Guideline Summary: Tapering Lisdexamfetamine (Vyvanse) in Older Adults

Dose‑Reduction Strategy

Reduce the daily dose by approximately 25 % of the current amount every 1–2 weeks, using a hyperbolic taper to maintain more stable receptor occupancy and minimize withdrawal effects. [@1]
Extend the taper to a minimum of 2–4 weeks; slower tapers over several months may be better tolerated in geriatric patients. [@1]

Withdrawal symptoms to watch for include fatigue, low mood, increased appetite, and sleep disturbances; these typically appear within days of dose reduction and resolve within 1–3 weeks. [@4]
Cardiovascular monitoring (blood pressure and heart rate) is essential because older adults are at heightened risk for hypertension and tachycardia during stimulant discontinuation. [@5]

Apply lower starting doses and slower titration for all psychoactive medications in geriatric patients, reflecting age‑related pharmacokinetic and pharmacodynamic changes. [@3]
Recognize an increased risk of cardiovascular effects (e.g., hypertension, tachycardia) when tapering stimulants in this population. [@5]
Older adults have a higher susceptibility to cognitive impairment, falls, polypharmacy, and drug‑drug interactions, necessitating vigilant assessment throughout the taper. [@1]

Withdrawal generally resolves within 1–3 weeks, whereas return of ADHD symptoms may develop more gradually and persist. If worsening occurs, slow the taper rather than reinstating the full dose immediately. [@4]

When perceived benefits no longer outweigh risks (e.g., emerging cardiovascular concerns, significant weight loss, insomnia). [@1]
Patient preference after a thorough, informed discussion of risks and benefits. [@2]
Achievement and maintenance of functional goals (e.g., stable work performance, daily activities). [@2]

Provide behavioral strategies such as cognitive‑behavioral therapy for ADHD symptom management, environmental and organizational modifications, sleep‑hygiene optimization, and regular exercise with structured routines. [@1]

Educate patients that complete discontinuation typically requires at least 4–8 weeks of gradual dose reduction. [@2]
Emphasize the importance of not stopping the medication abruptly and advise when to contact the provider (e.g., severe mood changes, functional decline). [@2]
Schedule follow‑up visits every 2–4 weeks during active tapering and at 1–2 months post‑discontinuation to assess for delayed symptom recurrence. (no citation needed as this was not directly cited).