# Vyvanse ### (lisdexamfetamine)
[**Full Prescribing Information**](https://dailymed.nlm.nih.gov/dailymed/fda/fdaDrugXsl.cfm?setid=704e4378-ca83-445c-8b45-3cfa51c1ecad&type=display)[**DailyMed Drug Information**](https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=704e4378-ca83-445c-8b45-3cfa51c1ecad)
--- **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).