lisdexamfetamine

Lisdexamfetamine dimesylate, commonly marketed as Vyvanse, is a prescription stimulant used to treat attention deficit hyperactivity disorder (ADHD) in children, adolescents, and adults, and to treat moderate to severe binge eating disorder in adults. It is a Schedule II controlled substance in the United States.

Mechanism and pharmacology: Lisdexamfetamine is a prodrug of dextroamphetamine. After oral administration, it is enzymatically hydrolyzed in the blood to active dextroamphetamine and the amino acid L-lysine. This prodrug design yields a gradual onset and longer duration of effect compared with immediate-release amphetamines, with the aim of reducing abuse potential.

Administration and dosing: Lisdexamfetamine is taken once daily in the morning, with or without food, and should be used as part of a broader treatment plan. The onset of action typically occurs within about an hour, with effects lasting several hours (often up to about 12–14 hours). It is not intended for nighttime use due to potential insomnia and other stimulant-related effects. Available formulations include capsules and chewable tablets in various strengths.

Safety, efficacy, and contraindications: Common adverse effects include decreased appetite, insomnia, dry mouth, irritability, anxiety, tachycardia, and increased blood pressure. Growth suppression can occur with long-term use in children. Lisdexamfetamine should not be used in individuals with hypersensitivity to amphetamines, a history of cardiovascular disease or severe hypertension, glaucoma, hyperthyroidism, significant anxiety or agitation, or with monoamine oxidase inhibitors within the preceding 14 days. Caution is advised in patients with a history of substance use disorder. Abuse, misuse, and dependence potential exist despite the prodrug design.

Pregnancy and lactation considerations apply; treatment decisions should weigh benefits against risks.