What to Know About Vyvanse (Lisdexamfetamine Dimesylate)

Vyvanse (lisdexamfetamine dimesylate) is a stimulant medication that helps reduce or improve the symptoms of attention deficit hyperactivity disorder (ADHD), such as being distracted and the inability to focus thoughts.

Vyvanse belongs to a class of medications called central nervous system (CNS) stimulants. These medications work by increasing certain chemicals in the brain. The therapeutic action is not clear, but it is believed these chemicals (specifically dopamine and norepinephrine) play important roles in thinking and attention.

Vyvanse is also used to treat adults with moderate to severe binge eating disorder (BED), the most common eating disorder in the United States. Vyvanse has been shown to reduce the frequency of binge-eating days significantly and is effective at aiding in the prevention of relapse.

Vyvanse comes in the form of a capsule or chewable tablet. It is not available as a generic drug.

Uses

Vyvanse is approved to treat ADHD in adults and children over the age of 6 years old. It is only approved to treat moderate to severe BED in adults. 

It is a long-acting amphetamine stimulant that is thought to improve treatment adherence and have a lower risk of abuse compared to short-acting stimulants.

Immediate-release stimulants wear off within four to six hours and so need repeated doses during the day. Vyvanse works by releasing the stimulant gradually and over a longer period. It is reported to last for up to 13 hours in children and 14 hours in adults.

Off-Label Uses

It is not known if this medication is safe and effective for the treatment of obesity. While it may lead to weight loss in the treatment of BED, the FDA has clearly stated that Vyvanse should not be used for weight loss.

Before Taking

Available by prescription, Vyvanse is a first-line treatment for ADHD for both adults and children. A diagnosis of ADHD requires an extensive evaluation by a pediatrician, psychologist, or psychiatrist with expertise in ADHD.

Vyvanse is the first medication to be approved for moderate to severe BED. Psychotherapy is still the first-line treatment for BED, but Vyvanse can be useful for those who are nonresponsive to psychotherapy or for those in locations where psychotherapy is unavailable.

You should be assessed for the presence of several medical conditions, including mental health conditions, before you are prescribed this treatment. In particular, make sure that you tell your healthcare provider if you:

• Have instances of sudden death in your family
• Have personally or have a family history of heart disease, including sudden or ventricular arrhythmia
• Have high blood pressure or a history of high blood pressure
• Have personally or have a family history of bipolar disorder
• Have personally or have a family history of depression
• Have personally substance abuse issues or have a history of substance abuse

Vyvanse should be avoided or used with caution under certain circumstances. These include:

• Serious heart problems: Central nervous system stimulants like Vyvanse should not be used in people with serious heart problems. Sudden death, strokes, and heart attacks have been reported in those taking stimulant medication.
• High risk of substance abuse: CNS stimulants, including Vyvanse, have a high potential for abuse and dependence. Its use may not be suitable if you are at high risk of substance abuse.
• Bipolar disorder: CNS stimulants may cause a manic episode for those with bipolar disorder or new or worsening of psychotic symptoms. Patients should be screened for risk factors for developing a manic episode before treatment.
• Urinary alkalinizing agents: Taking both Vyvanse and urinary alkalinizing agents, such as Diamox (acetazolamide) and some thiazides, should be avoided.
• Breastfeeding: It is not recommended to take Vyvanse while breastfeeding. Amphetamines can be passed to the infant in breast milk. There is the risk of serious adverse reactions, such as serious cardiovascular reactions, blood pressure and heart rate increase, suppression of growth, and peripheral vasculopathy.

There is limited data available on the use of Vyvanse in people who are pregnant. There is a risk of premature delivery and low weights in infants born to mothers who are dependent on amphetamines while pregnant. There is also the risk of long-term behavioral or neurochemical changes.

Precautions and Contradictions

There are no absolute contraindications for the use of Vyvanse other than:

• An allergy to the compound itself
• Concurrent use of a monoamine oxidase inhibitor (MAOI) or if you have taken MAOIs in the 14 days before starting Vyvanse treatment.

MAOIs are used to treat illnesses such as depression and Parkinson’s disease. They act by slowing the metabolism of amphetamines and increase their effects. Interaction between MAOIs and Vyvanse can cause toxic neurological effects and malignant hyperpyrexia, which can be fatal.

Other medications may interact with Vyvanse. Make sure you talk to your healthcare providers about all medications, supplements, and vitamins you currently take. While some drugs pose minor interaction risks, others may outright contraindicate use or prompt careful consideration of whether the pros of treatment outweigh the cons in your case.

Especially make sure to mention if you are taking any of the following:

• Diamox (acetazolamide)
• Vitamin C
• Other medications for ADHD
• Sodium bicarbonate (baking soda)
• OsmoPrep or Visicol (sodium phosphate)

Other Central Nervous Stimulants

Other central nervous stimulants used to treat ADHD are Adderal (dextroamphetamine-amphetamine) and Concerta (methylphenidate HCl).

Dosage

Vyvanse comes as a capsule or a chewable tablet. The whole capsule or tablet should be taken, do not divide the dose. 

The recommended starting dose for both BED and ADHD, for adults and children, is 30 milligrams (mg) per day. The maximum dose is 70 mg per day. For BED, your dose will be increased on a weekly basis with the recommended dose between 50 mg and 70 mg per day. 

If you or your child is being treated for ADHD, your dose may be adjusted on a weekly basis so that your healthcare provider can find the right dose for you.

For those with severe renal impairment, the maximum dose is 50 mg per day, and for those with end-stage renal disease, the maximum dose is 30 mg per day.

Both capsules and chewable tablets come in strengths of 10 mg, 20 mg, 30 mg, 40 mg, 50 mg, and 60 mg. The capsules also come in a strength of 70 mg.

Do not increase your dose without consulting your healthcare provider. You should take Vyvanse exactly as your healthcare provider tells you to. 

How To Take and Store

According to the manufacturer, Vyvanse should be taken once a day in the morning and can be taken with or without food. The capsule can be swallowed whole or the contents mixed with orange juice, yogurt, or water.

You should store Vyvanse in a safe place, like a locked cabinet. Do not throw away unused medication in your household trash as it may harm other people or animals.

Side Effects

You may experience side effects when taking Vyvanse. Most side effects recorded in clinical trials are mild to moderately serious. However, you should talk to your healthcare provider if you have any side effects that bother you or do not go away.

Common

The most common side effects of Vyvanse differ depending on what condition is being treated. In treatment for those with ADHD, these include:

• Decreased appetite
• Insomnia
• Dry mouth
• Upper abdominal pain
• Irritability
• Vomiting
• Weight loss
• Nausea
• Diarrhea
• Anorexia
• Dizziness

The most common side effects of Vyvanse treatment for those with BED include:

• Dry mouth
• Insomnia
• Decreased appetite
• Increased heart rate
• Constipation
• Feeling jittery
• Anxiety

According to a 2014 systematic review of clinical trials, the side effects reported in long-term trials are largely similar to those reported in short-term trials.

Severe

Some side effects can be serious. You should call your healthcare provider immediately or get emergency medical treatment if you experience any of the following:

• Chest pain
• Shortness of breath
• Fainting 
• Slow or difficult speech
• Weakness or numbness of an arm or leg
• Seizures
• Symptoms of psychosis, such as hallucinations, seeing things or hearing voices that do not exist, or delusions, including paranoia.
• Mood swings
• Motor or verbal tics
• Hives
• Rash
• Swelling of the eyes, face, tongue, lips, or mouth
• Blurred vision or other vision problems
• Unexplained wounds appearing on fingers or toes

Warnings and Interactions

Given the potential risks associated with Vyvanse, particularly if you have certain health concerns, your healthcare provider may need to routinely monitor you while you take this medication.

Signs of Abuse or Dependence

Vyvanse carries a black box warning, the FDA’s most serious warning, concerning its high potential for abuse and dependence. It is important to be monitored for signs of abuse and dependence while taking this medication and being assessed for substance abuse before its use.

Impact on Growth in Children

Reductions in weight and expected height gains have been reported in multiple clinical trials assessing the use of stimulants for treatments of ADHD in children. 

A 2016 controlled cohort study of children aged 6 to 12 found a delay in height growth related to the dose of stimulant medication but found no significant delay in bone age after three years of treatment. It was concluded that this lack of correlation between growth and bone age might negatively affect a child’s growth potential.

A 2017 follow-up of a long-term observational study of children with ADHD assessed the group in early adulthood. It looked at the effects of long-term treatment with stimulant medications.

It showed that extended use of medications consistently from childhood to adulthood was associated with greater suppression of adult height but without a relative reduction in the severity of symptoms in adulthood.

Children should be carefully monitored by their healthcare provider while they are taking Vyvanse. Their healthcare provider may stop treatment if a problem is found. 

Psychiatric Symptoms

New or a worsening of psychiatric symptoms can occur in both those with and without a prior history of psychiatric illness. Different symptoms will be experienced depending on who is taking Vyvanse.

In adults, it can cause:

• New or worsening behavior and thought problems
• New or worsening of bipolar disorder

In children and teenagers, it can cause the symptoms listed above, and also:

• New symptoms of psychosis such as hearing voices, believing things that are not true, being suspicious
• New manic symptoms

You should speak to your healthcare provider if you or your child has any new or worsening mental symptoms or problems, especially those related to psychosis. 

Blood Pressure

CNS stimulants can cause an increase in blood pressure and heart rate. You should be monitored for potential tachycardia—a heartbeat over 99 beats per minute—as well as for high blood pressure.

Circulation Problems

Vyvanse can cause circulation problems in fingers and toes. Signs of this include:

• Fingers or toes that feel numb, cool, or painful
• Fingers or toes changing color from pale to blue to red

Serotonin Syndrome

When amphetamines are used in combination with certain drugs, it can cause a potentially life-threatening but rare reaction called serotonin syndrome. These medications include:

• Monoamine oxidase inhibitors (MAOIs)
• Selective serotonin reuptake inhibitors (SSRIs)
• Serotonin-norepinephrine reuptake inhibitors (SNRIs)
• Triptans
• Tricyclic antidepressants
• Fentanyl
• Lithium
• Tramadol
• Tryptophan
• Buspirone
• St. John’s wort

Serotonin syndrome is caused by a buildup of the chemical serotonin in the body. Symptoms can differ greatly from person to person. They include:

• Restlessness and/or anxiety
• Confusion and/or disorientation
• Pressured speech
• Diarrhea and vomiting
• Sweating
• Tremor
• Muscle stiffness, especially in the legs
• Difficulty with balance
• Shivering

Contact your healthcare provider right away if you are not feeling well or are concerned about serotonin syndrome.