Lisdexamfetamine
VYVANSE
Pronunciation: lis-dex-am-FET-a-meen (VYE-vans)
“Lis decks amp with feta to reVive Vance”
What it isCatecholamine-releasing dextroamphetamine prodrug; ADHD and binge-eating disorder.
Why this oneEnzymatic activation produces a slower rise and makes tampering less rewarding than with immediate-release amphetamine.
What limits itAppetite suppression, insomnia, tachycardia and blood-pressure rise can end treatment. Diversion and dependence still matter.
Pearls
- Lasts 13–14 h; once-morning dosing.
- Capsule contents can be sprinkled on soft food.
- Efficacy similar to OROS methylphenidate (Concerta).
Lisdexamfetamine prescription history
Animated chart of estimated U.S. prescriptions per year, ADHD meds (1938–2026). Lisdexamfetamine enters in 2007 (estimated).
FDA-approved for
- ADHD (2007)
- binge-eating disorder (2015)
Classes and tags
Clinical profile
Legacy pregnancy categoryC
Defining liabilityCardiovascular stimulation, appetite suppression, insomnia, misuse and stimulant-induced psychosis.
FDA label
Read the full label on DailyMed ↗
| FDA dosing | Population | Start | Target | Max |
|---|---|---|---|---|
| ADHD | Adults & pediatric >=6 yr | 30 mg QAM | 30–70 mg/day (titrate 10–20 mg weekly) | 70 mg/day |
| Moderate to severe binge eating disorder (BED) | Adults | 30 mg QAM (titrate 20 mg weekly) | 50–70 mg/day | 70 mg/day |
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.
Available strengths
- cap 10, 20, 30, 40, 50, 60, 70 mg
- chew tab 10, 20, 30, 40, 50, 60 mg
- sol 10 mg/mL
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.
Cost
| Strength | #/mo | generic $/mo | CostPlus | |
|---|---|---|---|---|
| 10 mg | cap | 4 q-wk | $10.50 | not offered |
| 20 mg | cap | 4 q-wk | $9.75 | not offered |
| 30 mg | cap | 4 q-wk | $10.80 | not offered |
| 40 mg | cap | 4 q-wk | $10.41 | not offered |
| 50 mg | cap | 4 q-wk | $10.56 | not offered |
| 60 mg | cap | 4 q-wk | $10.69 | not offered |
| 70 mg | cap | 4 q-wk | $10.70 | not offered |
| 10 mg | chew tab | 4 q-wk | $14.95 | not offered |
| 20 mg | chew tab | 4 q-wk | $17.35 | not offered |
| 30 mg | chew tab | 4 q-wk | $13.17 | not offered |
| 40 mg | chew tab | 4 q-wk | $15.92 | not offered |
| 50 mg | chew tab | 4 q-wk | $14.59 | not offered |
| 60 mg | chew tab | 4 q-wk | $14.58 | not offered |
Generic entry2023
Serotonin and MAOI
Provisional washout figures
Elevating mechanismNone identified
Non-elevating actionNone recorded
Exposure dependenceNo serotonin-elevating mechanism identified
Evidence confidenceModerate
InterpretationNo clinically meaningful serotonin-elevating mechanism identified in this first-pass Gillman-based review.
Active metabolites
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Self-check
- What active drug does lisdexamfetamine release?
Dextroamphetamine. - Why is tampering with lisdexamfetamine less rewarding than with IR amphetamine?
Enzymatic activation produces a slower rise.