Vyvanse

Attention Deficit Hyperactivity Disorder (ADHD)

Vyvanse is approved to treat ADHD in adults and children aged 6 years and older. As a central nervous system stimulant, it helps manage symptoms by affecting certain chemicals in the brain. It is typically used as part of a total treatment program that may include counseling or other therapies. Common goals of treatment include:

• Increasing the ability to pay attention and stay focused.
• Decreasing impulsivity and hyperactivity.
• Improving organization and task completion.

Binge Eating Disorder (BED)

Vyvanse is also used to treat moderate to severe binge eating disorder in adults. It is the first FDA-approved medication for this condition. In this context, the medication is used to help reduce the number of binge eating days per week. It is not intended for use in treating obesity or for weight loss, and its safety and effectiveness for those purposes have not been established.

How Vyvanse Works in the Body

Vyvanse is a central nervous system stimulant. It is classified as a prodrug, meaning it is inactive when you first take it. After it is swallowed, the body must convert the medication into its active form, dextroamphetamine, before it can begin to work. This conversion primarily occurs in the blood.

Once converted, the medication increases the levels of two important chemicals in the brain called neurotransmitters:

• Dopamine: This chemical plays a role in how the brain processes rewards, focus, and motivation.
• Norepinephrine: This chemical is involved in alertness and how the brain responds to tasks.

By boosting these chemicals, Vyvanse helps improve the communication between different parts of the brain. For individuals with attention deficit hyperactivity disorder (ADHD), this can lead to better focus, increased attention span, and improved control over impulsive or hyperactive behaviors.

Binge Eating Disorder

The exact mechanism by which Vyvanse treats binge eating disorder is not entirely known. However, experts believe it works by affecting the same brain chemicals that influence impulse control and the urge to binge eat.

Common Side Effects

Many people using Vyvanse experience mild side effects as their body adjusts to the medication. These often include:

• Dry mouth
• Decreased appetite and weight loss
• Difficulty falling asleep or staying asleep
• Dizziness or irritability
• Nausea, vomiting, or stomach pain
• Diarrhea or constipation
• Increased heart rate or feeling jittery
• Anxiety

Serious Side Effects

While less common, some side effects require immediate medical attention. Contact a healthcare provider if you experience:

• Heart-related issues: Chest pain, shortness of breath, or fainting.
• Psychiatric symptoms: Hallucinations (seeing or hearing things that are not real), paranoia, extreme suspicion, or new manic episodes.
• Circulation problems: Numbness, pain, or skin color changes (turning blue or red) in the fingers or toes.
• Growth concerns: Slowed growth or weight gain in children.
• Allergic reactions: Swelling, itching, or severe rash.

In rare cases, Vyvanse may contribute to serotonin syndrome when taken with certain other medications, resulting in symptoms like shivering, sweating, or muscle stiffness. Seizures and vision changes have also been reported.

Abuse and Dependence

Vyvanse is a federally controlled substance because it can be a target for people who abuse prescription stimulants or street drugs. Prolonged use may lead to physical and psychological dependence. Healthcare providers typically assess the risk of abuse before prescribing and monitor for signs of misuse during treatment.

Heart-Related Problems

Serious cardiovascular events, including sudden death, stroke, and heart attack, have been reported in people with structural heart defects or other serious heart conditions. This medication can also increase blood pressure and heart rate. Regular monitoring of heart health is often recommended.

Psychiatric Symptoms

Stimulant medications may cause new or worsening psychiatric symptoms, such as:

• Manic episodes or bipolar disorder symptoms.
• Hallucinations or delusional thinking.
• Increased aggression or hostility.

Drug Interactions

Taking Vyvanse with or within 14 days of a monoamine oxidase inhibitor (MAOI) is contraindicated due to the risk of a hypertensive crisis. There is also a risk of serotonin syndrome when used with certain other medications, such as antidepressants.

Other Precautions

• Growth in Children: Long-term use may slow growth and weight gain in children. Healthcare providers often monitor height and weight during treatment.
• Circulation Issues: Some patients experience circulation problems in fingers and toes (peripheral vasculopathy), which may cause numbness, pain, or color changes.
• Seizures: This medication may increase the risk of seizures in patients with a history of them.

Pregnancy

Using Vyvanse during pregnancy may cause harm to an unborn baby. Research suggests that exposure to stimulant medications like lisdexamfetamine during pregnancy can increase the risk of certain complications, including:

• Premature birth
• Low birth weight
• Withdrawal symptoms in the newborn, such as agitation or unusual tiredness

If you are pregnant or planning to become pregnant, it is important to talk to your doctor about the risks and benefits of continuing treatment. If you become pregnant while taking this medication, contact your healthcare provider immediately to determine the best course of action.

Breastfeeding

Lisdexamfetamine passes into breast milk and may cause side effects in a nursing infant. Because of the potential for serious adverse reactions in the baby, breastfeeding is generally not recommended while using Vyvanse. Consult with a healthcare professional to discuss the safest way to feed your baby while managing your medical condition.

Available Dosage Forms

Vyvanse is provided in two oral forms for daily use:

• Capsules: These are designed to be swallowed whole. For patients who have difficulty swallowing, the capsule may be opened and the contents mixed with water, orange juice, or yogurt.
• Chewable Tablets: These tablets must be chewed thoroughly before swallowing.

Generic versions are available for both the capsule and chewable tablet formulations.

FDA Approval and Indications

Vyvanse (lisdexamfetamine dimesylate) is FDA-approved for the treatment of attention deficit hyperactivity disorder (ADHD) in adults and children 6 years of age and older. It is also approved for the treatment of moderate to severe binge eating disorder (BED) in adults. In August 2023, the FDA approved the first generic versions of this medication for both ADHD and BED.

Boxed Warning

The FDA requires a Boxed Warning for Vyvanse because it is a central nervous system stimulant with a high potential for abuse and misuse. Use of this medication can lead to addiction and overdose. Healthcare providers are required to assess the risk of abuse before prescribing and monitor patients for signs of misuse during treatment.

Regulatory Classification

Vyvanse is classified by the Drug Enforcement Administration (DEA) as a Schedule II controlled substance. This classification is for drugs that have a high potential for abuse, which may lead to severe psychological or physical dependence. Because of these risks, there are strict regulations regarding how the medication is prescribed and dispensed, including limitations on refills.

Safety Communications

The FDA has issued warnings regarding serious cardiovascular events associated with stimulant use, including sudden death in patients with pre-existing heart problems. Additionally, the medication may cause or worsen psychiatric symptoms, such as hallucinations, delusional thinking, or mania. Vyvanse is not FDA-approved for weight loss or the treatment of obesity.

Withdrawal Symptoms

When Vyvanse is discontinued abruptly after regular or high-dose use, individuals may experience withdrawal symptoms, sometimes called a crash. These symptoms occur as the body adjusts to the lack of the stimulant.

Common symptoms of Vyvanse withdrawal include:

• Extreme tiredness or exhaustion
• Depression or significant mood changes
• Sleep problems, such as trouble sleeping or sleeping too much
• Increased appetite

Safe Discontinuation

It is important to talk to a doctor before stopping Vyvanse. To prevent or reduce withdrawal symptoms, a healthcare professional may provide a schedule to slowly decrease the dose over time. This tapering process helps the body adjust safely and reduces the risk of severe mood or energy shifts.