Vyvanse

Mechanism of Action
​Vyvanse (lisdexamfetamine dimesylate) is a prodrug of dextroamphetamine. It becomes active only after being metabolized in the body, reducing its potential for abuse. Once converted, dextroamphetamine works by increasing the release and blocking the reuptake of dopamine and norepinephrine in the brain. These neurotransmitters are key in regulating attention, behavior, and executive functioning, making Vyvanse effective for treating conditions like ADHD and binge eating disorder.
Clinical Benefits
  1. ADHD (Attention-Deficit/Hyperactivity Disorder):
    • Improves focus, attention span, and impulse control.
    • Enhances daily functioning in both children and adults.
  2. Moderate to Severe Binge Eating Disorder (BED):
    • Reduces the frequency of binge-eating episodes by regulating impulse control.
Vyvanse’s extended mechanism of action provides steady symptom relief throughout the day, minimizing peaks and crashes commonly associated with shorter-acting stimulants.
Dosage
Vyvanse is available in capsules and chewable tablets, ranging from 10 mg to 70 mg.
  • ADHD Initial Dose:
    • Children (6-17 years): Start with 30 mg once daily in the morning.
    • Adults: Start with 30 mg once daily.
  • BED Initial Dose:
    • Start with 30 mg once daily and increase by 20 mg increments weekly.
  • Maintenance Dose: Typically ranges from 30-70 mg per day.
  • Maximum Dose: 70 mg per day.
Prevalence of Side Effects
Vyvanse’s side effects are similar to other stimulants and depend on individual factors such as dosage and tolerance.
  • Common Side Effects (10-30%):
    • Decreased appetite
    • Dry mouth
    • Insomnia
    • Nausea
    • Irritability or anxiety
    • Weight loss
  • Less Common Side Effects (1-10%):
    • Increased heart rate or blood pressure
    • Sweating
    • Dizziness
  • Rare but Serious Side Effects (<1%):
    • Cardiovascular Events: Tachycardia, hypertension, or myocardial infarction in predisposed individuals.
    • Psychiatric Symptoms: New or worsening psychosis, mania, or suicidal ideation.
    • Dependency/Abuse: Low compared to other stimulants due to prodrug properties, but still a Schedule II controlled substance.
Efficacy and Safety
​Vyvanse is highly effective, with studies showing 70-80% response rates in ADHD patients. Its prodrug formulation reduces the risk of misuse, making it a safer option for long-term management when monitored.
Sources
  1. Prescribing Information for Vyvanse, Takeda Pharmaceuticals.
  2. Adler LA, et al. "Clinical efficacy of lisdexamfetamine in ADHD and BED." Journal of Clinical Psychiatry.
  3. Cortese S, et al. "Pharmacological treatment of ADHD: Systematic review and meta-analysis." The Lancet Psychiatry, 2018.
  4. FDA Label for Vyvanse: FDA.gov