Drug Action
Lisdexamfetamine is a prodrug of dexamfetamine.
PDF page 391
Loading InternPractice…
Drug reference
Lisdexamfetamine is a prodrug of dexamfetamine.
PDF page 391
Attention deficit hyperactivity disorder (initiated by a specialist) ▶BY MOUTH ▶Child 6–17 years: Initially 30 mg once daily, alternatively initially 20 mg once daily, increased in steps of 10–20 mg every week if required, dose to be taken in the morning, discontinue if response insufficient after 1 month; maximum 70 mg per day ▶Adult: Initially 30 mg once daily, increased in steps of 20 mg every week if required, dose to be taken in the morning, discontinue if response insufficient after 1 month; maximum 70 mg per day
PDF page 391
Advanced arteriosclerosis. agitated states. hyperthyroidism. moderate hypertension. severe hypertension. symptomatic cardiovascular disease
PDF page 391
Bipolar disorder. history of cardiovascular disease. history of substance abuse. may lower seizure threshold (discontinue if seizures occur). psychotic disorders. susceptibility to angle-closure glaucoma. tics. Tourette syndrome CAUTIONS, FURTHER INFORMATION ▶Cardiovascular disease Manufacturer advises caution in patients with underlying conditions that might be compromised by increases in blood pressure or heart rate; see also Contra-indications.
PDF page 391
Scottish Medicines Consortium (SMC) decisions The Scottish Medicines Consortium has advised (May 2013) that lisdexamfetamine dimesylate (Elvanse ®) is accepted for use within NHS Scotland as part of a comprehensive treatment programme for attention deficit hyperactivity disorder (ADHD) in children aged 6 years and over when response to previous methylphenidate treatment is considered clinically inadequate. ▶In adults The Scottish Medicines Consortium has advised (September 2015) that lisdexamfetamine dimesylate (Elvanse Adult ®) is accepted for use within NHS Scotland as part of a comprehensive treatment programme for attention deficit hyperactivity disorder (ADHD) in adults. Based on clinical judgment, patients should have ADHD of at least moderate severity. All Wales Medicines Strategy Group (AWMSG) decisions The All Wales Medicines Strategy Group has advised (December 2013) that lisdexamfetamine dimesylate (Elvanse ®) is recommended as an option for use within NHS Wales as part of a comprehensive treatment programme for attention deficit hyperactivity disorder (ADHD) in children aged six years and over when response to previous methylphenidate treatment is considered clinically inadequate. Treatment must be under the supervision of a specialist in childhood and/or adolescent behavioural disorders. ▶In adults The All Wales Medicines Strategy Group has advised (October 2015) that lisdexamfetamine dimesylate (Elvanse Adult ®) is recommended as an option for use within NHS Wales as part of a comprehensive treatment programme for attention deficit hyperactivity disorder (ADHD) in adults.
PDF pages 391, 392
→Appendix 1: amfetamines
PDF page 391
▶Common or very common Abdominal pain upper. anxiety. appetite decreased. behaviour abnormal. constipation. diarrhoea. dizziness. dry mouth. dyspnoea. fatigue. feeling jittery. headache. hyperhidrosis (uncommon in children). insomnia. mood altered. movement disorders (uncommon in children). nausea. palpitations. sexual dysfunction (uncommon in children). tachycardia. tremor . weight decreased ▶Uncommon Depression (very common in children). drowsiness (very common in children). fever (very common in children). logorrhea. psychiatric disorders (very common in children). skin reactions (very common in children). taste altered. vision blurred. vomiting (very common in children) ▶Frequency not known Angioedema. cardiomyopathy (uncommon in children). drug dependence. hallucination (uncommon in children). hepatitis allergic. mydriasis (uncommon in children). psychotic disorder. Raynaud’s phenomenon (uncommon in children). seizure. Stevens- Johnson syndrome Overdose Amfetamines cause wakefulness, excessive activity, paranoia, hallucinations, and hypertension followed by exhaustion, convulsions, hyperthermia, and coma. See Stimulants under Emergency treatment of poisoning p. 1430.
PDF page 391
Manufacturer advises use only if potential benefit outweighs risk.
PDF page 391
Manufacturer advises avoid—present in human milk.
PDF page 391
Dose adjustments Manufacturer advises max. dose 50 mg daily in severe impairment. Nervous system
PDF page 391
▶Manufacturer advises monitor for aggressive behaviour or hostility during initial treatment. ▶Manufacturer advises monitor pulse, blood pressure, and for psychiatric symptoms before treatment initiation, following each dose adjustment, and at least every 6 months thereafter. Monitor weight in adults before treatment initiation and during treatment; in children, height and weight should be recorded before treatment initiation, and height, weight and appetite monitored at least every 6 months during treatment.
PDF page 391
Manufacturer advises swallow whole or mix contents of capsule with soft food such as yoghurt or in a glass of water or orange juice; contents should be dispersed completely and consumed immediately.
PDF page 391
There can be variation in the licensing of different medicines containing the same drug. Capsule CAUTIONARY AND ADVISORY LABELS 3, 25 Nervous system ▶Elvanse (Shire Pharmaceuticals Ltd) Lisdexamfetamine dimesylate 20 mg Elvanse 20mg capsules | 28 capsule P £54.62 DT = £54.62 b Lisdexamfetamine dimesylate 30 mg Elvanse Adult 30mg capsules | 28 capsule P £58.24 DT = £58.24 b Elvanse 30mg capsules | 28 capsule P £58.24 DT = £58.24 b Lisdexamfetamine dimesylate 40 mg Elvanse 40mg capsules | 28 capsule P £62.82 DT = £62.82 b Lisdexamfetamine dimesylate 50 mg Elvanse Adult 50mg capsules | 28 capsule P £68.60 DT = £68.60 b Elvanse 50mg capsules | 28 capsule P £68.60 DT = £68.60 b Lisdexamfetamine dimesylate 60 mg Elvanse 60mg capsules | 28 capsule P £75.18 DT = £75.18 b Lisdexamfetamine dimesylate 70 mg Elvanse 70mg capsules | 28 capsule P £83.16 DT = £83.16 b Elvanse Adult 70mg capsules | 28 capsule P £83.16 DT = £83.16 b SYMPATHOMIMETICS › ALPHA2-ADRENOCEPTOR AGONISTS
PDF page 392
Avoid abrupt withdrawal.
PDF page 391
Patients and carers should be counselled on the administration of capsules. Driving and skilled tasks Drugs and Driving Prescribers and other healthcare professionals should advise patients if treatment is likely to affect their ability to perform skilled tasks (e.g. driving). This applies especially to drugs with sedative effects; patients should be warned that these effects are increased by alcohol. General information about a patient’s fitness to drive is available from the Driver and Vehicle Licensing Agency at www.gov.uk/ government/organisations/driver-and-vehicle-licensing-agency. For information on 2015 legislation regarding driving whilst taking certain controlled drugs, including amfetamines, see Drugs and driving under Guidance on prescribing p. 1.
PDF page 391
Initially 30 mg once daily, alternatively
First-line fragment. Read the complete Indications and Dose section above.
PDF page 391
Initially 30 mg once daily, increased in steps of
First-line fragment. Read the complete Indications and Dose section above.
PDF page 391