Using lisdexamfetamine (Vyvanse®) in Children and Adolescents
Generic Name: Lisdexamfetamine
Brand Name: Vyvanse®
Lisdexamfetamine is approved by Health Canada for treating AD/HD in adolescents and children age six and over.
It is used to improve the mental and behavioral symptoms of AD/HD, which includes short attention span, impulsive behaviour, and hyperactivity.
Your doctor may be using this medication for another reason. If you are unclear why this medication is being prescribed, please ask your doctor.
Lisdexamfetamine works by increasing the activity of the brain chemicals (neurotransmitters) called dopamine, and to a lesser extent, norepinephrine. This medication activates areas of the brain that control attention and body movements, thereby improving symptoms of AD/HD.
Lisdexamfetamine does not cure AD/HD. It aims to improve functioning by reducing core AD/HD symptoms such as the inability to pay attention, impulsive behaviour, and hyperactivity. Lisdexamfetamine improves core AD/HD symptoms in approximately three-quarters of children and adolescents. It can also help you tolerate frustration better and improve social and peer relationships. It is expected that your overall functioning will improve substantially. Whenever possible, adding behavioral management strategies (for example: rewarding good behaviour, teaching problem-solving techniques) to lisdexamfetamine increases the chance for benefit.
If you do not experience a significant improvement with lisdexamfetamine at a younger age, it does not mean that lisdexamfetamine will not work later on in life.
Lisdexamfetamine comes in capsules that are taken by mouth. Your doctor will determine how much you should take, according to your own needs. If you are starting treatment with lisdexamfetamine, it should be taken everyday (7 days a week). This lets your body to get used to the medication, and helps to determine if and when the medication is working in different settings and as observed by different people. Lisdexamfetamine is a long-acting medication, and each dose lasts for up to 14 hours. Lisdexamfetamine must be taken first thing in the morning. If you sleep late or forget to take it, do not take it later in the day as this may interfere with sleep. Lisdexamfetamine capsules should be swallowed whole with liquids, and should never be crushed or chewed. Lisdexamfetamine is soluble in water. The capsule can be opened and the white powder dissolved in water so that it is possible to drink this medication if there is difficulty swallowing pills, or if your doctor prescribes a dose that is less than a full pill.
Your doctor will increase the dose of the medication slowly to find the dose that gives optimal benefit with minimal side effects. Some of the benefits of lisdexamfetamine are noticeable within the first month of starting the medication. Symptoms will only improve when there is enough medication in the body. Once the medication wears off at the end of the day, symptoms of AD/HD can return. Your doctor will adjust the amount and timing of each dose according to your needs. For example, a dose may be timed so that there is enough medication in your body during key subjects in school (like math), times of day when you have the most difficulty, and transition periods (like recess or driving home).
Different people take lisdexamfetamine for different lengths of time. Whether or not you need medication should be reevaluated from time to time. Some people only require it during particular times of their life such as when they are in school, whereas some people continue to benefit from medication for many years. Your doctor may suggest that you take a “drug holiday” from the medication for a month in the summer to see if you still need it, to optimize growth, and to minimize the body getting too used to the medication.
When used properly as directed by your doctor, lisdexamfetamine is not addictive. In fact, this medication has special technology that makes it inactive if someone tries to abuse it by taking it in any way except swallowing it. In general, people with AD/HD may be at an increased risk to abuse substances over the long run. By effectively treating AD/HD, patients may be less likely to abuse substances than those who do not take medications to help manage AD/HD.
You have been prescribed lisdexamfetamine because your doctor has determined that the benefits of this medication are greater than the risks of you taking it. However, as with most medications, side effects may occur. These effects are usually more common when starting a medication or after a dose increase. Most side effects are mild and almost always decrease with time. It is also possible to experience a side effect that you feel is serious or long-lasting. If this occurs, speak to your doctor about ways to manage the side effects at your next appointment. Shown below are some of the more common side effects of taking this medicine. In brackets are suggested ways to lessen these effects.
If any of these side effects bother you or are a change from your usual pattern, please discuss them with your doctor, nurse or pharmacist. For more suggestions on managing common side effects, see our handout “Managing stimulant medication in children and adolescents”.
- Loss of appetite, weight loss (take the medication with breakfast, drink a smoothie or high protein drink or Boost at lunch, and have a major meal when the medication wears off)
- Trouble sleeping (try taking the last dose of the day at an earlier time; starting a bedtime routine; or try adding melatonin 3 – 6 mg taken 30 minutes before bedtime)
- Nausea, vomiting, stomach aches (this is often a sign of hunger, try eating something)
- Stuffy nose (try using a saline nasal spray)
- Fast heart rate (discuss this with your doctor)
- Irritability, agitation, energized feelings, nervousness (avoid caffeine from colas, coffee, or tea)
- Dry mouth (try increasing fluid intake; or chewing sugarless gum or sucking on hard sugar-free candies)
- Headaches (this usually decreases after using medication for 1-3 weeks. Try using a pain relieving medication such as acetaminophen (Tylenol®). This may also be a sign of hunger. Try eating or drinking.)
Potentially serious but uncommon side effects (uncommon side effects occurring in less than 5% of patients)
There are risks involved with taking any medication. Make sure you have had a conversation with your doctor about the potentially serious effects of lisdexamfetamine.
Contact your doctor IMMEDIATELY if you have any of these potentially serious side effects:
- Skin rash
- Persistent head throbbing
- Psychiatric effects such as agitation; prolonged sadness; seeing, hearing, or feeling things that are not there; or other unusual changes in mood (discuss this with your doctor)
- Appearance or worsening of vocal or motor tics, such as shrugging, blinking, head turning, muscle twitches, and throat clearing
- Delay in growth (Your doctor will monitor your growth and may adjust treatment as necessary.)
There have been concerns that lisdexamfetamine may increase the risk for heart problems in children and adolescents. However, studies have shown that rates of sudden death (from a heart problem) are similar between children taking stimulant medications and those who did not take the medication. Nevertheless, this may be a concern for children with pre-existing heart conditions, heart defects, or who undergo strenuous exercise. Lisdexamfetamine should be used with caution in patients who are at a higher risk for heart problems.
Several medications can interact with lisdexamfetamine, including some cough and cold medications; monoamine oxidase inhibitors such as selegiline (Eldepryl®) or phenelzine (Nardil®); some antidepressants such as nortriptyline (Aventyl®), and several others. If you are (or begin) taking any other prescription or over-the-counter medications, be sure to check with your doctor or pharmacist to see if they are safe to use. Your doctor may need to change the doses of your medication(s) or monitor you carefully for side effects if you are taking certain other medications.
It is important to tell the doctor if you:
- have heart conditions or a family history of early heart disease or sudden death
- have structural heart defects or hardening of blood vessels (atherosclerosis)
- have an overactive thyroid
- have problems with fainting, dizziness, chest pain or irregular heart beat
- have high blood pressure
- have extreme exercise demands
- have a seizure disorder that is not well controlled
- have hallucinations (seeing or hearing things that are not there)
- have psychiatric conditions such as depression or bipolar disorder
- have glaucoma (an eye disease)
- use alcohol to excess or street drugs
- have allergies or bad reactions to lisdexamfetamine or any other medications
- are currently pregnant (or plan to become pregnant) or are breast-feeding
- Keep all appointments with your doctor and the laboratory. Your doctor may order certain assessments and tests (for example: reports from teachers, AD/HD rating scales, height, weight, pulse, blood pressure, electrocardiogram (EKG)) to check how you are responding to lisdexamfetamine.
- Do not allow anyone else to use your medication.
If you take lisdexamfetamine regularly and you forget to take it, take it as soon as you remember. If it is later than 10 AM, do not take medication that day. Your doctor may prescribe a shorter acting medication that is similar to take in circumstances where you sleep late, forget your medication, or do not want to be on medication for 14 hours.
What storage conditions are needed for lisdexamfetamine?
- Store this medication at room temperature away from moisture and heat (e.g., not in the bathroom).
- Keep this medication out of reach and sight of children, especially if it is in an unmarked cup dissolved in water.
Special thanks to the Kelty Mental Health Resource Centre for permission to adapt this document. The original document was developed by health professionals of BC Mental Health and Addiction Services, an agency of the Provincial Health Services Authority and reviewed by the staff of the Kelty Mental Health Resource Centre. French translation provided courtesy of the Ontario Centre of Excellence for Child and Youth Mental Health.
You are free to copy and distribute this material unchanged and in its entirety as long as 1) this material is not used in any way that suggests we endorse you or your use of the material, 2) this material is not used for commercial purposes (non-commercial), 3) this material is not altered in any way (no derivative works). View full license at http://creativecommons.org/licenses/by-nc-nd/2.5/ca/. For any other uses, please contact the original rights holder, the Kelty Mental Health Resource Centre (http://www.keltymentalhealth.ca).
Date of Last Revision: Oct 16, 2016