lisdexamfetamine

Adjunctive therapy

Brands: VYVANSE

Last reviewed 2025-12-29

Reviewed by PsychMed Editorial Team.

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Quick answers

What is lisdexamfetamine?
Lisdexamfetamine (brand Vyvanse) is a Schedule II stimulant used for ADHD. It is a prodrug converted to dextroamphetamine, which tends to produce a smoother onset and longer duration for many patients compared with some immediate-release amphetamine products.
What is VYVANSE?
VYVANSE is a brand name for lisdexamfetamine.
What is VYVANSE (lisdexamfetamine) used for?
Label indications include: Attention-deficit/hyperactivity disorder (ADHD); binge eating disorder in adults (product-dependent).
What drug class is VYVANSE (lisdexamfetamine)?
Prodrug stimulant converted to dextroamphetamine; increases dopamine and norepinephrine signaling.
What strengths does VYVANSE (lisdexamfetamine) come in?
Oral capsules and chewable tablets (product-dependent).

Snapshot

Class: Adjunctive therapy
Common US brands: VYVANSE
Therapeutic drug monitoring not routinely recommended.
Last reviewed: 2025-12-29

Label indications

Attention-deficit/hyperactivity disorder (ADHD); binge eating disorder in adults (product-dependent).

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Clinical Highlights

Lisdexamfetamine (brand Vyvanse) is a Schedule II stimulant used for ADHD. It is a prodrug converted to dextroamphetamine, which tends to produce a smoother onset and longer duration for many patients compared with some immediate-release amphetamine products. The prodrug design does not make it “tamper-proof.” Misuse and diversion can still occur, and the safest prescribing approach treats it like any other Schedule II stimulant (locked storage, no sharing, and careful refill policies).

It can improve attention, initiation, and impulse control, but it can also worsen insomnia, anxiety, irritability, mania, or psychosis in susceptible patients. These risks matter when ADHD is comorbid with serious mental illness.
Vyvanse is also approved for binge eating disorder in adults; regardless of indication, safe prescribing centers on clear functional targets, gradual titration, and monitoring for misuse/diversion.
The compare view, the lisdexamfetamine evidence feed, and the lisdexamfetamine print page support side-by-side review and patient-friendly counseling on safe use and monitoring.

Dosing & Formulations

Usually dosed once daily in the morning; late-day dosing is typically avoided due to insomnia risk. Typical adult starting dose is 30 mg once daily, with titration in 10–20 mg steps (often weekly) based on response and tolerability.

Typical effective range is 30–70 mg/day; maximum recommended dose is 70 mg/day (label).
If response is inconsistent across the day, reassess sleep, adherence, and dosing timing before escalation; switching stimulant class or moving to a non-stimulant is often higher value than continuing dose escalation.

Monitoring & Risks

Vital signs: blood pressure and heart rate are commonly monitored at baseline and periodically, especially during titration. Appetite and weight: appetite suppression and weight loss are common; track weight/BMI and meal timing.

Sleep: delayed sleep onset is common; morning-only dosing and sleep hygiene are part of the regimen.
Psychiatric activation: anxiety, agitation, mood elevation, or hallucinations can emerge; if mania or psychosis symptoms appear, discontinuation and reassessment are typical.
Misuse/diversion: controlled substance with high misuse potential; safe storage counseling is common and non-stimulants are often considered when risk is high.

Drug Interactions

Contraindicated with MAO inhibitors; a washout period is typically used. Urinary pH affects exposure (acidifying agents can reduce effect; alkalinizing agents can prolong effects and adverse reactions).

Additive sympathomimetic effects can occur with decongestants and other stimulants; vitals and anxiety symptoms are often monitored.

Practice Notes

Anchor titration to function (work/school output, fewer errors, safer driving) rather than subjective energy or appetite suppression. In patients with bipolar spectrum illness, psychosis vulnerability, or active substance use, non-stimulants are often considered, and follow-up is typically closer if stimulants are trialed.

If benefit is minimal at reasonable doses, reassess ADHD diagnosis and comorbid sleep/anxiety/depression rather than escalating indefinitely.

References

Vyvanse (lisdexamfetamine dimesylate) prescribing information — DailyMed (2025)
Attention deficit hyperactivity disorder (NICE guideline NG87) — NICE (2018)
Clinical Practice Guideline FOR THE Diagnosis, Evaluation, AND Treatment OF Attention Deficit/hyperactivity Disorder IN Children AND Adolescents — Pediatrics (2019)
Comparative Efficacy AND Tolerability OF Medications FOR Adhd (systematic Review AND Network Meta Analysis) — Lancet Psychiatry (2018)