ABOUT

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Lisdexamfetamine, sold under the brand name Vyvanse among others, is a medication that is a derivative of amphetamine. It is mainly used to treat attention deficit hyperactivity disorder (ADHD) in people over the age of five as well as moderate-to-severe binge eating disorder in adults.^[10] Lisdexamfetamine is taken by mouth.^[10][11] In the United Kingdom, it is usually less preferred than methylphenidate.^[12] Its effects generally begin within 2 hours and last for up to 14 hours.^[10]

Common side effects of lisdexamfetamine include loss of appetite, anxiety, diarrhea, trouble sleeping, irritability, and nausea.^[10] Rare but serious side effects include mania, sudden cardiac death in those with underlying heart problems, and psychosis.^[10] It has a high potential for Substance abuse per the DEA.^[10][11] Serotonin syndrome may occur if used with certain other medications.^[10] Its use during pregnancy may result in harm to the baby and use during breastfeeding is not recommended by the manufacturer.^[12][10][11] Lisdexamfetamine is a central nervous system (CNS) stimulant that works after being converted by the body into dextroamphetamine.^[10][13] Chemically, lisdexamfetamine is composed of the amino acid L-lysine, attached to dextroamphetamine.^[14]

Lisdexamfetamine was approved for medical use in the United States in 2007.^[10] In 2018, it was the 82nd most commonly prescribed medication in the United States, with more than 10 million prescriptions.^[15][16] It is a Schedule II controlled substance in the United Kingdom and a Schedule II controlled substance in the United States.

Medical Use

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Lisdexamfetamine is used primarily as a treatment for attention deficit hyperactivity disorder (ADHD) and binge eating disorder;^[18] it has similar off-label uses as those of other pharmaceutical amphetamines.^[9] Individuals over the age of 65 were not commonly tested in clinical trials of lisdexamfetamine for ADHD.^[18] Long-term amphetamine exposure at sufficiently high doses in some animal species is known to produce abnormal dopamine system development or nerve damage,^[19][20] but, in humans with ADHD, pharmaceutical amphetamines, at therapeutic dosages, appear to improve brain development and nerve growth.^[21][22][23] Reviews of magnetic resonance imaging (MRI) studies suggest that long-term treatment with amphetamine decreases abnormalities in brain structure and function found in subjects with ADHD, and improves function in several parts of the brain, such as the right caudate nucleus of the basal ganglia.^[21][22][23]

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Reviews of clinical stimulant research have established the safety and effectiveness of long-term continuous amphetamine use for the treatment of ADHD.^[24][25][26] Randomized controlled trials of continuous stimulant therapy for the treatment of ADHD spanning 2 years have demonstrated treatment effectiveness and safety.^[24][25] Two reviews have indicated that long-term continuous stimulant therapy for ADHD is effective for reducing the core symptoms of ADHD (i.e., hyperactivity, inattention, and impulsivity), enhancing quality of life and academic achievement, and producing improvements in a large number of functional outcomes^{[note 1]} across 9 categories of outcomes related to academics, antisocial behavior, driving, non-medicinal drug use, obesity, occupation, self-esteem, service use (i.e., academic, occupational, health, financial, and legal services), and social function.^[24][26] One review highlighted a nine-month randomized controlled trial of amphetamine treatment for ADHD in children that found an average increase of 4.5 IQ points, continued increases in attention, and continued decreases in disruptive behaviors and hyperactivity.^[25] Another review indicated that, based upon the longest follow-up studies conducted to date, lifetime stimulant therapy that begins during childhood is continuously effective for controlling ADHD symptoms and reduces the risk of developing a substance use disorder as an adult

Adverse effects

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Products containing lisdexamfetamine have a comparable drug safety profile to those containing amphetamine.^[14]

Interactions

• Acidifying Agents: Drugs that acidify the urine, such as ascorbic acid, increase urinary excretion of dextroamphetamine, thus decreasing the half-life of dextroamphetamine in the body.^[18][61]
• Alkalinizing Agents: Drugs that alkalinize the urine, such as sodium bicarbonate, decrease urinary excretion of dextroamphetamine, thus increasing the half-life of dextroamphetamine in the body.^[18][61]
• Monoamine Oxidase Inhibitors: Concomitant use of MAOIs and central nervous system stimulants such as lisdexamfetamine can cause a hypertensive crisis