Lisdexamfetamine (Vyvanse®)
 

Lisdexamfetamine, commonly known by the brand name Vyvanse, is a central nervous system stimulant. It affects the brain chemicals dopamine and norepinephrine, which are involved in attention, impulse control, activity level, and other functions.
 

Lisdexamfetamine is also a Schedule II controlled substance, which means it has recognized medical uses but also carries a risk of misuse, abuse, and dependence.
 

What Is Lisdexamfetamine Used For?
 

Lisdexamfetamine is FDA-approved to treat:
 

• Attention-deficit/hyperactivity disorder (ADHD) in adults and children age 6 and older

• Moderate to severe binge eating disorder (BED) in adults
   

For ADHD, treatment is intended to improve symptoms such as difficulty paying attention, distractibility, impulsivity, and hyperactivity.
 

For binge eating disorder, treatment may help decrease the frequency of binge-eating episodes.
 

Other Uses (Off-Label)
 

Lisdexamfetamine may sometimes be used for conditions that are not specifically included in its FDA-approved indications.
 

One of the clinical references used for this education lists uses such as:
 

• Narcolepsy

• Treatment-resistant depression
   

This is called off-label use. Off-label prescribing means a medication is being used for a condition outside of its FDA-approved indications. Your provider will consider the available evidence, your symptoms, medical history, and potential risks and benefits before recommending an off-label treatment.
 

How Does Lisdexamfetamine Work?
 

Lisdexamfetamine is a prodrug. This means the medication must first be absorbed and converted by the body into its active form, dextroamphetamine.
 

After this conversion occurs, the medication increases the activity of dopamine and norepinephrine in the brain.
 

These changes may help improve:
 

• Attention and concentration

• Distractibility

• Impulse control

• Hyperactivity

• Executive functioning
   

In people being treated for binge eating disorder, these effects may also help improve control over binge-eating behaviors.
 

How Long Does It Take to Work?
 

Some effects of lisdexamfetamine may be noticeable beginning with the first doses.
 

However, finding the dose that provides the best balance of symptom improvement and tolerability can take time. Maximum benefit may not be clear until treatment has been adjusted and monitored over several weeks.
 

Your provider will evaluate how well the medication is working and whether side effects are occurring.
 

How Should I Take It?
 

Lisdexamfetamine is generally taken once daily in the morning.
 

Taking it later in the day may interfere with sleep.
 

It can be taken with or without food.
 

Depending on the formulation you have:
 

• Capsules may be swallowed whole.

• Some capsules may be opened and the entire contents mixed with an appropriate liquid or food as directed.

• If mixed, the entire amount should be taken rather than saving part for later.

• A single capsule should not be divided into smaller doses.

• Chewable tablets should be thoroughly chewed.
   

Always follow the instructions on your prescription and those provided by your pharmacist.
 

Do not increase, decrease, divide, or otherwise change your dose without discussing it with your provider.
 

Common Side Effects
 

Not everyone experiences side effects.
 

Possible side effects include:
 

• Decreased appetite

• Weight loss

• Dry mouth

• Nausea or stomach discomfort

• Constipation or diarrhea

• Trouble sleeping

• Headache

• Dizziness

• Nervousness

• Irritability

• Restlessness or feeling overstimulated

• Tremor or shakiness

• Increased heart rate

• Increased blood pressure
   

If a side effect becomes bothersome or persistent, let your provider know.
 

Appetite, Weight, and Growth
 

Stimulant medications can decrease appetite and may lead to weight loss.
 

Children taking stimulant medication over longer periods should have their height and weight monitored. Growth may slow temporarily in some children.
 

Tell your provider if you or your child experiences significant appetite loss, weight loss, or concerns about growth.
 

Your provider may periodically reassess whether the medication and dose continue to be appropriate.
 

Heart Rate and Blood Pressure
 

Lisdexamfetamine can increase heart rate and blood pressure.
 

Your provider may check your blood pressure and pulse before treatment and periodically while you are taking the medication.
 

Before beginning treatment, your provider may also ask about your personal and family history of heart problems.
 

Tell your provider if you have a history of heart disease, abnormal heart rhythms, high blood pressure, fainting, or other cardiovascular problems.
 

When Should I Contact My Provider?
 

Contact your provider if you develop new or worsening symptoms such as:
 

• Persistent or significant insomnia

• Severe nervousness or agitation

• Significant irritability

• Persistent rapid heartbeat

• New or worsening high blood pressure

• Significant appetite loss or weight loss

• New or worsening tics

• New numbness, pain, coolness, or color changes in the fingers or toes

• Unexplained sores on the fingers or toes

• Significant changes in mood or behavior
   

Lisdexamfetamine may worsen certain psychiatric symptoms in some people.
 

Contact your provider promptly if you experience symptoms such as:
 

• Unusually elevated or irritable mood

• Dramatically decreased need for sleep

• Racing thoughts

• Unusually increased energy

• Significant impulsivity

• Hallucinations

• Paranoia or unusual suspiciousness

• Other symptoms that are significantly different from your usual behavior
   

When Should I Seek Immediate Medical Attention?
 

Seek immediate medical care for severe symptoms such as:
 

• Chest pain

• Difficulty breathing

• Unexplained fainting

• Seizures

• Severe agitation or confusion

• Hallucinations or severe changes in behavior

• Very rapid or irregular heartbeat

• Severe elevation in blood pressure

• Loss of consciousness

• Signs of a serious allergic reaction
   

If you believe too much medication may have been taken, seek immediate medical assistance.
 

Misuse, Abuse, and Dependence
 

Lisdexamfetamine is a Schedule II controlled medication and has the potential for misuse, abuse, addiction, and dependence.

Take it only as prescribed.
 

Never share your medication with another person, even if that person has similar symptoms or has been diagnosed with ADHD.
 

Taking stimulant medication in larger amounts or in ways other than prescribed can lead to serious medical complications, including overdose and death.
 

Safe Storage
 

Store lisdexamfetamine in a secure location, preferably somewhere locked and out of the reach of children or other individuals who could take it.
 

Protect your medication from theft.
 

Do not give or sell your prescription medication to anyone else.
 

Can I Stop Taking It Suddenly?
 

Do not stop or change lisdexamfetamine without discussing it with your provider.
 

Stopping stimulant treatment may cause symptoms of the underlying condition to return.
 

After long-term use, some individuals may also experience withdrawal-related symptoms. Your provider can help determine the safest way to discontinue treatment if the medication is no longer needed.
 

Medication Interactions
 

Tell your provider and pharmacist about all medications, vitamins, supplements, and over-the-counter products you take.
 

Some medications can interact with lisdexamfetamine.
 

Important interactions may include:
 

• MAO inhibitors

• Certain antidepressants

• Some medications that affect serotonin

• Some blood pressure medications

• Other stimulant or sympathomimetic medications

• Lithium

• Certain antipsychotic medications

• Some seizure medications
   

Lisdexamfetamine should generally not be taken with an MAO inhibitor or within 14 days of MAO inhibitor use because serious reactions can occur.
 

Do not start a new prescription medication, over-the-counter medication, or supplement without letting your provider or pharmacist know what you are taking.
 

Serotonin Syndrome
 

Certain combinations of medications can increase the risk of a rare but potentially serious reaction called serotonin syndrome.

Symptoms may include a combination of:
 

• Significant agitation or confusion

• Fever

• Rapid heartbeat

• Changes in blood pressure

• Muscle twitching or overactive reflexes

• Poor coordination

• Nausea, vomiting, or diarrhea
   

Seek medical attention if you develop symptoms concerning for serotonin syndrome.
 

Pregnancy and Breastfeeding
 

Tell your provider if you are pregnant, planning a pregnancy, trying to conceive, or breastfeeding.
 

The potential benefits and risks of stimulant treatment during pregnancy should be discussed individually with your provider.
 

The clinical references used for this guide also recommend avoiding lisdexamfetamine during breastfeeding because amphetamine can pass into breast milk.
 

Do not make medication changes on your own because of pregnancy or breastfeeding. Discuss your treatment with your provider first.
 

What Monitoring May Be Needed?
 

Depending on your age, health history, and treatment, your provider may monitor:
 

• Blood pressure

• Heart rate

• Weight

• Appetite

• Height and growth in children

• Changes in sleep

• Mood and behavior

• ADHD or binge-eating symptoms

• Signs of misuse or dependence

• Continued need for treatment
   

Regular follow-up appointments are an important part of safe stimulant treatment.
 

What If Lisdexamfetamine Does Not Work?
 

If symptoms are not improving, it does not automatically mean stimulant treatment cannot help.
 

Your provider may consider:
 

• Whether enough time has been allowed to evaluate the current treatment

• Adjusting the dose

• Trying another medication

• Behavioral therapy or other non-medication treatment

• Whether another medical or psychiatric condition could be affecting symptoms
   

Treatment should be individualized based on both benefits and side effects.
 

Common Questions and Misconceptions
 

“If a stimulant helps me focus, that proves I have ADHD.”
 

Medication response is only one piece of treatment and should not replace a complete clinical evaluation. ADHD is diagnosed based on symptoms, history, functioning, and other clinical information.
 

“If my medication stops working as well, I should take more.”
 

No. Do not increase your dose on your own. Changes in effectiveness should be discussed with your provider.

“Vyvanse cannot be misused because it is a prodrug.”
 

Lisdexamfetamine must be converted by the body into its active form, but it is still a Schedule II controlled substance with the potential for misuse, abuse, and dependence.
 

“I can give one of my pills to someone else who has ADHD.”
 

No. Controlled medications should never be shared. Your prescription is intended only for you.
 

“I don't need follow-up appointments if the medication is working.”
 

Regular monitoring is still important. Your provider needs to evaluate symptoms, blood pressure, heart rate, appetite, weight, side effects, and whether continued treatment remains appropriate.
 

The Bottom Line
 

Lisdexamfetamine can be an effective treatment for ADHD and moderate to severe binge eating disorder when it is appropriately prescribed and monitored.
 

Because it is a stimulant and a controlled substance, safe treatment includes more than simply taking the medication. Regular follow-up, monitoring for side effects, appropriate storage, and taking the medication exactly as prescribed are all important.
 

Ask questions and tell your provider about side effects or changes you notice.
 

Your treatment should be a collaborative process between you and your provider.
 

Download the Lisdexamfetamine (Vyvanse®) Patient Education Guide

Clinical References
 

Neuroscience Education Institute. Lisdexamfetamine medication monograph.
 

Vallerand, A. H., Sanoski, C. A., & Quiring, C. Davis’s Drug Guide for Nurses: Lisdexamfetamine.

Educational Disclaimer: This material is intended for general patient education and does not replace individualized medical advice, diagnosis, or treatment. Medication recommendations, dosing, monitoring, and decisions to start, change, or stop medication should be discussed with your healthcare provider. Always follow the medication instructions provided by your prescriber.