Posted: August 23rd, 2023

Lisdexamfetamine (Vyvanse): An Evidence-Based Approach to Treating ADHD

Lisdexamfetamine (Vyvanse): An Evidence-Based Approach to Treating ADHD

Introduction:
Attention-Deficit/Hyperactivity Disorder (ADHD) is a neurodevelopmental disorder affecting both children and adults. Lisdexamfetamine (Vyvanse) is a medication widely prescribed to manage ADHD symptoms. This article provides a comprehensive overview of Lisdexamfetamine, including its mechanism of action, prescription format, evidence-based rationale, potential side effects, required diagnostic testing, and medication-related teaching points.

Medication Class and Mechanism of Action:
Lisdexamfetamine is classified as a stimulant and functions as both a dopamine and norepinephrine reuptake inhibitor and releaser (Stahl, 2020). The medication is a prodrug of dextroamphetamine and remains inactive until absorbed in the gastrointestinal tract, where it is converted into an active form. Lisdexamfetamine targets symptoms commonly associated with ADHD, such as decreased concentration, attention, increased hyperactivity, and impulsiveness.

Prescription Format:
Patient Name: XX
Age/DOB: xx/xx/xxxx
Pt Address: [if not automatically generated]
NKDA
Date: April 16th, 2023
RX: Lisdexamfetamine (Vyvanse) 30mg capsules
SIG: Take one capsule, by mouth, (30mg) every morning
Dispense: #30 (thirty) tablets
Refills: zero refills
CMW, MSN, RN, PMHNP
NPI: 123456789
DEA: 987654321
[Note: No refills were provided for this initial prescription.]

Evidence-Based Rationale:
Lisdexamfetamine has gained prominence due to its effectiveness and safety profile in treating ADHD. The American Academy of Pediatrics (AAP) recognizes FDA-approved medications, including Lisdexamfetamine, as a Grade A, strong recommendation for ADHD treatment in children aged 6 to 12 (Wolraich et al., 2019). Clinical trials by Newcorn et al. (2017) and a review by Quintero et al. (2022) highlight the efficacy of Lisdexamfetamine in increasing dopamine and norepinephrine levels. The medication’s extended duration of 10–12 hours (Stahl, 2020) aligns well with the demands of a school day and potential homework time. Furthermore, Lisdexamfetamine’s approval for binge eating disorder can address concerns of excess weight in the patient (CDC, 2023).

Side Effects and Adverse Effects:
Lisdexamfetamine may cause several side effects, including insomnia, headaches, irritability, overstimulation, tremor, dizziness, anorexia, nausea, dry mouth, constipation, diarrhea, and weight loss (Stahl, 2020). According to the FDA, common side effects include decreased appetite, insomnia, abdominal pain, irritability, vomiting, and decreased weight (FDA, 2017).

Required Diagnostic Testing:
Prior to Lisdexamfetamine initiation, assessment of cardiac history is essential due to the medication’s impact on cardiac function (Stahl, 2020). Routine blood pressure monitoring is necessary during treatment, and consistent documentation of the child’s height and weight is crucial.

Medication-Related Teaching Points:

Strict adherence: Lisdexamfetamine is a controlled substance and should be taken as prescribed.
Alert for cardiac reactions: Notify the prescriber if the child experiences chest pain, shortness of breath, or fainting.
Monitor for behavioral changes: Report new or worsening behaviors, hallucinations, paranoia, or unusual thoughts to the prescriber.
Timing and appetite: Administer in the morning to avoid sleep disturbances and potential decreased appetite.
Duration of effect: The medication’s effects may last throughout the school day and into the evening.
Patience in efficacy: Although effects can begin on the first day, full therapeutic benefits may take up to a week.
Secure storage: Store all medications, especially controlled substances, in a locked cabinet.
Conclusion:
Lisdexamfetamine (Vyvanse) offers a well-documented and evidence-based approach to managing ADHD symptoms in children. Its mechanism of action, extended duration, and potential positive impacts on associated conditions make it a favorable choice under appropriate medical supervision.

References:

Stahl, S. M. (2020). Prescriber’s Guide, 7th Edition.
Wolraich et al. (2019). Clinical Practice Guideline for the Diagnosis, Evaluation, and Treatment of Attention-Deficit/Hyperactivity Disorder in Children and Adolescents. Pediatrics, 144(4), e20192528.
Newcorn et al. (2017). Randomized, Double-Blind, Placebo-Controlled Acute Comparator Trials of Lisdexamfetamine and Extended-Release Methylphenidate in Adolescents With Attention-Deficit/Hyperactivity Disorder. CNS Drugs, 31(11), 999–1014.
Quintero, J., Gutiérrez-Casares, J. R., & Álamo, C. (2022). Molecular Characterisation of the Mechanism of Action of Stimulant Drugs Lisdexamfetamine and Methylphenidate on ADHD Neurobiology: A Review. Neurology and therapy, 11(4), 1489–1517.
CDC. (2023). BMI Percentile Calculator for Child and Teen: Results. Retrieved from https://www.cdc.gov/healthyweight/bmi/result.html?
FDA. (2017). Vyvanse. Retrieved from https://www.accessdata.fda.gov/drugsatfda_docs/label/2017/208510lbl.pdf