Initiating Vyvanse Treatment for ADHD

Initial Dosing and Titration

The American Academy of Pediatrics recommends starting Vyvanse at 30 mg once daily in the morning for newly diagnosed ADHD patients, regardless of age, with a therapeutic dose range of 30-70 mg daily 1, 2
Increase the dose by 10 mg or 20 mg increments at approximately weekly intervals based on clinical response and tolerability 1
The typical titration period requires 2-4 weeks to reach optimal dosing 1
Most patients achieve optimal response at 50-70 mg daily 1

Obtain baseline blood pressure, pulse, height, and weight in the context of a physical examination before starting treatment 1
Screen adolescents specifically for substance abuse symptoms before initiating treatment 3
Collect ADHD rating scales from teachers and parents (for children) or from the patient and significant others (for adults) before each dose increase 1, 2
Systematically assess for specific side effects at each contact: insomnia, decreased appetite, headaches, and weight loss 1
Monitor blood pressure and pulse at each dose adjustment 1
Use standardized ADHD rating scales (such as ADHD-RS-IV) to objectively track response 2

Lisdexamfetamine has lower abuse potential compared to other amphetamines due to its prodrug formulation, making it particularly appropriate for adolescents at risk for diversion 3, 2
Monitor prescription refill requests for signs of misuse or diversion in adolescents 3

Starting at too high a dose leads to unnecessary side effects and decreased medication adherence 1, 4
Failing to systematically assess both benefits and side effects during titration 1, 4
Continuing to escalate dose when symptom control plateaus—switch medications or add non-stimulant options instead 4, 2