Top 300 Pharmacy Drug Cards

LISDEXAMFETAMINE: Vyvanse

Class: Amphetamine, CNS Stimulant. C-II

Dosage Forms. Capsule: 20 mg, 30 mg, 40 mg, 50 mg, 60 mg, 70 mg

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Common FDA Label Indication, Dosing, and Titration.

1. Attention-deficit hyperactivity disorder (ADHD): 30 mg po daily in the morning; may increase by 10- to 20-mg/d increments at weekly intervals to max 70 mg po daily

Off-Label Uses. None

MOA. Lisdexamfetamine is converted to dextroamphetamine. The mechanism of action of dextroamphetamine in the treatment of ADHD is unknown. Amphetamines may block the reuptake of norepinephrine and dopamine at the presynaptic neuron and thus increase the release of norepinephrine and dopamine into the extraneuronal space.

Drug Characteristics: Lisdexamphetamine

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Medication Safety Issues: Lisdexamphetamine

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Drug Interactions: Lisdexamphetamine

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Adverse Reactions: Lisdexamphetamine

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Efficacy Monitoring Parameters. Improvement of mental and behavioral symptoms of ADHD (inappropriate inattention, impulsivity, hyperactivity, and cognitive performance).

Toxicity Monitoring Parameters. Palpitations, near syncope, or syncope; may be indicative of a cardiac condition. Blood pressure and heart rate should be evaluated at baseline, during routine follow-up within 1-3 mo, and at follow-up visits every 6-12 mo.

Key Patient Counseling Points. Take dose in the morning with or without food. Growth rate and weight may need to be monitored more frequently for children using this drug. Report new or worsened psychiatric problems (behavior and thought problems, bipolar illness, aggressive behavior or hostility). Also report chest pain, palpitations, dyspnea, or signs/symptoms of cardiac dysrhythmia, myocardial infarction, or cerebrovascular accident.

Clinical Pearls. Amphetamines have a high potential for abuse, and administration for prolonged periods of time may lead to drug dependence and must be avoided. Misuse of amphetamines may cause sudden death and serious cardiovascular adverse events. A complete family and patient history for conditions associated with sudden cardiac death is required and current use of any other prescription or over-the-counter medications needs to be determined. A complete physical evaluation of the patient for hypertension, cardiac murmurs, physical findings associated with Marfan syndrome, and signs of irregular cardiac rhythms should be conducted. Medication guide required at dispensing.