced with dexamphetamine, potentially decreasing side effects like anxiety and insomnia.
Some key points to consider when choosing between lisdexamfetamine and dexamphetamine include:
- Duration of action: Lisdexamfetamine has a longer duration of action, which can lead to better medication adherence and reduced risk of rebound effects.
- Abuse potential: Lisdexamfetamine has a lower abuse potential due to its requirement for metabolic activation in the bloodstream.
- Side effects: Both medications have similar side effect profiles, but lisdexamfetamine's gradual conversion process may reduce the risk of anxiety and insomnia.
- Cost: Lisdexamfetamine is generally more expensive than generic dexamphetamine.
As noted in another study 1, psychostimulants, including methylphenidate and amphetamine, are first-line pharmacotherapies for patients with ADHD. The study highlights the importance of considering individual patient needs and factors, such as severity of symptoms, presence of comorbidities, and patient preferences, when selecting a medication.
In terms of monitoring and adjusting treatment, a study from 2002 1 provides guidance on titration schedules, assessment of drug response, and management of treatment-related side effects. The study emphasizes the importance of regular follow-up appointments and adjustments to the treatment regimen as needed.
Overall, while both lisdexamfetamine and dexamphetamine can be effective treatments for ADHD, lisdexamfetamine's benefits make it a preferred choice for many patients. However, the decision between the two medications should be made on a case-by-case basis, taking into account individual patient needs and factors.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Benefits of Lisdexamphetamine over Dexamphetamine
- Lisdexamfetamine is a long-acting, prodrug formulation of dexamfetamine, which provides an extended duration of effect that is consistent throughout the day 2.
- Clinical trials have demonstrated robust clinical efficacy of lisdexamfetamine in the treatment of children, adolescents, and adults with ADHD, with dose-dependent improvements in the core symptoms of ADHD 2, 3.
- The duration of action of lisdexamfetamine continues for 13 hours post-dosing in children and for 14 hours in adults, which can improve adherence and reduce abuse compared to short-acting preparations of amfetamines 2, 3.
Comparison with Other Medications
- Lisdexamfetamine has been compared to other medications for ADHD, including atomoxetine and mixed amphetamine salts, and has shown significant improvements in ADHD symptoms and executive function 4, 5.
- A head-to-head study comparing lisdexamfetamine and atomoxetine found that lisdexamfetamine had a faster and more robust treatment response, with a median time to first clinical response of 12 days compared to 21 days for atomoxetine 5.
- Lisdexamfetamine has also been shown to have a better treatment adherence compared to other ADHD medications, except for amphetamine/dextroamphetamine long acting in adults and osmotic release methylphenidate hydrochloride long acting in treatment-naïve children and adolescents 6.
Safety and Tolerability
- Lisdexamfetamine has a tolerability profile consistent with those of other stimulant medications, with decreased appetite, insomnia, abdominal pain, and irritability among the more frequent treatment-emergent adverse events 2, 3.
- The safety profile of lisdexamfetamine is similar to that of other long-acting stimulants, with increases in systolic and diastolic blood pressure, pulse rate, and decreases in weight 5.