Vyvanse – The New Medicine for ADD/ADHDBy
What is Vyvanse?
[Article Updated May 2010]
Vyvanse is a new ADD/ADHD drug manufactured by Shire that was approved by the FDA in February 2007 to treat ADD/ADHD symptoms in children aged 6 through 12. It is a prodrug, which means that it must be orally ingested to activate its main ingredient, lisdexamfetamine dimesylate. So the actual medication is inert – i.e. it doesn’t do anything – until an enzyme in the body converts the medicine into the active drug. Because Vyvanse is a stimulant which is not a functioning stimulant (until it is converted by an enzyme in the body), it has a much lower abuse potential than other ADHD stimulant medicines.
When Vyvanse enters the stomach and small bowel, there are enzymes which will break the medicine up. Vyvanse will become: lysine (an amino acid that has no impact on ADHD), as well as dextroamphetamine. Dextroamephetamine is a medical amphetamine (different than the ‘street drugs’) which is very helpful for ADHD. It has been used for treatment of ADHD for decades, and has been available under different names like: Dexedrine and Dextrostat. Once the active medicine is broken from the amino acid lysine, it can now begin to function to help ADHD.
Thus, if someone tries to abuse Vyvanse by snorting it, or even trying to inject it – they will not get a high because it will not be an active medicine until an enzyme in the body works on it and ‘activates’ it.
Although it is generally thought that the medicine is mainly broken down or ‘activated’ in the stomach/small bowel, it may also be ‘activated’ in the blood as well.
In clinical studies, parents reported that their children’s ADD/ADHD symptoms were consistently controlled throughout the day, even through homework time from 4 P.M. to 6 P.M. Newer research is showing that Vyvanse can work for 13 hours and maybe even longer. Additionally, children taking Vyvanse in the study were able to focus and perform better on tests; in a timed math test, a group taking Vyvanse attempted 51% more math problems than the group given placebo, and provided correct answers 54% more often than the placebo group.
An overall improvement was recorded in 95% of children that took Vyvanse for 12 months.
What are the characteristics of Vyvanse?
Vyvanse is in the same medication family as Adderall; its active ingredient is lisdexamfetamine dimesylate. It provides consistent ADD/ADHD symptom control for 13 hours. Vyvanse is a capsule that can be swallowed whole or the capsule can be opened and mixed with water (for kids who can’t swallow).
Vyvanse is taken once daily and is available in six dosage strengths (when it was first launched in the US, it was only available in three strengths, but there are more options now):
- 20 mg
- 30 mg
- 40 mg
- 50 mg
- 60 mg
- 70 mg
These different strengths give you and your doctor some flexibility in determining which dosage is right for you, your teen or your child. The recommended starting dose for Vyvanse is 30 mg once per day taken orally in the morning. The dosage may then be increased by up to 20 mg per day at weekly intervals, up to a maximum of 70 mg per day.
Who is Vyvanse approved for?
Currently, Vyvanse is approved for children aged 6 to 12 years, as well as adults aged 18-65 years old.
While there is not yet official approval for Vyvanse in Adolescent ADHD, many doctors are using this medicine for teens, and presumably the official indication will be coming soon.
What are the side effects of Vyvanse?
Vyvanse was very well tolerated in clinical studies with children. The most common side effects were decreased appetite, difficulty falling asleep, irritability, and stomachache. Generally, the side effects were described as mild to moderate; occurrence and severity of side effects decreased over time. As with any prescription medication, it is important to remember that your doctor has prescribed it because he/she feels that the benefits will outweigh the possibility of side effects.
How much does Vyvanse cost?
Vyvanse will cost the same as Shire’s other popular ADD/ADHD drug, Adderall XR: around $3.40 a day. The cost may even be less than Adderall XR because it is estimated that patients who switch from Adderall XR to Vyvanse might need fewer doses.
Ritalin remains the cheapest ADD/ADHD drug; Vyvanse costs considerably more than Ritalin and Ritalin SR. The cost is comparable to the 36mg and 54 mg doses of Concerta, which is around $140 per month.
When can Vyvanse be used?
Vyvanse should be taken once daily in the morning. It provides consistent ADHD symptom control throughout the day for up to 13 hours. In clinical studies, parents reported that their children’s ADD/ADHD symptoms were controlled at approximately 10 A.M., 2 P.M., and 6 P.M., and demonstrated consistent symptom control throughout the day.
Vyvanse is a once-a-day capsule that should be taken in the morning, either with or without food as prescribed by your child’s doctor. If your child is unable or unwilling to swallow pills, Vyvanse capsules may be opened and the entire contents of the pill can be dissolved in water. The entire portion must be finished and should not be stored for later use.
New research is demonstrating that Vyvanse’s absorption and effectiveness is completely unaffected by stomach factors. So – whether Vyvanse is taken with or without food, whether someone is taking antacid medicines, or has a GI disorder (like Celiac’s for example) – it will NOT have an impact on the effectiveness and delivery of vyvanse in the body. This is different than the other medicines for ADHD – like Adderall XR and Concerta, for example.
Can Vyvanse be abused?
The abuse potential of Vyvanse is extremely low; the medication is designed to have a reduced or minimal abuse potential. Since Vyvanse requires oral ingestion to be converted to the active drug, the capsule contents are highly unlikely to be sought out for inhalation or injection.
How does Vyvanse compare to Ritalin, Ritalin SR, and Concerta?
Vyvanse is a new class of ADD/ADHD medication. It is the only medicine which is a pro-drug for ADHD.
Unlike Ritalin, Vyvanse is not an immediate release stimulant. Vyvanse has much lower abuse and addiction potential. Ritalin SR and Concerta are long-acting formulations like Vyvanse, but Vyvanse has been shown to provide more consistent symptom control over a longer period of time than Ritalin SR and Concerta.
Ritalin, or methylphenidate, must be taken two or three times a day for symptom control, whereas Vyvanse is only taken once. The effectiveness of Ritalin is often inconsistent. It is inexpensive, but abuse and addiction potential is much higher with Ritalin than with Vyvanse.
Ritalin SR is a long-acting formulation of methylphenidate with inconsistent performance reviews. It doesn’t work for everyone and usually lasts up to 6 hours. However, like short acting Ritalin, Ritalin SR is inexpensive.
Of the three, Concerta is the most comparable ADD/ADHD medication to Vyvanse. They both control symptoms for up to 12 hours and are generally well-tolerated. Concerta is not a prodrug, so the abuse potential is theoretically higher than it is for Vyvanse.
Where is Vyvanse Available?
At the time of this article update (May 2010), Vyvanse is only available in the USA and Canada. It is not yet available in other parts of the world. Please check back, as I will update this article when Vyvanse will be available in other countries such as: the UK, Australia, Europe, etc.
New Data On Duration of Action of Vyvanse in Adults with ADD/ADHD:
New research has shown that Vyvanse works in adults with ADD/ADHD for up to 14 hours. This is a real benefit for Vyvanse, as adults have many responsibilities throughout the day and into the evening. This suggests that many people can avoid taking a short acting stimulant in the early evening (i.e. Taking Adderall XR in the morning, and short acting Adderall in the late afternoon to make the medicine last), by just taking Vyvanse which will last long enough to cover the symptoms throughout the day and the early evening.
The Bottom Line About Vyvanse
Treatment and management of ADD/ADHD requires many components; this article focuses only medication. Vyvanse is a breakthrough ADD/ADHD drug and many doctors and parents will seriously consider switching from their current ADD/ADHD medication for the benefits Vyvanse offers: low abuse and addiction potential, one daily dose, and symptom control for up to 13 hours. For more information on the other treatments of ADD/ADHD: 1) sign up for my ADD/ADHD newsletter at www.TheADHDDoctor.com, and 2) peruse this blog for more articles about ADD/ADHD.