Names and pronunciation
(lis-dex′am-fet′a-meen) Vyvanse
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Drug reference
(lis-dex′am-fet′a-meen) Vyvanse
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Func. class.: CNS stimulant
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Chem. class.: Amphetamine Controlled Substance Schedule II
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ACTION: Increases release of norepi- nephrine, DOPamine in cerebral cortex to reticular activating system
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USES: Attention-deficit/hyperactivity disorder (ADHD), binge eating disorder
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CONTRAINDICATIONS: Breast- feeding, hyperthyroidism, hypertension, glaucoma, severe arteriosclerosis, hyper- sensitivity to sympathomimetic amines
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Black Box Warning: Substance abuse Precautions: Pregnancy, children <6 yr, Gilles de la Tourette’s disorder, depres- sion, anorexia nervosa, psychosis, sei- zure disorder, suicidal ideation, MI, heart failure, alcoholism, aortic stenosis, bipolar disorder, CV disease Black Box Warning: Before giving this product, identify presence of substance abuse; high potential for abuse, may be fatal • Psychotic manic episodes: may occur when patients have underlying psychiat- ric conditions • Gum, hard candy, frequent sips of wa- ter for dry mouth • Pregnancy/breastfeeding: avoid use in pregnancy and breastfeeding Black Box Warning: Serious CV effects may occur from increasing dose • Pregnancy/breastfeeding: to avoid use in pregnancy, breastfeeding
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SIDE EFFECTS CNS: Hyperactivity, insomnia, rest- lessness, talkativeness, dizziness, head- ache, dysphoria, irritability, CNS tumor, dependence, addiction, mild euphoria, somnolence, lability, psychosis, mania, hallucinations, aggression; movement disorders, psychiatric events (child) CV: Palpitations, tachycardia, hyper- tension, decrease in heart rate, dysrhyth mias, MI, cardiomyopathy EENT: Blurred vision, mydriasis, diplopia ENDO: Growth inhibition GI: Anorexia, dry mouth, diarrhea, weight loss GU: Impotence, change in libido INTEG: Urticaria, angioedema, Stevens- Johnson syndrome, toxic epidermal necrolysis MISC: Rhabdomyolysis
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INTERACTIONS • Hypertensive crisis: MAOIs or within 14 days of MAOIs Increase: serotonin syndrome, neurolep tic malignant syndrome—SSRIs, SNRIs, serotonin-receptor agonists Increase: lisdexamfetamine effect—acet- aZOLAMIDE, antacids, sodium bicarbon- ate, urinary alkalinizers Increase: CNS effect—haloperidol, tricy- clics, phenothiazines, modafinil, meperi- dine, PHENobarbital, phenytoin Increase: CNS stimulation—melatonin Decrease: absorption of phenytoin Decrease: lisdexamfetamine effect— ascorbic acid, ammonium chloride, uri- nary acidifiers Decrease: effect of—adrenergic block- ers, antidiabetics Drug/Herb L • Serotonin syndrome: St. John’s wort Increase: stimulant effect—khat, melato- nin, green tea, guarana Decrease: stimulant effect—eucalyptus Drug/Food Increase: amine effect—caffeine
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TREATMENT OF OVERDOSE: Administer fluids, antihypertensive for increased B/P, ammonium chloride for increased excretion, chlorproMAZINE for antagonizing CNS effects
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DOSAGE AND ROUTES ADHD • Adult/child 6-17 yr: PO 30 mg/day in AM; may increase by 10-20 mg/day at weekly intervals, max 70 mg/day Moderate to severe binge eating disorder • Adult: PO 30 mg/day in AM, increase by 20 mg weekly to target of 50-70 mg/day Renal dose • Adult: PO Severe impairment (GFR 15-<30 mL/min/1.73 m2): max 50 mg/ day; ESRD (GFR <15 mL/min/1.73 m2): max 30 mg/day
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Available forms: Caps 10, 20, 30, 40, 50, 60, 70 mg
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Administer: • Give daily in AM • Without regard to meals • Caps: may take whole or opened and contents dissolved in water, take immedi- ately
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Assess: • ADHD: obtain history from parents, patient, counselors, as well as testing; confirm diagnosis before use • Binge eating disorder: obtain history of diet bingeing times and food • VS, B/P; product may reverse antihy- pertensives; check patients with cardiac disease often • CBC, urinalysis; in diabetes: blood glu- cose; insulin changes may be required because eating may decrease • Height, growth rate in children; growth rate may be decreased; treatment should be discontinued if this is present • Mental status: mood, sensorium, af- fect, stimulation, insomnia, irritability • Serotonin syndrome, neuroleptic malignant syndrome: increased heart rate, shivering, sweating, dilated pupils, tremors, high B/P, hyperthermia, head ache, confusion; if these occur, stop product, administer serotonin antagonist if needed; at least 2 wk should elapse between discontinuation of serotonergic agents and start of product • Tolerance or dependency: increased amount of product may be used to get same effect; will develop after long-term use • Overdose: pain, fever, dehydration, in- somnia, hyperactivity
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Evaluate: • Therapeutic response: increased CNS stimulation, decreased drowsiness
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CLINICAL CONSIDERATIONS
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Patient and caregiver information: • Seizures: that product may decrease seizure threshold; those with a seizure disorder should notify prescriber if sei zure occurs • To report CNS changes, blurred vision; decrease in dose may be needed • To decrease caffeine consumption (coffee, tea, cola, chocolate); may in- crease irritability, stimulation • To avoid OTC preparations unless ap- proved by prescriber • To taper product over several weeks; depression, increased sleeping, lethargy may occur • To avoid alcohol ingestion • To avoid breastfeeding • To avoid hazardous activities until sta- bilized on medication • To get needed rest; patient will feel more tired at end of day
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PHARMACOKINETICS Metabolized by liver; urine excretion pH dependent; crosses placenta, breast milk; half-life <1 hr
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• Adult/child 6-17 yr: PO 30 mg/day in AM; may increase by 10-20 mg/day at weekly intervals, max 70 mg/day Moderate to severe binge eating disorder
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• Adult: PO 30 mg/day in AM, increase by 20 mg weekly to target of 50-70 mg/day Renal dose
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• Adult: PO Severe impairment (GFR 15-<30 mL/min/1.73 m2): max 50 mg/ day; ESRD (GFR <15 mL/min/1.73 m2): max 30 mg/day
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