Vyvanse – The New Medicine for ADD/ADHD
ByWhat 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.
vyvanse
Darrius – the medicines are just different. There’s no way to say that vyvanse is stronger than concerta or vice versa. It would depend on how they work for you.
I’ve been taking Concerta 36mg for a couple of years, but was recently switched to Vyvanse 30mg due to insurance change and a $75 co-pay for Concerta (vs. $35 for Vyvanse)… It’s been a little over a week now since I started taking it, and I’m feeling extremely fatigued and not focused at all. I also take 60mg of Fluoxetine daily… Could there be a negative interaction between the 2 drugs? Can I stop taking the Vyvanse “cold-turkey”???
Hello -
I have been reading most of these comments tonight, and all the negative responses to medications of this type scare me. I am the mother of a child who was diagnosed as AD/HD at age 6. I first had my son going to regular behavioral therapy to try a non medicinal approach to his symptoms. We have a psychiatric practice in our town that specializes in all areas of behavioral problems found in children. They found that my son had borderline anxiety issues as well as attention problems and worked a plan with me to make changes in the way I raise my child as a way to over come these issues he was having. It wasn’t enough. He was still not concentrating in school or performing remedial tasks in a timely manner at home, as well as not following basic instructions given to him by his teachers and by us, his parents. I made the decision, with hesitation, to medicate. We first tried Adderal, at 3 different dosages, with no luck. He would be ok for the first couple of hours at school, but then the teacher noticed a drop in attention by lunch time, and by the time it was time to do homework, forget it. He was as lost as he was without the help of medication. He was also having a hard time eating and sleeping on Adderal. So the doctor prescribed an anti-depressant, that when taken in its lowest dose, gave him the “negative” side effects of increased appetite and drowsiness. This helped with the negative side effects of the stimulant. After failed success with Adderal, he was put on Vyvanse, and it works great! The only thing I notice now is that his moods are getting more violent, and he cries in the middle of the night in his sleep. I just have to come up with creative ways to channel that emotion into something positive. He is mostly upset when his sister, who is 2 yrs younger, “bothers” him. I notice he likes seclusion. I’m not bothered by this because I was a child who liked to play alone most of the time myself, so I understand. He used to be such a sweet child, and he still is at school, just not at home. He was awarded the Character of the Month award at school last year for compassion because of his efforts towards trying to include all classmates and help others. So it is 50/50 with the Vyvanse. None of the issues we had in 1st grade did I see in 2nd grade, with the exception that towards the end of the school year, he had a little decline in attention, and we had to up his dose to the next dosage level. He is going into 3rd grade now, and I am confident that this medication is going to help him through the year again.
Not every medication is made for every person, or is right at every age. This I am experiencing myself with treating depression. I was diagnosed when I was 16 and the medication I took then worked great, but as an adult, it did not work as well as I had hoped for. This I hear is true with children who have AD/HD. Sometimes a child can outgrow a certain medication when they reach puberty, and again when they reach adulthood. Best advice I can give is to just keep an open dialog with your pediatrician and your child, and keep record of all the side effects or mood changes the child experiences. There has to be something that works for everyone, only trial and error will let you know for sure. Don’t give up!
My 9 yr old son’s second day on Vyvanse 30mg. He was recently on the Daytrana patch and Ritalin LA and he showed no response good or bad on the medications. I hope this will be the last time I have to change my son’s medicaton. So far so good with no side effects, but it’s going to be kind of hard for me to see a difference since he has the non-hyperactive ADD and it’s summertime vacation for the kids. I really hope he doesn’t get all of the mood swings I’ve read from everyone’s comment because I was really happy to read about it being a “pro drug”.
Just over 2 weeks ago, I was diagnosed with ADD/ADHD. I am 35 & have struggled w/it all my life, but have never sought help. My Dr. put me on 30 mg Vyvanse right away. The 1st 3 days were terrible-burning up the back of my neck, a super “high” feeling, etc., etc., etc. That 3rd night I slept 40 minutes all night long, & then spent hours scrubbing my entire house clean. I had lots of energy, a very “serious” outlook, & was very motivated to get stuff done everywhere I went. By the end of the 1st week, I started sleeping better at night, but required way less sleep. Then the 2nd week came- VERY tired, lethargic all day long….NO MOTIVATION to do anything. High feeling all day long. And, get this: STILL super ADD-easily distracted, forgetting things, etc. Consult w/Doc, & he ups my dosage to 40 mg. The side effects yesterday & today have been CRAZY. BAD nausea, spinning head, stiff/sore/burning neck, heaviness in chest. Are my side effects going to get WORSE with a higher dosage? Have I given the meds enough change to WORK, before giving up? I have not refilled my script yet, but do have a call in to my doctor, who I hope calls back by the end of the day, as he leaves on a long vacation tomorrow. I just don’t know what to do. I feel very sick. My body does not feel okay at all, & I can’t function this way. However, I was really excited to finally get some help for my crazy brain!! Ohhh, also, the biggest/worst side effect is my loss of joy. I am a happy, fun, joyful person usually. This drug has made me irritable, intolerant, & just plain ANGRY at the world. For no reason at all. It’s scary. Should I request Strattera, which my doctor had initially offered me? Did I choose the wrong drug? UGH. Any advice is MUCH appreciated!! Thank you!!
May not apply; but I went to a new Doc and now i’m not ADD, i’m Bipolar! Tho I did enjoy the Vyvanse, the Lamictal/Abilify seem to be working nicely. And with no high feeling, just feel alive and getting more done.
But you need serious good insurance for the Abilify!!!!! I HAVE good ins. and the RX for one dose one week, different for the next 3 weeks— was $250 out of my pocket! The full price AT WALMART was $1104 OMG!!!!! It is way too expensive to have a problem!!!
Good luck! I’ve been trying to get the Right help for about 17 years…
Dr. Kenny Handelman,
I am a 32 year old, stay at home mother of a one year boy. I have been so exhausted since my son was born and having a few other hormonal issues. I went to the Dr 2 days ago to talk about my problems and with my blood and other test all coming back showing that I am very health, my Dr (whom I just started going to) suggested Vyvanse. She put me on 50mg daily. Today was my first day taking the medication and it really freaked me out. I had tons of energy (which is great), but I felt weird all day. I have had a hard time focusing on anything (even typing the message has been hard). I realize that this is a drug, but I never expected to feel like I was on drugs all day. I was nervous to drive my son around and kind of felt guilty like I was a bad mother for taking drugs.
So my question is did this Dr give me something that is normally given for reasons like mine, is my dose to high or is this just the first few days effects?? Also if I take this drug for a few months and decide to stop taking it can I do that cold turkey or do I need to wean myself off? If so how?
I am so confused,
Andrea
Andrea – if you have a reaction to your medicine – you should really call your doctor and check with him or her about what to do.
I am 69 years old, have been on ADD med for about 12- 15 years. I was initially on Adderal, then Concerta, was recently switched to Vyvanse. With the short-term memory problems associated with ADD, I would do well in the mornings on Adderall, then forget to take the second dose! Concerta worked well for me, but over time the effectivness would decrease, indicating an increased doseage needed – which I did not want to do. I would instead pick a day I knew focus was not a big issue, skip a dose, and could resume the Concerta again. Knowing my concern about the potential for addiction and reluctance to increase doseage, my doctor suggested that I switch to Vyvanse. I do appreciate increased focus and better memory recall, but would warn that even medication will not help if I am not getting sufficient sleep.
I have found Dr. Amen’s book on Healing ADD to be one of the more helpful resources on better understanding ADD and the impact it has on both work and family issues. I would encourage anyone having difficulties with their medication to not give up. It may take another doctor and/or medications to find the one that works for you, but when you can find the right one, it is well worth it. Even as an oldster, I still want the better quality of life afforded by these medications.