Lisdexamfetamine

FDA label

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Titration Adjust at approximately weekly intervals (ADHD: 10–20 mg; BED: 20 mg).

Renal Severe impairment (GFR 15–<30): max 50 mg/day; ESRD (GFR <15): max 30 mg/day; not dialyzable

Hepatic Undefined

Instructions

• Take orally once in the morning with or without food; avoid afternoon doses (insomnia).
• Swallow capsule whole, or open and mix entire contents in yogurt, water, or orange juice and consume immediately; do not divide a dose or take less than one capsule.
• Urinary acidifiers (e.g., ascorbic acid) lower and alkalinizers (e.g., sodium bicarbonate) raise amphetamine levels — adjust dose accordingly.
• Before starting, assess for cardiac disease and for tics/Tourette's syndrome.

Contraindications

• MAOIs (concurrently or within 14 days) due to risk of serotonin syndrome

Cautions

• Serious cardiac disease / sudden death — avoid in structural cardiac abnormalities, cardiomyopathy, serious arrhythmia, CAD
• Increased blood pressure and heart rate
• Psychiatric reactions: may exacerbate psychosis, induce mania, or cause new psychotic/manic symptoms
• Long-term growth suppression in pediatric patients — monitor height and weight
• Peripheral vasculopathy, including Raynaud's phenomenon
• Serotonin syndrome with serotonergic drugs (SSRIs/SNRIs/triptans/TCAs) and with CYP2D6 inhibitors
• Motor and verbal tics and worsening of Tourette's syndrome

Adverse reactions

• Decreased appetite/anorexia
• Insomnia
• Dry mouth
• Anxiety, irritability
• Decreased weight
• Nausea, diarrhea, upper abdominal pain
• Dizziness
• Increased heart rate

Pregnancy Insufficient human data; amphetamine use is associated with premature delivery and low birth weight; monitor neonates for withdrawal.

Lactation Present in human milk; breastfeeding is not recommended during treatment.