Safe Combination of Vyvanse and Dexedrine

Introduction to Safe Dosage

The American Academy of Child and Adolescent Psychiatry establishes a maximum daily dose of 50mg for Adderall (mixed amphetamine salts), with some guidelines supporting up to 50-70mg total daily amphetamine dose for adults requiring extended coverage 1, 2
A proposed regimen of Vyvanse 50mg plus Dexedrine 5mg at 7:00am, followed by Dexedrine 5mg at 2:00pm, totals 60mg of dextroamphetamine equivalent daily, which remains within established maximum dosing limits 1, 2

The 2:00pm Dexedrine dose follows established guidelines that recommend giving the second stimulant dose preferably no later than 2:00pm to minimize insomnia risk 2, 3, 4
The National Comprehensive Cancer Network specifically recommends that methylphenidate or dextroamphetamine's second dose should be given at lunch, preferably no later than 2:00pm 3, 4

Check blood pressure and pulse quarterly, as small mean increases are expected with amphetamine therapy 2
Monitor weight at every visit to detect appetite suppression, which occurs in 25-39% of patients 2
Assess target ADHD symptoms using standardized rating scales at each visit 2

Do not administer the afternoon Dexedrine dose later than 2:00pm, as this increases insomnia risk 2, 3, 4
Avoid escalating beyond maximum recommended total daily doses if tolerance develops; instead consider medication holidays or switching agents 2
Do not crush or open Vyvanse capsules to attempt faster onset, as this destroys the prodrug mechanism and can cause dangerous immediate release 1

Active substance use disorder represents a relative contraindication to this combination 2
Cardiovascular risk factors such as hypertension or structural cardiac abnormalities require careful evaluation before initiating 2
Prohibitive side effects at lower doses should prompt consideration of alternative treatments rather than this combination 2