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CNS Stimulant (Prodrug) — Schedule 2 Controlled Drug (ADHD / Binge Eating Disorder) Pregnancy: Avoid — amphetamines associated with premature delivery, low birth weight, neonatal withdrawal. Discuss risk-benefit with specialist.

Lisdexamfetamine

Brand names: Vyvanse, Elvanse

Adult dose

Dose: ADHD: 20–30mg OD initially; increase by 10–20mg weekly; usual maintenance 30–70mg OD. Binge eating disorder (BED): 20mg OD initially; increase by 20mg weekly to 50–70mg OD.
Route: Oral (capsule — can be opened and dissolved in water)
Frequency: Once daily in the morning
Max: 70mg OD
Schedule 2 Controlled Drug — written CD prescription required; maximum 30-day supply. Prodrug: lysine–dexamphetamine conjugate; cleaved by peptidases in red blood cells to release active d-amphetamine. Abuse-deterrent design — cannot be injected or snorted to achieve a faster high as cleavage requires red blood cell enzymes. Once-daily dosing (long-acting, smooth onset) — good adherence. Licensed for ADHD in children ≥6 years and adults, and for BED in adults.

Paediatric dose

Route: Oral
Frequency: Once daily in morning
Max: 70mg OD
BNFc / NICE NG87: Children ≥6 years: 20–30mg OD initially; increase by 10–20mg weekly to maximum 70mg OD. Specialist ADHD assessment required. Not for under-6 years.

Dose adjustments

Renal

eGFR 15–30: maximum 50mg OD. eGFR <15 / dialysis: maximum 30mg OD.

Hepatic

No specific adjustment — prodrug cleavage occurs in red blood cells; hepatic metabolism of active d-amphetamine is not the primary limiting step.

Clinical pearls

  • Abuse-deterrent prodrug design: lisdexamfetamine requires enzymatic cleavage in red blood cells to become active d-amphetamine — this process cannot be accelerated by crushing, snorting, or injecting; reduces but does not eliminate abuse potential vs. immediate-release amphetamines
  • NICE NG87: lisdexamfetamine is an alternative to methylphenidate for ADHD — consider when methylphenidate ineffective or not tolerated after adequate trial
  • BED indication: lisdexamfetamine (Vyvanse) is the first FDA/EMA-approved pharmacotherapy for moderate-to-severe binge eating disorder in adults — reduces binge episodes and obsessive thoughts about food
  • Once-daily dosing advantage: no midday school dose needed; smoother blood levels than immediate-release formulations; less rebound effect at end of day

Contraindications

  • Symptomatic cardiovascular disease or structural cardiac defects
  • Severe hypertension
  • Hyperthyroidism
  • Phaeochromocytoma
  • Current or past psychosis or mania
  • MAOIs within 14 days
  • Hypersensitivity to lisdexamfetamine or amphetamines

Side effects

  • Decreased appetite and weight loss (very common)
  • Insomnia
  • Dry mouth
  • Tachycardia, hypertension
  • Headache, irritability
  • Growth restriction (children)
  • Psychosis (rare — high doses)
  • Tics (may worsen)
  • Dependence potential (Schedule 2)

Interactions

  • MAOIs — contraindicated (hypertensive crisis)
  • Alkalinising agents (antacids, sodium bicarbonate) — increase amphetamine absorption; avoid
  • Urinary acidifying agents (ascorbic acid) — increase renal amphetamine excretion; reduce levels
  • Antihypertensives — stimulant-induced BP rise may antagonise effect
  • TCAs — additive cardiovascular effects

Monitoring

  • Blood pressure and heart rate (baseline; every 3–6 months)
  • Height and weight (6 monthly in children)
  • Sleep quality
  • Appetite and nutrition
  • Mood and psychosis screening
  • ADHD symptom rating

Reference: BNFc; BNF 90; NICE NG87 (ADHD); NICE NG123 (BED); Elvanse SPC. Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

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