Lisdexamfetamine mesilate

How it works

After absorption it is metabolised to active dexamfetamine, which increases synaptic dopamine and noradrenaline by promoting release and blocking reuptake, improving attention and reducing impulsivity.

Prescribing in practice

• As a stimulant it can raise heart rate and blood pressure and is contraindicated in significant cardiovascular disease, so assess cardiovascular history and check blood pressure, heart rate and growth before and during treatment.
• It is a controlled drug with potential for dependence and misuse and should not be used where there is a history of stimulant or substance misuse without specialist judgement.
• Monitor for psychiatric effects such as new or worsening anxiety, agitation, tics or psychotic symptoms, and for appetite suppression and growth retardation in children.

Monitoring

Monitor heart rate, blood pressure, weight, height and appetite, mental state and for signs of dependence throughout treatment.

Counselling the patient

• Take in the morning to avoid disturbed sleep.
• Report chest pain, palpitations, fainting or new mood or behavioural changes.
• Reduced appetite is common; keep regular meals and attend growth and monitoring checks.

Evidence & guidelines

NICE ADHD guidance includes lisdexamfetamine among recommended stimulant options, with structured cardiovascular and growth monitoring.