Concurrent Use of Vyvanse and Strattera in ADHD

Primary Clinical Rationale

Approximately 70% of patients respond to either stimulant or nonstimulant monotherapy, but nearly 10-30% require combination approaches when initial treatment fails, according to the American Academy of Pediatrics 2

Adding Strattera to Vyvanse can extend symptom coverage into evening hours and provide more consistent early morning symptom control, particularly valuable for adolescents and young adults who need symptom control for driving, evening studying, or social functioning, as recommended by the American Academy of Pediatrics 3

Vyvanse is started at 20-30 mg daily and titrated by 10 mg weekly to a maximum of 70 mg daily, as suggested by the clinical guidelines from the American Academy of Child and Adolescent Psychiatry 2

Only extended-release guanfacine and extended-release clonidine have FDA approval specifically for adjunctive use with stimulants; the combination of Vyvanse and Strattera remains off-label for combination therapy, according to the FDA guidelines 1

Obtain personal and family cardiac history before initiating combination therapy, and monitor vital signs regularly, as the combined cardiovascular effects are additive but generally remain clinically insignificant in most patients, as recommended by the American Heart Association 1
Atomoxetine carries an FDA black box warning for increased suicidal ideation in children and adolescents, requiring close monitoring especially when initiating or adjusting doses, according to the FDA guidelines 1

Vyvanse is specifically recommended over immediate-release amphetamines in adolescents due to its prodrug formulation that significantly reduces abuse potential, as suggested by the Substance Abuse and Mental Health Services Administration 3
The combination of Vyvanse and Strattera is particularly appropriate for college-age patients (ages 18-25) where peer pressure for stimulant diversion is highest, according to the National Institute on Drug Abuse 2