Vyvanse

(lisdexamfetamine)

Forms/Strengths

• Capsules: 10 mg, 20 mg, 30 mg, 40 mg, 50 mg, 60 mg, 70 mg
• Chewable (Strawberry-flavored): 10 mg, 20 mg, 30 mg, 40 mg, 50 mg, 60 mg

Dosing

• 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
  

Quick Facts

• 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

Indications

•  ADHD (ICD-10: F90.0)
• Moderate to severe binge eating disorder (BED) in adults (ICD-10: F50.81)

Off-Label Uses

• 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.

How to Take

• 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.

Side Effects

• 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
  

Monitoring / Labs

• 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.

Education

• 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. 

Additional Information

• 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).