Lisdexamfetamine

• Attention-deficit/hyperactivity disorder (ADHD)
• Binge eating disorder
• Treatment of ADHD in patients requiring long-acting stimulant
• Alternative when other stimulants cause problematic peaks and troughs

Lisdexamfetamine is a prodrug stimulant medication used to treat attention-deficit/hyperactivity disorder (ADHD) and moderate-to-severe binge eating disorder. As a prodrug, it must be converted to its active form (dextroamphetamine) in the body, providing a smoother onset and potentially reduced abuse potential.

How Lisdexamfetamine Works

Lisdexamfetamine is pharmacologically inactive until it is converted to dextroamphetamine in red blood cells through enzymatic hydrolysis. Dextroamphetamine then increases dopamine and norepinephrine release in the brain, improving attention, focus, and impulse control.

Prodrug Advantages

The conversion process provides a gradual release of active medication, reducing the peak-and-trough effect seen with immediate-release stimulants. This design also makes it harder to abuse by snorting or injection, as the conversion requires the enzyme present in red blood cells.

Available Formulations

Lisdexamfetamine (Vyvanse) is available as:

• Capsules: 10 mg, 20 mg, 30 mg, 40 mg, 50 mg, 60 mg, 70 mg
• Chewable tablets: 10 mg, 20 mg, 30 mg, 40 mg, 50 mg, 60 mg

Capsules can be swallowed whole or opened and mixed with water, yogurt, or orange juice.

Medical Uses

Lisdexamfetamine is FDA-approved for:

• ADHD in patients 6 years and older
• Moderate-to-severe binge eating disorder in adults

It is the first and only medication specifically approved for binge eating disorder.

Dosing Information

For ADHD, the typical starting dose is 30 mg once daily in the morning, increased weekly by 10-20 mg to a maximum of 70 mg daily. For binge eating disorder, start at 30 mg daily and titrate to 50-70 mg daily. The medication provides up to 14 hours of symptom control.

Important Safety Information

Lisdexamfetamine is a Schedule II controlled substance with potential for abuse and dependence. It carries boxed warnings for abuse potential and serious cardiovascular events. Monitor for signs of misuse, cardiovascular effects (increased heart rate and blood pressure), and psychiatric symptoms.

Cardiovascular Considerations

Stimulants can increase blood pressure and heart rate. They are contraindicated in patients with structural cardiac abnormalities, cardiomyopathy, serious heart rhythm abnormalities, or coronary artery disease. Cardiac evaluation may be recommended before starting treatment.

Drug Interactions

MAO inhibitors are contraindicated within 14 days of lisdexamfetamine use due to risk of hypertensive crisis. Acidifying agents may decrease absorption, while alkalinizing agents may increase it. Use caution with other medications that affect norepinephrine or dopamine.

Special Populations

Safety and efficacy are established in children 6 years and older. Use during pregnancy should weigh benefits against potential risks including premature birth and low birth weight. Lisdexamfetamine can pass into breast milk. Dose adjustment is needed for renal impairment.

Learn more at MedlinePlus