Vyvanse for ADHD

Vyvanse is one of our top choices when we decide to use the amphetamine class of stimulants in the treatment of ADHD.

Vyvanse is an amphetamine based compound that has been altered to create lisdexamphetamine. This compound, when absorbed, is then converted to dextroamphetamine which is the psychoactive element of the medication that helps with ADHD symptoms. This has two distinct advantages over Adderall and Adderall XR: 
-it makes the release of the active form of the medication more gradual and longer acting. When compared to the long acting version of Adderall, which lasts 8-10 hours for most patients, Vyvanse lasts 2 hours longer. This is very important in terms of how patients feel as the Vyvanse wears off— it’s thought to be a slower wear off period, making the end of the day withdrawal period feel “less abrupt”. Many clients state they don't even notice it wearing off. 
-the abuse potential is less than Adderall since the onset takes a little bit longer. 

Which populations is Vvyvase FDA approved to treat?
‍Patients age six and older with a diagnosis of ADHD. 
It is also approved to treat Binge Eating Disorder. 
It is often used off-label for narcolepsy and treatment resistant depression.

How long does Vyvanse work when taken?
The medication usually lasts 10-12 hours, so needs to be taken in the AM with or after breakfast (so we don't have too much weight loss, as these meds impair appetite). 

What is the mechanism of action for Vyvanse? 
Vyvanse, or lisdexamfetamine, is a prodrug of dextroamphetamine and is thus not active until after it has been absorbed by the intestinal tract and converted to dextroamphetamine (active component) and l-lysine. Once converted to dextroamphetamine, it works in the brain by enhancing norepinephrine and dopamine activity by blocking their reuptake and facilitating their release. 
-Enhancement of dopamine and norepinephrine in certain brain regions (e.g., dorsolateral prefrontal cortex) may improve attention, concentration, executive dysfunction, wakefulness, and cortical inhibitory control of striatum. 
-Enhancement of dopamine actions in other brain regions (e.g., basal ganglia) may improve hyperactivity. 
-Enhancement of dopamine and norepinephrine in yet other brain regions (e.g., medial prefrontal cortex, hypothalamus) may improve depression, fatigue, sleepiness, and appetite regulation. 

What is the dose of Vyvanse? 
Dose ranges are 10mg to 70mg per day, always taken in the morning.
-For children and teens, we usually start at 10mg and work our way up. If nothing is felt on day 1 of taking the 10mg dose, on days 2 and 3 we usually move up to 20mg and go from there. 
-Adults may start at 10, 20, or even 30mg on day 1 and adjust accordingly. 
Your provider can discuss an individualized plan with you during your session. 

Can Vyvanse capsules be opened?
Yes, they can be opened and put onto applesauce or yogurt, or even sprinkled into orange juice or water. 

Do I need an EKG prior to taking a stimulant?
Stimulants like Vyvanse can lead to worsening of arrhythmias or other cardiac conditions in those who have preexisting conditions. In these populations, an EKG is recommended prior to taking the stimulant. If no known cardiac conditions exist in the patient, or in the case of children, in their parents and siblings, then an EKG is not necessary. 

What are the big side effects on Vyvanse and other stimulants? 
Stimulants are the most commonly prescribed treatment for ADHD & impulse control disorders. The reason for this is that they are SO effective and they tend to be reasonably well tolerated. That said, they have side effects to watch for. Here are the big 5 that we really want to watch for, followed by other issues to consider in general: 
-Appetite suppression (with weight loss eventually)
-Irritability (either when on the med or, more likely, when it wears off)
-Anxiety while on the medication (just as caffeine makes some people more anxious)
-Insomnia
-Tics -- motor and/or verbal tics, which tend to be more of an issue in boys under the age of 10 

The other issues for all stimulants are
Gi upset
Headache 
Dry mouth