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Lisdexamfetamine: 7 things you should know

Medically reviewed by Carmen Fookes, BPharm. Last updated on March 20, 2020.

1. How it works

  • Lisdexamfetamine may be used in the treatment of attention deficit hyperactivity disorder (ADHD) or binge eating disorder (BED).
  • Lisdexamfetamine is a prodrug (a biologically inactive drug which is converted in the body to produce an active drug). Red blood cells break down lisdexamfetamine to dextroamphetamine and l-lysine (an essential amino acid).
  • The exact way dextroamphetamine works in ADHD is not known; however, it does block the reuptake of norepinephrine and dopamine, two neurotransmitters, which leads to an increase in their concentrations in the nerve synapse (the space between two nerves). An imbalance in norepinephrine and dopamine is thought to contribute to the symptoms of ADHD.
  • Lisdexamfetamine belongs to the class of medicines known as CNS stimulants.

2. Upsides

  • May be used in the treatment of Attention Deficit Hyperactivity Disorder (ADHD) to reduce symptoms such as impulsiveness and hyperactivity and to increase attention. Should be used in addition to other treatments such as counseling or behavioral therapies.
  • May be used in the treatment of moderate-to-severe Binge Eating Disorder (BED) to increase the number of binge-free days per month.
  • Lisdexamfetamine should never be used for weight loss.
  • Lisdexamfetamine is ineffective if taken by abusers in any other way other than orally (for example, by inhalation or injection).

3. Downsides

If you are between the ages of 18 and 60, take no other medication or have no other medical conditions, side effects you are more likely to experience include:

  • Insomnia, decreased appetite, stomach pain, irritability, nausea and dry mouth have all been reported. Psychotic thoughts, hallucinations, and manic symptoms are also potential side effects.
  • High potential for abuse and dependence. Tolerance to the effects of lisdexamfetamine may develop over time (this means that the same dose no longer produces the same effects).
  • Withdrawal symptoms (extreme fatigue, depression) may occur if lisdexamfetamine is abruptly stopped; taper dosage off slowly under medical advice.
  • May cause dizziness and impair judgment and affect a person's ability to drive or operate machinery. Alcohol should be avoided.
  • May cause serious cardiac side effects. The risk is greater in those with preexisting cardiac abnormalities or heart problems.
  • May not be suitable for people with cardiac disease. Your doctor should assess a patient for the presence of cardiac disease before lisdexamfetamine is prescribed, which requires taking a careful family history including noting any instances of sudden death or ventricular arrhythmia and conducting a physical exam.
  • May not be suitable for people with a history of drug or alcohol abuse.
  • Other adverse effects include an increase in blood pressure and heart rate, exacerbation of preexisting psychiatric disorders, allergic reactions, and peripheral tissue disorders.
  • Interaction or overdosage may cause serotonin syndrome (symptoms include mental status changes [such as agitation, hallucinations, coma, delirium]), fast heart rate, dizziness, flushing, muscle tremor or rigidity and stomach symptoms (including nausea, vomiting, and diarrhea).
  • May cause growth suppression and weight loss in children. The height and weight of children taking long-term lisdexamfetamine should be monitored.
  • Vyvanse is the only brand of lisdexamfetamine available in the United States.

Note: In general, seniors or children, people with certain medical conditions (such as liver or kidney problems, heart disease, diabetes, seizures) or people who take other medications are more at risk of developing a wider range of side effects. View complete list of side effects

4. Bottom Line

Lisdexamfetamine is a stimulant which may be used for the treatment of ADHD and BED; however, its use is limited by its risk for dependence and other serious side effects.

5. Tips

  • May be taken with or without food. Take in the morning; avoid afternoon dosing due to the potential for insomnia.
  • Capsules may be swallowed whole or the capsule opened and the contents mixed with yogurt, water, or orange juice, then drunk immediately. Chew the chewable tablets thoroughly before swallowing. The same dosage capsule may be substituted for the same dosage chewable tablet and vice versa (for example, 30 mg capsules for a 30 mg chewable tablet).
  • Do not attempt to divide a capsule or chewable tablet into smaller dosages.
  • Take exactly as directed by your doctor, do not take more than recommended. Tell your doctor if you think you have become dependent on lisdexamfetamine or if it does not seem effective.
  • Do not drive or operate machinery if lisdexamfetamine affects your judgment or causes dizziness. Do not drink alcohol while taking lisdexamfetamine.
  • Tell your doctor if you experience chest pain on exertion, unexplained temporary loss of consciousness, or other symptoms suggestive of heart disease.
  • May precipitate psychotic symptoms even in people with no psychiatric history.
  • May cause circulatory problems in the fingers and the toes, a slowing of the growth rate in children, and weight loss.

6. Response and Effectiveness

  • Peak effects reached in approximately four hours.
  • Differences in behavior have been observed two to four hours after taking a dose of lisdexamfetamine to treat symptoms of ADHD.
  • When lisdexamfetamine is used in the treatment of binge eating disorder, a reduction in symptoms (specifically the number of binge days per week) may not happen for several weeks (in some people symptom reduction may take up to 12 weeks).

7. Interactions

Medicines that interact with lisdexamfetamine may either decrease its effect, affect how long it works for, increase side effects, or have less of an effect when taken with lisdexamfetamine. An interaction between two medications does not always mean that you must stop taking one of the medications; however, sometimes it does. Speak to your doctor about how drug interactions should be managed.

Common medications that may interact with lisdexamfetamine include:

  • antacids, such as those that contain aluminum
  • anticoagulants (blood thinners), such as warfarin, or other drugs that have blood-thinning effects such as aspirin or NSAIDs
  • anticonvulsants, such as phenytoin, phenobarbital, or primidone
  • antidepressants, such as tricyclic antidepressants (eg, amitriptyline), monoamine oxidase inhibitors (eg, isocarboxazid, phenelzine, and tranylcypromine), or SSRIs (eg, citalopram, fluoxetine, sertraline)
  • antipsychotics (such as butyrophenones, phenothiazines, or thioxanthenes) and atypical antipsychotics (eg, olanzapine, quetiapine, ziprasidone)
  • any medication that may cause drowsiness, such as benzodiazepines (eg, diazepam, lorazepam), first-generation antihistamines (such as doxylamine or promethazine), metoclopramide, or opioids (such as codeine, morphine)
  • beta-blockers, such as atenolol, labetalol or metoprolol
  • bupropion
  • cold, flu, or allergy medications that contain decongestants such as phenylephrine or pseudoephedrine
  • diet medications, such as benzphetamine, dexfenfluramine, or phentermine
  • diuretics such as furosemide
  • drugs of abuse, such as cocaine
  • duloxetine
  • heart medications such as doxazosin, prazosin, clonidine or methyldopa
  • HIV medications (fosamprenavir, ritonavir)
  • linezolid
  • medications that increase or decrease the pH of the stomach or urinary tracts, such as PPIs (eg, omeprazole, pantoprazole), sodium bicarbonate, acetazolamide, ascorbic acid, or ammonium chloride
  • medications that inhibit CYP2D6 enzymes
  • medications that make the urine more acidic, such as vitamin C, or more alkaline, such as sodium bicarbonate
  • other medications that affect serotonin, such as amphetamines, fentanyl, lithium, tramadol, triptans (eg, almotriptan, eletriptan, or sumatriptan), or St. John's Wort
  • propoxyphene
  • selegiline.

Avoid drinking alcohol or taking illegal or recreational drugs while taking lisdexamfetamine.

Note that this list is not all-inclusive and includes only common medications that may interact with lisdexamfetamine. You should refer to the prescribing information for lisdexamfetamine for a complete list of interactions.

References

Lisdexamfetamine Updated 11/2019 Drugs.com https://www.drugs.com/ppa/lisdexamfetamine.html

Further information

Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use lisdexamfetamine only for the indication prescribed.

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