Ctrl

K

Lisdexamfetamine

Class
Psychostimulants
Subclass
Amphetamines
Substance name
Lisdexamfetamine dimesylate, lisdexamphetamine
Brand names
Vyvanse®
Common formulations
Capsule
Dosage and administration
Adults patients
ADHD
•
Maintenance: 30 mg PO qAM
•
Maximum: 70 mg per day
Consider titrating in 10-20 mg/day increments at approximately weekly intervals.
Binge eating disorder • Moderate-to-severe
•
Start at: 30 mg PO qAM
•
Maintenance: 50-70 mg PO qAM
•
Maximum: 70 mg per day
Titrate in 20 mg increments at approximately weekly intervals.
Indications for use
Labeled indications
Adults
•
Treatment of ADHD
•
Treatment of binge eating disorder (moderate-to-severe)
Children
•
Treatment of ADHD (in patients ≥ 6 years)
Safety risks
Boxed warnings
Drug abuse, drug misuse, stimulant use disorder
•
Use extreme caution in all patients. Assess the risk of abuse, misuse, and addiction before prescribing lisdexamfetamine. Reassess the risk throughout treatment and frequently monitor for signs and symptoms of abuse, misuse, and addiction.
Contraindications
Hypersensitivity to lisdexamfetamine or its components or other amphetamines
Coronary artery disease, serious cardiac arrhythmia, or structural cardiac abnormalities
•
Do not use lisdexamfetamine in patients with structural cardiac abnormalities, cardiomyopathy, serious cardiac arrhythmia, coronary artery disease, or other serious cardiac disease.
Concomitant use of MAOIs
•
Do not use lisdexamfetamine with or within 14 days of stopping MAOIs, including reversible MAOIs, such as linezolid and methylene blue.
Warnings and precautions
Exacerbation of motor tics, verbal tics
•
Use caution in patients with Tourette's syndrome.
Exacerbation of psychosis
•
Use caution in patients with psychotic disorders.
Hypertension, tachycardia, Raynaud's phenomenon
•
Maintain a high level of suspicion, as lisdexamfetamine has been associated with an increased risk for these adverse events.
Manic episode
•
Use caution in patients with bipolar disorder.
Serotonin syndrome
•
Use extreme caution in patients taking other serotonergic agents.
Weight loss, growth delay
•
Use caution in pediatric patients.
Specific populations
Renal impairment
GFR > 30 mL/min
•
Use acceptable. No dose adjustment required.
GFR 15-30 mL/min
•
Maximal dose of 50 mg. Do not exceed frequency of once daily.
GFR < 15 mL/min
•
Maximal dose of 30 mg. Do not exceed frequency of once daily.
Renal replacement therapy
Any modality
•
Dose as in eGFR < 15 mL/min/1.73 m².
Hepatic impairment
Any severity
•
Use acceptable. No dose adjustment required.
Pregnancy and breastfeeding
Pregnancy
All trimesters • Australia Category: B3
•
Avoid use. Evidence of fetal harm in humans. Monitor neonates for withdrawal symptoms and sedation. The active metabolite of lisdexamfetamine crosses the placenta. Amphetamines induce vasoconstriction, potentially reducing blood flow to the placenta. Furthermore, they may stimulate uterine contractions, increasing the risk of preterm labor and low birth weight.
Breastfeeding
Consider alternative agents that may be safer.
Low excretion in breastmilk (5-25%).
Low levels in breastfed infants (5-25%).
No overt adverse effects reported in breastfed infants.
No overt adverse effects on lactation reported.
Adverse reactions
Very common > 10%
•
Dystonia, dry mouth, dry mouth, epigastric pain, insomnia, irritability, loss of appetite
Common 1-10%
•
Anxiety, constipation, blurred vision, ↓ libido, diarrhea, dizziness, emotional lability, skin rash, agitation, hypertension, hyperhidrosis, restlessness, erectile dysfunction, fever, somnolence, tics, dyspnea, tremor, palpitations, nausea, nervousness, paresthesia, itching, throat pain, nightmares, vomiting, weight loss, tachycardia, urinary tract infections
Unknown frequency
•
Raynaud's phenomenon, chest pain, growth delay, headache, urticaria, hair loss, dysgeusia, angioedema, dyskinesia, mydriasis, stimulant use disorder, rhabdomyolysis
Interactions
Drug(s)
Check Interactions
Reset

What did you think about this content?

Create free account

Sign up for free to access the full drug resource