Lisdexamfetamine Dosing and Monitoring for ADHD

Initial Dosing and Titration

Administer the medication in the early morning to provide coverage throughout the school day, according to the American Academy of Pediatrics guidelines 1
Increase the dose by 10 mg increments at approximately weekly intervals until optimal symptom control is achieved, as recommended by the American Academy of Pediatrics 1

Use standardized ADHD rating scales (such as ADHD-RS-IV) from both parents and teachers before each dose increase to objectively assess response, as suggested by the American Academy of Child and Adolescent Psychiatry 2
Assess blood pressure, pulse, height, and weight at each visit, as stimulants can affect growth and cardiovascular parameters, according to the American Academy of Child and Adolescent Psychiatry 2
Rating scales should be obtained through phone contact between visits if needed to guide titration decisions, as recommended by the American Academy of Child and Adolescent Psychiatry 2

Some clinicians use a "forced titration" approach where the child receives all dose levels (30 mg, 50 mg, 70 mg) for one week each, with rating scales collected at each dose, as described by the Journal of the American Academy of Child and Adolescent Psychiatry 2

The prodrug formulation of lisdexamfetamine (converted to dextroamphetamine after ingestion) provides lower abuse potential compared to other amphetamines, which becomes increasingly relevant as children approach adolescence, according to the American Academy of Pediatrics 3

Titration of chewable lisdexamfetamine should continue until optimal symptom control is achieved without adverse effects, with dosage adjustments in increments of 10 mg or 20 mg at approximately weekly intervals 4

Regular assessment of height, weight, pulse, and blood pressure is necessary during treatment with chewable lisdexamfetamine, according to the American Academy of Child and Adolescent Psychiatry 4
The American Academy of Child and Adolescent Psychiatry recommends using standardized ADHD rating scales to evaluate treatment response with chewable lisdexamfetamine 5

The American College of Obstetricians and Gynecologists recommends alternative starting approaches, including 20-30 mg, though the standard starting dose is 30 mg 6