Lisdexamfetamine

DEA Class; Rx

Common Brand Names; Vyvanse

Oral CNS stimulant in the amphetamine class and pro-drug of dextroamphetamine
Indicated for ADHD in adult and pediatric patients 6 years and older; efficacious for binge-eating disorder (BED) in adults 18 to 55 years
Assess the risk of substance abuse prior to prescribing; monitor for abuse and dependence during treatment

Indicated dor the treatment of attention-deficit hyperactivity disorder (ADHD).

Hypersensitivity

Patient taking MAOIs or within 14 days of stopping MAOIs (including linezolid or IV methylene blue) owing to increased risk of hypertensive crisis

Use with caution in hyperthyroidism, glaucoma, mild to severe hypertension, advanced arteriosclerosis, symptomatic CVD, agitated states, history of psychosis or drug abuse

May cause psychotic or manic symptoms in patients with no prior history, or exacerbation of symptoms in patients with pre-existing psychosis; evaluate for bipolar disorder prior to stimulant use

Misuse of dextroamphetamine may cause sudden death and serious cardiovascular adverse events

Monitor blood pressure and pulse; consider benefits and risks before use in patients for whom blood pressure increases may be problematic

Sudden death has been reported in association with CNS stimulant treatment at recommended doses in pediatric patients with structural cardiac abnormalities or other serious heart problems; in adults, sudden death, stroke, and myocardial infarction have been reported; avoid use in patients with known structural cardiac abnormalities, cardiomyopathy, serious heart arrhythmia, or coronary artery disease

Patients who develop symptoms such as exertional chest pain, unexplained syncope, or other symptoms suggestive of cardiac disease during stimulant treatment should undergo a prompt cardiac evaluation

Particular care should be taken in using stimulants to treat ADHD patients with comorbid bipolar disorder because of concern for possible induction of mixed/manic episode in such patients; screen for risk factors for developing a manic episode before initiating

Aggressive behavior or hostility is often observed in children and adolescents with ADHD; monitor for the appearance of or worsening of aggressive behavior or hostility

Monitor growth of children ages 7 to 10 years during treatment with stimulants; may need to interrupt therapy in patients not growing or gaining weight as expected

There is a pregnancy exposure registry that monitors pregnancy outcomes in women exposed to ADHD medications during pregnancy

Lisdexamfetamine is a prodrug of dextroamphetamine; based on limited case reports in published literature, amphetamine (d-or d, l-) is present in human milk, at relative infant doses of 2% to 13.8% of the maternal weight-adjusted dosage and a milk/plasma ratio ranging between 1.9 and 7.5; there are no reports of adverse effects on breastfed infant;