Vyvanse

Boxed warning:

Vyvanse has a boxed warning. Because Vyvanse is a stimulant containing amphetamines and other compounds, it has a high potential for dependence and abuse. Prescribers are cautioned to assess each patient for these risks before initiating treatment. Patients should be closely monitored for signs of dependence or abuse while they are taking Vyvanse.¹

What is Vyvanse?

Vyvanse works as a central nervous system (CNS) stimulant. It is a long-acting prodrug, the first of its kind, requiring a biological transformation in the body to the active form. The drug contains lisdexamfetamine, an inactive precursor to amphetamines, that is metabolized by the red blood cells into the active drug amphetamine.² ³

Amphetamines work by increasing the levels of certain neurotransmitters in the CNS. These include norepinephrine, which triggers the metabolic and cardiovascular adaptations to stress called fight-or-flight, as well as dopamine, a neurotransmitter that regulates the reward aspect of learning.⁴ ⁵

What is Vyvanse used to treat?

The US Food and Drug Administration (FDA) has approved Vyvanse for the treatment of attention-deficit/hyperactivity disorder (ADHD) in adults and children aged six years and older. In adults, it’s also approved for the treatment of moderate to severe binge-eating disorder.⁶

What You Need To Know About Attention-Deficit Hyperactivity Disorder (ADHD)

What You Need To Know About Binge Eating Disorder

Doctors occasionally prescribe Vyvanse off-label to treat certain types of depression and severe daytime sleepiness. Some have prescribed it for weight loss. These are unregulated uses that have not been thoroughly researched for safety or effectiveness and are not approved by the US FDA.

Dosage forms and strengths

Vyvanse is available in capsule and chewable tablet forms in the following strengths:

Capsules: 10mg, 20mg, 30mg, 40mg, 50mg, 60mg, and 70mg

Chewable tablets: 10mg, 20mg, 30mg, 40mg, 50mg, and 60mg

The recommended starting dose for the treatment of ADHD in both children (six and older) and adults is 30mg per day. The dose may be increased weekly by 10–20mg to a maximum of 70mg daily. It is common for doctors to adjust the dose as needed to adequately control symptoms while minimizing side effects.

In adults, the same dosing parameters apply to treating binge eating disorder.

How do you take Vyvanse?

Most people take Vyvanse once daily with a full glass of water. People taking the capsule version can choose to open the capsule and sprinkle its contents into water, juice, or yogurt if swallowing the capsule is difficult. The mixture must be consumed promptly. Chewable tablets are often prescribed to children because they are easier to take. Vyvanse can be taken with or without food.

Seeing results

The time it takes to experience the benefits of Vyvanse can vary from person to person. In general, individuals taking the drug will begin to feel its effects within two hours. Vyvanse may prove effective as long as 14 hours after the initial dose.⁷

If you take Vyvanse as directed by your doctor, you can expect the drug to reach peak efficacy within a few weeks. It is important to continue taking the medication as prescribed and to speak with your prescriber if you have any concerns about its effectiveness or side effects.

Who should not take Vyvanse?

Vyvanse is a prescription medication that is not suitable for everyone. 

Individuals who should not take Vyvanse or must be cautious when taking it include anyone with the following conditions:⁸ ⁹

• Allergy to Vyvanse, any of its components, or a similar drug

• History of cardiovascular disease, including heart attack, stroke, congenital heart abnormalities, or a family history of sudden death

• Abnormal heart rhythms

• Moderate to severe high blood pressure

• Hyperthyroidism

• Glaucoma

• Kidney disease

• Tourette syndrome or tic disorder

• Raynaud syndrome

• Seizure disorder or history of an abnormal electroencephalogram (EEG)

• History of drug or alcohol use disorder or misuse

• Taking monoamine oxidase inhibitors (MAOIs) or have taken them in the past two weeks

• History of mental illness, including bipolar disorder, suicidal ideas, and psychosis

• Pregnant, planning a pregnancy, or breastfeeding

It is important to inform your prescriber of any medical conditions you have or medications you are taking before starting Vyvanse to help determine if the drug is safe and appropriate for you.

Potential side effects of Vyvanse

Vyvanse has known side effects. While most side effects are mild and resolve without intervention, some are severe and require urgent medical attention.

Side effects in children

Early research on Vyvanse found that the most common minor side effects included the following:¹⁰

• Irritability

• Headaches

• Nausea, vomiting

• Upper abdominal pain

• Decreased appetite

• Weight loss

• Elevated heart rate

• Trouble sleeping

In 2006, two years prior to the approval of Vyvanse, the US FDA's Drug Safety and Risk Management Advisory Committee and Pediatric Advisory Committee expressed concerns over ADHD medications generally. They cited cases involving severe adverse reactions, including sudden death, in patients with certain preconditions:¹¹

• Heart problems

• Aggressive behaviors

• Hallucinations, psychosis, and mania

ADHD medications have also been implicated in physically suppressing children's growth. In a four-week trial involving pediatric patients, researchers noted an association between taking Vyvanse and a decrease in weight. The decline was more significant with higher doses. If your child is taking Vyvanse and is not growing or gaining weight as expected, their doctor may decide to pause or discontinue treatment with the drug. Note that Vyvanse is not approved for children younger than six years.¹²

Side effects in adults and children

Other side effects seen in both adults and children include the following:¹³

• Dry mouth

• Diarrhea

• Rash

• Dizziness

• Elevated heart rate

• Increased blood pressure

• Shortness of breath

• Headache

• Insomnia

• Tics, tremor

• Jittery feeling

• Anxiety, irritability, emotional lability (quick or unusually strong changes in emotion)

• Loss of appetite, weight loss

Severe adverse effects

Some rare but more serious side effects have been reported:

• Chest pain

• Heart palpitations or increased heart rate

• Heart attack

• Stroke

• Seizure

• Poor circulation, color change, or numbness in fingers and toes

• Psychotic or manic episodes, hallucinations

• Serotonin syndrome (characterized by elevated heart rate, dry mouth, nausea, vomiting, muscle rigidity, sweating, flushed skin, fever, anxiety, and confusion)

• Severe, life-threatening skin reactions, such as Stevens-Johnson syndrome and toxic epidermal necrolysis

• Anaphylaxis

If you experience any severe side effects while taking Vyvanse, seek immediate medical care.

Overdose

The following are symptoms of an overdose, which are generally consistent with those of amphetamine toxicity:¹⁴ ¹⁵

• Rapid heart rate and abnormal rhythm

• Pounding or fluttering in your chest

• Rapid breathing

• Overactive reflexes

• Hypertension or hypotension

• Tremor or muscle twitches

• Muscle pain or weakness

• Restlessness, irritability, aggression, or violent behavior

• Confusion, panic, or hallucinations

• Very high fever

• Abdominal cramps

• Nausea and vomiting

• Seizure

• Serotonin syndrome

• Dark urine

• Circulatory collapse

• Coma

If you see any of these signs or suspect an overdose, call 911 or the National Poison Control helpline at 1-800-222-1222, depending on the severity of your symptoms.

Allergy information

It’s possible to be allergic to the active or inactive ingredients in Vyvanse or other stimulants like amphetamine (Adderall) or dextroamphetamine (Adderall, Dexedrine, Xelstrym). Speak with your doctor about any known allergies before taking a new medication.

Allergic reactions can be mild to severe. Symptoms of an allergic reaction may include:

• Hives

• Itching

• Rash or peeling skin

• Swelling of the lips, face, or throat

• Vomiting

• Difficulty breathing or wheezing

• Loss of consciousness

In the event of an allergic reaction, seek immediate medical attention. Depending on the severity of the symptoms, contact your doctor, call 911, or go to the nearest emergency department.

Long-term use of Vyvanse

It’s not unusual for patients with ADHD to take Vyvanse long-term. In a two-year study of children and adolescents with ADHD, researchers found that participants saw continued improvements in their ADHD symptoms across the study period. They also noted that side effects were more significant early on and gradually improved over time, indicating that long-term use was not associated with an increase in adverse effects. However, cardiovascular tests and weight measurements showed that Vyvanse might affect these parameters, so patients taking the drug for longer periods should undergo regular assessments with their prescribing doctor.¹⁶

It’s worth noting that Vyvanse is a controlled substance, which means its manufacturing and distribution are closely monitored because of the associated risk of misuse. People who abuse or misuse Vyvanse may experience severe reactions, including aggression, hostile behavior, psychosis, and suicidal (or homicidal) ideas or behavior. The risk of misuse may be higher for people taking Vyvanse long-term, as they may be more likely to build tolerance (requiring more medication to achieve the desired effects) and develop dependence.¹⁷

Vyvanse and pregnancy

The US FDA designated Vyvanse as a pregnancy category C drug. While animal studies have shown adverse effects on the fetus, there are no adequate studies on pregnant women. Therefore, it is not recommended to take Vyvanse during pregnancy unless the benefits outweigh the potential risks.

Amphetamines are known to cause constriction of blood vessels and uterine contractions, which are risks for insufficient blood supply to the placenta and premature delivery. Newborns are also at risk for developing withdrawal syndrome.¹⁸

If you are pregnant or planning to become pregnant, it is essential to discuss the risks and benefits of Vyvanse with your doctor. They may be able to recommend alternative treatments or adjust your dose to minimize the potential risks.

There is also not enough data to know if Vyvanse can pass to a nursing infant through breast milk. Research involving mothers taking dextroamphetamine has shown no ill effects on the infant’s growth and development, only that they are less likely to continue breastfeeding after hospital discharge. This is something to discuss with your doctor, who will determine the best course of therapy for your condition.¹⁹

Missed doses

If you miss a dose of Vyvanse early in the day, take it as soon as you remember. If it’s nearly evening or later, skip the missed dose and resume your regular dosing schedule the next morning. Never double your dose to make up for a missed one.²⁰

Drug interactions

It is important to check with your doctor or pharmacist before taking Vyvanse alongside any other medications and over-the-counter (OTC) drugs, herbs, or supplements. Below are some known to have negative interactions with Vyvanse.

• MAOIs, such as isocarboxazid (Marplan) and phenelzine (Nardil)

• Antibiotics, such as linezolid (Zyvox)

• Muscle relaxants like metaxalone (Skelaxin)

• Selective serotonin reuptake inhibitors (SSRIs), including fluoxetine (Prozac), sertraline (Zoloft), and escitalopram (Lexapro)

• Serotonin-norepinephrine reuptake inhibitors (SNRIs), such as venlafaxine (Effexor)

• Tricyclic antidepressants like amoxapine (Asendin) and desipramine (Norpramin)

• Drugs for Parkinson disease, such as safinamide (Xadago) and topical selegiline (Eldepryl, Zelapar)

• Decongestants like pseudoephedrine (Sudafed and other OTC versions)

• Migraine medications, such as dihydroergotamine mesylate (Migranal), almotriptan (Axert), and eletriptan (Relpax)

• Other amphetamine-containing drugs, including those commonly used for weight loss, such as benzphetamine (Didrex), and others used to treat ADHD (or ADD — attention-deficit disorder), including dexmethylphenidate (Focalin)

• Opiate pain medications, such as hydromorphone (Dilaudid), meperidine (Demerol), tramadol (Ultram), and oxycodone (Oxycontin, Roxibond, and others)

• GI medications, including those containing simethicone, such as the combination drug Mylanta, as well as Alka-Seltzer, sodium bicarbonate, and other OTC drugs

• Recreational drugs like MDMA (also known as ecstasy), cocaine, and opium

• Herbs such as St. John’s wort and ephedra

• Other substances, including vitamin C and baking soda

This list is not exhaustive. Review all of your medications, herbs, and supplements (prescribed or OTC) with your doctor.

Can I drink alcohol while taking Vyvanse?

You should not consume alcohol while taking ADHD medications.

Because Vyvanse is a stimulant and alcohol can act as a depressant, one may counter the effects of the other. If alcohol mutes the effects of Vyvanse, a person may feel compelled to take too much of the drug to achieve the desired effect, resulting in an overdose. Likewise, Vyvanse can suppress the effects of alcohol, and a person combining the two may underestimate the volume of alcohol they consume, resulting in overconsumption.²¹ ²²

What to discuss with your doctor before starting Vyvanse

Vyvanse is available by prescription only, so you’ll need to meet with your doctor before you start taking it. At your appointment, you should discuss the following topics:²³

• Known drug allergies and previous adverse reactions to stimulant medications

• All medications, herbs, vitamins, or supplements you’ve recently taken (particularly MAOIs), take occasionally, or are currently taking, whether prescribed or OTC

• Your lifestyle, especially if you regularly engage in activities requiring alertness

• Any medical problems you have or any family history of illness, including:

  • Heart problems, abnormal heart rhythms, or family history of sudden death

  • Cardiovascular disease (including clogged arteries, heart attack, or stroke)

  • High blood pressure

  • Depression

  • Bipolar disorder

  • Suicidal thoughts or behaviors

  • Tics or Tourette syndrome

  • Raynaud syndrome

  • Hyperthyroidism

  • Glaucoma

  • Seizures

  • Kidney disease

  • Alcohol or drug use disorder

• Current or planned pregnancy or breastfeeding

Stopping Vyvanse

Stopping Vyvanse abruptly can cause a number of withdrawal symptoms, such as any of the following:²⁴

• Nausea or vomiting

• Anxiety, irritability, aggressive behavior, or psychosis

• Sweating

• Shaking

• Abdominal pain

• Insomnia or sleepiness

• Fatigue

• Increased appetite

• Increased heart rate, respiratory rate, or blood pressure

Withdrawal symptoms can be severe. Work closely with your prescriber when discontinuing Vyvanse to prevent serious withdrawal effects.

Drug approval history

• 2007: Vyvanse was approved for treating ADHD in children aged 6 to 12 years.²⁵

• 2008: The US FDA granted approval for the same use (ADHD) in adults.²⁶

• 2016: Moderate to severe binge eating disorder was added as an approved indication.²⁷

Tips for taking Vyvanse

• Vyvanse may be taken with or without food.

• Vyvanse may increase symptoms of depression or psychosis in patients with a history of those conditions, so it’s crucial to monitor your symptoms closely.

• Children taking Vyvanse should have their weight and height checked regularly for signs of growth suppression. Vyvanse is not approved for children younger than six years.

• Report symptoms and side effects to your prescriber, as your dosage may need adjusting.

• Do not attempt to split doses or give your medication to another person.

• Store your medicines at room temperature in a dark and dry location, and keep them out of the reach of children.

Vyvanse FAQs

What is the difference between Vyvanse and Adderall?

The branded medications Vyvanse and Adderall contain different active ingredients. Adderall contains amphetamine salts, while Vyvanse is a prodrug that is converted to its active form within the body. Both are used to treat ADHD. Your doctor will determine which is best for you.

Does Vyvanse help with anxiety?

Vyvanse is not intended to treat anxiety. While you may feel less anxious when your ADHD symptoms are in check, anxiety is also a known side effect of Vyvanse. Before starting the medication, tell your doctor about any anxiety symptoms you have. It’s impossible to predict how your body will react to Vyvanse, but if you experience any persistent or severe anxiety while taking the drug, consult your doctor.

Can you take Vyvanse if you don’t have ADHD?

Vyvanse has a number of on- and off-label uses. However, given the significant risk of misuse, it’s essential you only take the drug if your doctor prescribes it for you. Taking Vyvanse without a prescription or prescribed for someone else is extremely dangerous.