Vyvanse

Forms/Strengths

Age: ≥ 6 y/o
Onset: ~60 min
Duration: 8-12 hours
Considerations: Can be taken with or without food. It is a pro-drug that is metabolized into 100% dextroamphetamine, with a reduced risk of abuse. The chewable tablet and capsule are interchangeable on a mg-to-mg basis.
- Chewable tablet: Strawberry-flavored and can be taken with or without food.
- Capsule: The capsule can be opened and its contents dissolved in liquid, such as water, yogurt, or orange juice. Use immediately after dissolving.
Initial Dose: 20-30 mg
Titration: 10-20 mg every 3-7 days
Max Dose: 70 mg

Prodrug converted to dextroamphetamine; increases synaptic dopamine/norepinephrine
Enhances focus, attention, and impulse control
Unique prodrug formulation provides a smooth onset and extended duration
Common side effects: decreased appetite, insomnia, dry mouth, irritability, abdominal pain

Depression (F33.9): Sometimes used adjunctively for treatment-resistant depression (limited data).
Narcolepsy (ICD-10: G47.411): Sometimes used off-label but not FDA-approved for this indication.

Take once daily in the morning to minimize the risk of insomnia.
Can be taken with or without food.
Swallow the capsule whole; do not crush or chew.
If needed, the capsule may be opened, and contents mixed with water, yogurt, or orange juice—consume immediately without chewing.
If using the chewable tablet, chew thoroughly before swallowing.

Common: Decreased appetite, insomnia, dry mouth, irritability, nausea, vomiting, anxiety, weight loss
Serious: Cardiovascular events, psychiatric adverse reactions, growth suppression in pediatric patients, peripheral vasculopathy, serotonin syndrom

Cardiovascular: Baseline and routine monitoring of heart rate and blood pressure.
Growth in Pediatrics: Regular monitoring of height and weight to detect growth suppression.
Psychiatric Symptoms: Observe for mood changes, anxiety, or psychosis.
Abuse Potential: Monitor for misuse or diversion.

When to Call the Doctor:
- Severe mood changes, aggression, or suicidal thoughts.
- Chest pain, rapid heartbeat, shortness of breath (cardiovascular concerns).
- Uncontrolled movements, tics, or worsening anxiety.
- Numbness, coldness, or color changes in fingers or toes (circulatory issues).
- Unexplained weight loss or delayed growth in pediatric patients.
Safety Tips:
- Monitor blood pressure and heart rate, especially in patients with cardiovascular risk.
- Use caution in patients with anxiety, bipolar disorder, or psychosis, as symptoms may worsen.
- Avoid caffeine and other stimulants, which may amplify side effects.
- Ensure adequate hydration and nutrition, as appetite suppression is common.
- Tapering may be required if discontinuing after long-term use.
Parent Tips for Pediatric Patients:
- Encourage a nutrient-dense diet to counteract appetite suppression.
- Administer in the morning before school for optimal effect.
- Monitor school performance and behavioral changes.
- Observe for sleep disturbances; adjust timing if necessary.
- Communicate regularly with teachers and caregivers about medication effects.

Contraindications:
- Hypersensitivity to lisdexamfetamine or formulation components.
- Use within 14 days of MAOI therapy (risk of hypertensive crisis).
- Symptomatic cardiovascular disease, moderate-to-severe hypertension, hyperthyroidism, glaucoma.
- History of substance use disorder, unless benefits outweigh risks.
Pregnancy:
- Category C; use only if benefits outweigh risks.
- May cause neonatal withdrawal symptoms or low birth weight.
Lactation:
- Excreted in breast milk; not recommended due to potential infant exposure.
Drug Interactions:
- Serotonergic drugs (e.g., SSRIs, SNRIs, MAOIs) increase serotonin syndrome risk.
- Acidifying agents (e.g., ascorbic acid) may reduce drug absorption.
- Alkalinizing agents (e.g., sodium bicarbonate) may increase amphetamine levels.
- May potentiate hypertensive effects of certain medications (e.g., decongestants, beta-agonists).