Lisdexamfetamine

What is Lisdexamfetamine?

Lisdexamfetamine is a central nervous system stimulant medication that belongs to the amphetamine class of drugs. It is a prodrug, meaning it becomes active only after being metabolized in the body into dextroamphetamine. This medication is primarily prescribed to treat attention deficit hyperactivity disorder (ADHD) in children, adolescents, and adults, as well as moderate to severe binge eating disorder in adults.

Uses

Attention Deficit Hyperactivity Disorder (ADHD): The primary indication for lisdexamfetamine is treating ADHD symptoms including inattention, hyperactivity, and impulsivity in patients aged 6 years and older.

Binge Eating Disorder: Approved for treating moderate to severe binge eating disorder in adults, helping to reduce the frequency of binge eating episodes.

Narcolepsy (off-label): Sometimes prescribed off-label to help manage excessive daytime sleepiness associated with narcolepsy, though this is not an FDA-approved indication.

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Treatment-resistant depression (off-label): Occasionally used as an adjunctive treatment for depression that hasn’t responded to other medications, though this requires careful monitoring.

How it works

Lisdexamfetamine works by increasing the levels of certain neurotransmitters in the brain, particularly dopamine and norepinephrine. After oral administration, it is converted to dextroamphetamine, which blocks the reuptake of these neurotransmitters and promotes their release from nerve terminals. This enhanced neurotransmitter activity in areas of the brain responsible for attention, focus, and impulse control helps improve ADHD symptoms and reduces binge eating behaviors.

Side effects

Common side effects:

• Decreased appetite and weight loss
• Difficulty sleeping or insomnia
• Dry mouth
• Increased heart rate
• Headache
• Nervousness or anxiety
• Nausea and stomach upset
• Dizziness

Serious side effects to watch for:

• Chest pain or irregular heartbeat
• Severe mood changes, including aggression or suicidal thoughts
• Signs of psychosis such as hallucinations or paranoia
• Severe allergic reactions with rash, swelling, or difficulty breathing
• Circulation problems in fingers and toes

Warnings and precautions

Cardiovascular risks: Patients with heart problems, high blood pressure, or a family history of sudden cardiac death should be carefully evaluated before starting treatment, as stimulants can increase heart rate and blood pressure.

Mental health monitoring: The medication can worsen symptoms of anxiety, agitation, or bipolar disorder, and may trigger new or worsening psychotic symptoms in susceptible individuals.

Pregnancy and breastfeeding: Lisdexamfetamine may cause harm to an unborn baby and can pass into breast milk, so the risks and benefits must be carefully weighed during pregnancy and lactation.

Substance abuse potential: As a controlled substance with abuse potential, it should be used with caution in patients with a history of drug or alcohol abuse.

Growth suppression: In children, the medication may slow growth and weight gain, requiring regular monitoring of height and weight during treatment.

Interactions

MAO inhibitors: Dangerous interactions can occur with monoamine oxidase inhibitors, potentially causing severe hypertension and should be avoided within 14 days of each other.

Antacids and acid reducers: Medications that increase stomach pH can increase amphetamine absorption, potentially leading to increased side effects.

Tricyclic antidepressants: May enhance the effects of both medications and increase the risk of cardiovascular side effects.

Blood pressure medications: Stimulants can counteract the effects of antihypertensive drugs and may require dose adjustments.

Seizure medications: Some anticonvulsants may have altered effectiveness when combined with lisdexamfetamine.

Proton pump inhibitors: Can increase the absorption of the medication, potentially intensifying effects and side effects.

Lithium: May reduce the stimulant effects and could potentially increase the risk of lithium toxicity.

St. John’s Wort: This herbal supplement may reduce the effectiveness of lisdexamfetamine through enzyme induction.

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Dosage

For ADHD in adults, the typical starting dose is 30 mg once daily in the morning, which may be increased by 10-20 mg weekly intervals up to a maximum of 70 mg daily. For binge eating disorder in adults, treatment usually begins at 30 mg daily and may be increased to 50-70 mg daily based on response. Pediatric dosing for ADHD typically starts at 20-30 mg daily and may be adjusted up to 70 mg daily. The medication should be taken in the morning to minimize sleep disturbances, and dosage adjustments should always be made under medical supervision based on individual response and tolerability.

Sources: FDA DailyMed drug labels (public domain), BNF, WHO Essential Medicines List. This article is for informational purposes only and does not constitute medical advice. Always consult your healthcare provider before starting or stopping any medication.

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