Generic Name: Lisdexamfetamine dimesylate (lis-dex-am-FET-a-meen die-MESS-ill-ate)
Brand Name: Vyvanse (VIE-vance)
Marketed by: Shire Pharmaceuticals
What Is Vyvanse?
Vyvanse is the latest central nervous system stimulant approved to treat adult ADHD. As with other stimulants, it affects chemicals in the brain that play a part in hyperactivity and impulse control.
The drug was launched in July 2007 to treat ADHD in children. Then, in April of 2008, Vyvanse was FDA approved for the treatment of adult attention deficit hyperactivity disorder.
How Is Vyvanse Different from Other Stimulant Drugs?
It is likely that Shire Pharmaceuticals launched Vyvanse for two reasons. First, their flagship ADHD drug Adderall XR will soon be going generic. So having a new, patented brand name ADHD drug is good business for them.
Secondly, on the less cynical side, Vyvanse is truly different from other extended release stimulant ADHD drugs. Lisdexamfetamine dimesylate, the active ingredient, is actually a therapeutically inactive prodrug. This means that the psychostimulant is released and activated more slowly, because the body needs to change the lisdexamphetamine molecule before it is therapeutically active. This process naturally makes lisdexamfetamine into an extended-release formulation. The extended release feature is therefore an integral part of the molecule itself, rather than being dependent on how the capsule is constructed.
Shire Pharmaceutical’s main message in marketing Vyvanse is that this type of natural time-release medication is less prone to misuse and abuse, a safety factor important for doctors prescribing the drug. Drugs that are prone to abuse are not only potentially dangerous for patients, but may also be stolen by others seeking stimulants for illegal recreational drug use.
How Does Vyvanse Work?
As with all other stimulant drugs used to treat adult ADHD, Vyvanse is believed to increase the flow of the neurotransmitters dopamine and norepinephrine, chemicals that carry the signal between neurons (cells of the nervous system). This can result in an increase in a person’s ability to focus over extended periods of time.
How Do I Take Vyvanse?
When first launched, Vyvanse was only available in 3 dosages: 30 mg, 50 mg and 70 mg. In January of 2008, Shire Pharmaceuticals announced the FDA approval of three new dosage strengths of 20mg, 40mg, and 60 mg.
Vyvanse should be taken with a full glass of water in the morning as a once-a-day capsule. Once a day dosing is convenient and makes it easier for patients to avoid missing doses.
Another unique advantage of the prodrug formulation is that patients who have difficulty swallowing pills can open their Vyvanse capsule and sprinkle the medicine into a glass of water, as long as they drink the water right away. This can’t be done with extended release formulations that are dependent of the structure of the capsule to slowly release the medication.
Do not, however, mix Vyvanse with anything other than water. Juice and other acidic or alkaline foods and beverages can interfere with the effectiveness of amphetamines.
Is Vyvanse Effective for Adult ADHD?
In its Phase II trials, Vyvanse was shown to be effective within the first week of use in the treatment of symptoms of adult ADHD. Clinical studies with adults have shown that Vyvanse does significantly improve the symptoms of adult ADHD (inattention, hyperactivity and impulsivity) when compared with placebo (no drug). It is still unknown whether Vyvanse is more effective than the other stimulant medications used to treat adult ADHD.
Vyvanse Minor Side Effects
The most commonly reported side effects of Vyvanse are dry mouth, decreased appetite and insomnia. These problems generally decrease over time.
Addiction & Abuse
Although, as a prodrug, Vyvanse is less prone to being abused, it is still ultimately converted into a stimulant drug, so there is always the potential for abuse. As a stimulant, it is also possible for patients to develop an increasing tolerance to the medication over time. If you are taking this drug, or any stimulant for the management of adult ADHD, keep track of how many capsules you have used from each new prescription bottle.
Seek immediate emergency medical attention if you believe that you may have taken too much of this medicine. Overdose of Vyvanse can be fatal.
Stimulant drug therapy may not be right for you if you have a history of heart problems, such as hardened arteries (arteriosclerosis), heart disease, high blood pressure (hypertension), or any other pre-existing cardiac condition.
The drug is also not recommended for people with overactive thyroid, glaucoma, epilepsy and seizure disorders, severe anxiety or agitation and those who have taken MAO inhibitors within the past two weeks. Before taking Vyvanse, be sure to tell your doctor if you have any of these problems.
Pregnancy Category C
As a category C medication, Vyvanse may be harmful to an unborn baby. Vyvanse can also be passed to the baby through breast milk. Tell your doctor if you are pregnant or plan to become pregnant while you are receiving drug treatment for adult ADHD.
Total Treatment of ADHD
Vyvanse, or any medication used to treat ADHD, should be used as a part of a total treatment program. Comprehensive treatment of the adult ADHD often includes education, support groups, regular doctor appointments and therapy or counseling.
If you stop taking Vyvanse abruptly, it can result in severe withdrawal symptoms, including mood swings, fevers, insomnia, cravings for Vyvanse, and sleepiness.
Adler L et al. Efficacy and Safety of Lisdexamfetamine Dimesylate in Adults with Attention Deficit Hyperactivity Disorder. Paper presented at: American Academy of Child and Adolescent Psychiatry Annual Meeting; October 25, 2007; Boston, MA.
Vyvanse [package insert]. Wayne, PA: Shire Pharmaceuticals Inc; 2006.