lisdexamfetamine

Contraindicated in:

Hypersensitivity to lisdexamfetamine or other sympathomimetic amines;
Advanced arteriosclerosis;
Serious structural cardiac abnormalities, cardiomyopathy, serious cardiac arrhythmia, coronary artery disease, or other serious cardiac disease (may ↑ risk of sudden death);
Moderate to severe hypertension;
Glaucoma;
Agitation;
Concurrent use or use within 14 days of MAO inhibitors or MAO-like drugs (linezolid or methylene blue);
Lactation: Lactation.

Use Cautiously in:

History of pre-existing psychosis, bipolar disorder, aggression, or seizures (may exacerbate condition);
Tics or family history/diagnosis of Tourette syndrome (may worsen condition);
History of substance abuse
;
Continual use (may result in psychological or physical dependence)
;
Severe renal impairment (↓ maximum daily dose);
OB: Use during pregnancy only if potential maternal benefit outweighs potential fetal risk;
Pedi: Children <6 yr (safety and effectiveness not established); growth suppression may occur in children with long-term use.

Adv. Reactions/Side Effects ⬆ ⬇

CV: hypertension, tachycardia, Raynaud phenomenon, SUDDEN DEATH

Derm: alopecia, rash

EENT: blurred vision, poor accommodation

GI: ↓appetite, abdominal pain, dry mouth, intestinal ischemia, nausea, vomiting, weight loss (especially with prolonged use)

GU: ↓libido, priapism

Metab: growth suppression (especially with prolonged use)

MS: RHABDOMYOLYSIS

Neuro: behavioral disturbances, dizziness, hallucinations, insomnia, irritability, mania, paresthesia, psychomotor hyperactivity, thought disorder, tics, Tourette syndrome

Misc: physical dependence, psychological dependence, SEROTONIN SYNDROME

Interactions ⬆ ⬇

Drug-drug:

Concurrent use with MAO inhibitors or MAO-inhibitor-like drugs, such as linezolid or methylene blue, may result in serious, potentially fatal reactions; wait ≥14 days following discontinuation of MAO inhibitor before initiation of amphetamine mixtures.
Drugs that affect serotonergic neurotransmitter systems, including MAO inhibitors, tricyclic antidepressants, SSRIs, SNRIs, fentanyl, buspirone, tramadol, lithium, and triptans, may ↑ risk of serotonin syndrome.
Sympathomimetic amines may result in additive effects and ↑ risk of adverse reactions.
Urinary acidifying agents, including sodium acid phosphate, ↑ excretion and ↓ levels and may result in ↓ effectiveness.
May ↓ effectiveness of adrenergic blockers.
↑risk of adverse cardiovascular reactions with tricyclic antidepressants.
May ↓ sedating effects of antihistamines.
May ↓ effectiveness of antihypertensives.
Effects may be ↓ by haloperidol, lithium, or chlorpromazine.
May ↓ absorption of phenobarbital or phenytoin.

Availability ⬆ ⬇

(Generic available)

Capsules: 10 mg; 20 mg; 30 mg; 40 mg; 50 mg; 60 mg; 70 mg
Chewable tablets: 10 mg; 20 mg; 30 mg; 40 mg; 50 mg; 60 mg
Oral solution (Arynta): 10 mg/mL

Route/Dosage ⬆ ⬇

Attention-Deficit Hyperactivity Disorder

PO (Adults and Children ≥6 yr): 30 mg once daily; may ↑ by 10–20 mg/day at weekly intervals, up to 70 mg/day.

Renal Impairment

PO (Adults and Children ≥6 yr): CCr 15–29 mL/min: Do not exceed 50 mg/day; CCr <15 mL/min: Do not exceed 30 mg/day.

Binge Eating Disorder

PO (Adults ): 30 mg once daily; may ↑ by 20 mg/day at weekly intervals, up to target dose of 50–70 mg/day.

US Brand Names ⬆ ⬇

Action ⬆ ⬇

Blocks reuptake and increases release of norepinephrine and dopamine resulting in increased levels in extraneuronal space.

Therapeutic effects:

Improved attention span in ADHD.
Reduction in number of binge eating days per wk.

Classifications ⬆ ⬇

Therapeutic Classification: central nervous system stimulants

Pharmacologic Classification: sympathomimetics

Pharmacokinetics ⬆ ⬇

Absorption: Rapidly absorbed and converted to dextroamphetamine, the active drug.

Distribution: Unknown.

Metabolism/Excretion: 42% excreted in urine as amphetamine.

Half-Life: <1 hr.

Contr. Subst. Schedule ⬆ ⬇

Time/Action Profile ⬆ ⬇

ROUTE	ONSET	PEAK	DURATION
PO	rapid	1 hr	24 hr

Patient/Family Teaching ⬆ ⬇

Instruct patient to take medication as directed. Advise patient and caregivers to read Patient Information before therapy and with each renewal of Rx refill. If more than prescribed amount is taken, notify health care provider immediately. Instruct patient not to alter dose without consulting health care provider. Emphasize the importance of routine follow-up exams to monitor progress.
- Advise patient to notify health care provider of all Rx or OTC medications, vitamins, or herbal products being taken and to consult health care provider before taking other medications.
- Advise caregivers to notify school nurse of medication regimen.
- Advise patient that lisdexamfetamine is a drug with known potential for abuse, misuse, or addiction. Store in safe place, protect it from theft, and never give to anyone other than the individual for whom it was prescribed.
- Advise patient to store in a safe place, preferably locked, and not to share this medication with anyone.
- Advise patient to check weight 2–3 times weekly and report weight loss to health care provider. If ↓ appetite and weight loss are a problem, advise parents to provide high-calorie meals when drug levels are low (at breakfast and or bedtime).
- Inform patients starting therapy of risk of peripheral vasculopathy. Instruct patients to notify health care provider of any new numbness; pain; skin color change, from pale to blue to red; or coolness or sensitivity to temperature in fingers or toes, and call if unexplained wounds appear on fingers or toes. May require rheumatology consultation.
- Advise caregivers to notify health care provider immediately if child has signs of heart problems (chest pain, shortness of breath, fainting) or if new or worsening mental symptoms or problems, especially seeing or hearing things that are not real or believing things that are not real or are suspicious, occur.
- May cause dizziness or blurred vision. Caution patient to avoid driving or activities requiring alertness until response to medication is known.
- Advise patient to notify health care provider if nervousness, restlessness, insomnia, dizziness, anorexia, or dry mouth becomes severe.
- Inform patient that health care provider may order periodic holidays from the drug to assess progress and to ↓ dependence.
- May cause fetal harm. Advise women of reproductive potential to notify health care provider if pregnancy is planned or suspected and to avoid breastfeeding. May cause premature delivery. Monitor infants born to mothers taking lisdexamfetamine for symptoms of withdrawal (feeding difficulties, irritability, agitation, excessive drowsiness). Inform pregnant patient of registry that monitors outcomes in women exposed to ADHD medications during pregnancy. Register patient by calling the National Pregnancy Registry for Psychostimulants at 1-866-961-2388 or visiting https://womensmentalhealth.org/clinical-and-researchprograms/pregnancyregistry/adhdmedications/.

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Indications ⬇

Contraind./Precautions ⬆ ⬇