Lisdexamfetamine (Vyvanse)

Class

Central nervous system stimulant, prodrug of dextroamphetamine

Mechanism

Converted to dextroamphetamine, which promotes release of dopamine and norepinephrine and inhibits their reuptake, enhancing attention and alertness

FDA-Approved Use

Attention-deficit/hyperactivity disorder (ADHD), binge eating disorder (adults)

Off-Label Use

Augmentation in treatment-resistant depression, fatigue and cognitive dysfunction related to traumatic brain injury (TBI) and other neurological conditions

Formulation

Oral capsules and chewable tablets

Titration

30 mg p.o. once daily in the morning, titrated as clinically indicated (typical dose range 30–70 mg/day)

Dose Range

30–70 mg/day

Kinetics

Prodrug converted to active dextroamphetamine after oral absorption; duration ~10–12 hours

Common AEs

Decreased appetite, insomnia, anxiety, dry mouth, elevated blood pressure and heart rate, gastrointestinal upset

Serious/Rare AEs

Potential for misuse and dependence, though lower risk than immediate-release stimulants due to prodrug status

Monitoring

Regular monitoring of blood pressure, heart rate, mood, and potential misuse

Black Box Warning

Risk of abuse and dependence; careful assessment recommended

Considerations

May improve apathy, executive dysfunction, or fatigue related to post-stroke or TBI. Use cautiously in elderly patients and those with cardiovascular disease. Regular cardiovascular and psychiatric monitoring is advised.