Lisdexamfetamine
Long-acting CNS stimulant for the treatment of ADHD in children, adolescents and adults
Quick facts about Lisdexamfetamine
Key things to know about Lisdexamfetamine
- Prodrug with gradual onset: Lisdexamfetamine is converted to dextroamphetamine in the body, providing smooth, long-acting symptom control for up to 13 hours
- Second-line ADHD treatment: Typically prescribed when methylphenidate has not provided adequate symptom relief, for both children (aged 6+) and adults
- Cardiovascular monitoring required: Blood pressure and heart rate must be checked regularly before and during treatment due to stimulant effects on the heart
- Risk of dependence: As an amphetamine-based medication, lisdexamfetamine has abuse potential. Never share your medication or take more than prescribed
- Do not combine with MAO inhibitors: Taking lisdexamfetamine with MAOIs (or within 14 days of stopping them) can cause a dangerous spike in blood pressure
What Is Lisdexamfetamine and What Is It Used For?
Lisdexamfetamine is a long-acting central nervous system (CNS) stimulant prescribed for Attention Deficit Hyperactivity Disorder (ADHD). It works by increasing the activity of dopamine and norepinephrine in underactive brain regions, helping to improve attention, concentration and impulse control over a period of up to 13 hours.
Lisdexamfetamine, sold under brand names including Elvanse (in Europe) and Vyvanse (in North America), belongs to the amphetamine class of medications. Unlike traditional amphetamines, it is a prodrug, which means the body must convert it into its active form — dextroamphetamine — before it takes effect. This conversion happens gradually in the bloodstream through the action of enzymes in red blood cells, giving lisdexamfetamine a smoother onset and longer duration of action compared to immediate-release stimulants.
The medication is approved for use in two main patient populations:
- Children and adolescents aged 6 to 17 years who have ADHD and have previously been treated with methylphenidate (such as Ritalin or Concerta) without adequate improvement in symptoms.
- Adults who have had ADHD symptoms since childhood. For adults who have not been previously treated, a thorough assessment confirming childhood-onset ADHD is required before the medication can be prescribed.
Lisdexamfetamine is not recommended for children under 6 years of age, as the safety and benefits have not been established in this age group. It is also not used as a first-line treatment — healthcare providers typically try methylphenidate-based medications first.
How does lisdexamfetamine work?
Lisdexamfetamine improves the activity of certain neurotransmitters in the brain, particularly dopamine and norepinephrine. In people with ADHD, specific brain regions responsible for attention and impulse control are underactive. By increasing the levels of these neurotransmitters, the medication helps to:
- Improve sustained attention and concentration
- Reduce impulsive behaviour
- Decrease hyperactivity
- Enhance executive function and working memory
Because it is a prodrug, lisdexamfetamine is pharmacologically inactive until it is enzymatically cleaved in the blood. This gradual conversion results in a more consistent plasma concentration of the active drug, which translates to a smoother therapeutic effect throughout the day and a lower potential for abuse compared to immediate-release amphetamine formulations.
Part of a comprehensive treatment programme
Lisdexamfetamine is prescribed as part of a broader ADHD management plan that typically includes:
- Psychological treatment (cognitive behavioural therapy)
- Educational support and classroom accommodations
- Social skills training
- Behavioural therapy
- Occupational therapy where indicated
Medication alone is usually not sufficient for optimal management of ADHD. The combination of pharmacological and non-pharmacological approaches provides the best outcomes. It is prescribed only by physicians experienced in the treatment of ADHD and neurodevelopmental disorders.
ADHD (Attention Deficit Hyperactivity Disorder) is a neurodevelopmental condition characterised by persistent patterns of inattention, hyperactivity and impulsivity that interfere with daily functioning. It affects approximately 5–7% of children and 2–5% of adults worldwide. ADHD does not affect intelligence — rather, it affects the brain's ability to regulate attention and behaviour. It is recognised as a legitimate medical condition by the WHO, the American Psychiatric Association, and all major health organisations globally.
What Should You Know Before Taking Lisdexamfetamine?
Before starting lisdexamfetamine, your doctor must assess your cardiovascular health, mental health history, and current medications. The drug is contraindicated in patients with heart disease, hyperthyroidism, glaucoma, or recent MAOI use. Tell your doctor about any history of substance abuse, seizures, or psychiatric conditions.
Contraindications
You must not take lisdexamfetamine if any of the following apply to you:
- You are allergic to lisdexamfetamine, other amphetamine-based compounds, or any of the other ingredients in the capsule
- You are currently taking monoamine oxidase inhibitors (MAOIs) for depression, or have taken them within the past 14 days
- You have an overactive thyroid gland (hyperthyroidism)
- You feel unusually excited, overactive or uninhibited (a manic or agitated state)
- You have or have had heart problems such as heart attack, irregular heartbeat, chest pain, heart failure, or a congenital heart defect
- You have high or very high blood pressure or narrowing of the blood vessels
- You have raised pressure in the eye (glaucoma)
- You have a phaeochromocytoma (a rare tumour usually found in the adrenal glands)
Never take lisdexamfetamine if you are using or have recently used (within the last 14 days) an MAO inhibitor. The combination can cause a sudden, dangerous increase in blood pressure (hypertensive crisis). If you are unsure whether any of your current medications are MAOIs, ask your doctor or pharmacist before taking lisdexamfetamine.
Warnings and Precautions
Talk to your doctor or pharmacist before using lisdexamfetamine if you:
- Have ever misused or been dependent on prescription medicines, alcohol, or illegal drugs
- Have had kidney problems
- Have had seizures (epilepsy, convulsions) or abnormal EEG findings
- Have tics (uncontrolled, repetitive movements or sounds) or Tourette syndrome
- Have high blood pressure
- Have a history of irregular heart rhythm or a family history of cardiac arrhythmias
- Have any heart condition not listed in the contraindications section above
- Have experienced mental health problems including:
- Mood swings or bipolar disorder
- Aggressive or hostile behaviour
- Hallucinations (seeing, hearing or feeling things that are not real)
- Delusions (believing things that are not real)
- Paranoia or unusual suspiciousness
- Anxiety, agitation or tension
- Depression or feelings of guilt
Your doctor will perform several checks before starting treatment, including a review of your medical history, family history of sudden death or cardiac events, current medications, and mental health status. Blood pressure and heart rate measurements are taken before treatment begins and monitored regularly throughout.
If lisdexamfetamine is not used correctly, it can cause abnormal behaviour and the user may become dependent. Tell your doctor if you or your child has ever had a substance use disorder or dependence on alcohol, prescription medicines, or illegal drugs. Never give this medicine to anyone else, even if they have similar symptoms.
Effects on weight and growth
Lisdexamfetamine can cause weight loss in some patients and may also slow growth in children and adolescents. Your doctor will carefully monitor your weight, height (in children), and eating habits during treatment. If growth or weight gain is not progressing as expected, or if significant weight loss occurs, your doctor may consider pausing or stopping treatment.
Cardiac monitoring
Lisdexamfetamine can cause disturbances in heart rhythm in some patients. If you experience palpitations or an irregular heartbeat during treatment, inform your doctor immediately. The risk of cardiac effects may increase with higher doses, so it is important to always follow the recommended dosage.
Pregnancy and Breastfeeding
If you are pregnant, think you may be pregnant, or are planning to have a baby, seek medical advice before using this medicine.
Lisdexamfetamine is broken down in the body into substances that can cross the placenta and pass into breast milk. Available data from use during the first three months of pregnancy do not suggest an increased risk of congenital malformations, but may increase the risk of:
- Pre-eclampsia (a condition characterised by high blood pressure and protein in the urine, typically after the 20th week of pregnancy)
- Premature birth
- Neonatal withdrawal symptoms (tremors, irritability, muscle stiffness in the newborn)
You should not use this medicine during pregnancy unless your doctor has specifically prescribed it after weighing the benefits against the risks. You should not breastfeed while taking lisdexamfetamine.
Driving and operating machinery
You may experience dizziness, difficulty focusing, or blurred vision while taking lisdexamfetamine. If this happens, do not drive, cycle, ride, or operate machinery. You are responsible for assessing whether you are fit to perform tasks that require alertness. The effects of the medication should be considered when making this assessment.
How Does Lisdexamfetamine Interact with Other Drugs?
Lisdexamfetamine has several clinically significant drug interactions. Most critically, it must never be combined with MAO inhibitors due to the risk of hypertensive crisis. It also interacts with antipsychotics, blood pressure medications, anaesthetics, and substances that alter urinary pH. Always inform your doctor about all medications, supplements and over-the-counter products you take.
Drug interactions can reduce the effectiveness of lisdexamfetamine or increase the risk of adverse effects. Some interactions are potentially life-threatening. It is essential to inform your healthcare provider about every medication you take, including prescription drugs, over-the-counter medicines, herbal products, and dietary supplements.
Major Interactions
| Interacting Drug/Class | Effect | Action Required |
|---|---|---|
| MAO Inhibitors (e.g. phenelzine, tranylcypromine, selegiline) | Risk of sudden, severe hypertension (hypertensive crisis); potentially fatal | Absolute contraindication. Do not use together or within 14 days of stopping an MAOI. |
| Antipsychotic medications (e.g. haloperidol, risperidone, olanzapine) | May reduce the effectiveness of both medications; antipsychotics may block the stimulant effect | Consult your doctor. Dose adjustments may be needed. |
| Blood pressure medications (antihypertensives) | Lisdexamfetamine can increase blood pressure, counteracting the effect of antihypertensives | Regular blood pressure monitoring. Dose adjustments may be needed. |
| Anaesthetic agents | Risk of cardiac arrhythmias if halogenated anaesthetics are used with stimulant medications | Inform your anaesthetist. Treatment may need to be paused before surgery. |
Other Interactions
| Interacting Substance | Effect | Recommendation |
|---|---|---|
| Vitamin C (ascorbic acid) | Acidifies urine, increasing excretion of amphetamine and reducing drug effectiveness | Avoid large doses of vitamin C supplements while on treatment. |
| Sodium bicarbonate (antacids) | Alkalinises urine, reducing excretion and potentially increasing drug levels and side effects | Discuss antacid use with your doctor. |
| Cough and cold remedies (containing pseudoephedrine, phenylephrine) | Combined stimulant effects may raise blood pressure to dangerous levels | Always check with a pharmacist before buying any cough or cold medicine. |
| Serotonergic drugs (SSRIs, SNRIs, triptans) | Possible increased risk of serotonin syndrome when combined with amphetamines | Report any symptoms of agitation, fever, tremor, or muscle rigidity to your doctor. |
Lisdexamfetamine may cause a positive result on standard drug screening tests for amphetamines. If you need to take a drug test (e.g. for employment or sport), inform the testing authority that you are taking a prescribed amphetamine-based medication and provide documentation from your doctor.
What Is the Correct Dosage of Lisdexamfetamine?
The recommended starting dose is 30 mg once daily in the morning (or 20 mg in some cases). Your doctor may gradually increase the dose up to a maximum of 70 mg per day. Take it before breakfast, swallowed whole or with the capsule contents mixed into yoghurt, water, or orange juice. Never take more than one capsule per day.
Always take lisdexamfetamine exactly as your doctor has instructed. The dose is individualised based on your response and tolerability. Do not change your dose without medical advice.
Adults
Standard adult dosage
- Starting dose: 30 mg once daily in the morning (some patients may start at 20 mg)
- Dose adjustments: Your doctor may increase or decrease the dose in increments of 10–20 mg at weekly intervals
- Maximum dose: 70 mg per day
- Timing: Take in the morning, before or with breakfast. Avoid afternoon dosing as it may cause insomnia.
If you have kidney problems, your doctor may prescribe a lower dose. For elderly patients, blood pressure and cardiovascular status will be monitored before and during treatment, and a dose reduction may be appropriate.
Children and Adolescents (6–17 years)
Paediatric dosage
- Starting dose: 30 mg once daily in the morning (20 mg may be used as a starting dose)
- Dose adjustments: Increments of 10–20 mg at weekly intervals based on response
- Maximum dose: 70 mg per day
- Growth monitoring: Height, weight and appetite will be checked regularly
Lisdexamfetamine is not approved for children under 6 years. For children and adolescents, the doctor will carefully monitor growth and development throughout the treatment period. If growth is significantly affected, a temporary treatment break may be considered.
Elderly Patients
There is limited data on the use of lisdexamfetamine in elderly patients. If treatment is considered, your doctor will perform a thorough cardiovascular assessment before starting and will monitor blood pressure and heart rate closely throughout treatment. A lower starting dose may be appropriate.
How to take lisdexamfetamine
Take lisdexamfetamine once daily in the morning, with or without food. You have two options:
- Swallow the capsule whole with a glass of water
- Open the capsule and empty the contents into:
- Soft food such as yoghurt
- A glass of water or orange juice
Do not split the dose — always use the entire contents of one capsule. Do not take less than one capsule per day unless specifically instructed by your doctor.
Missed Dose
If you forget to take your dose, do not take a double dose to make up for it. Simply skip the missed dose and take your next dose as usual the following morning. Avoid taking lisdexamfetamine in the afternoon or evening, as it may cause difficulty sleeping (insomnia).
Overdose
If you or someone else has taken too much lisdexamfetamine, contact your doctor or go to the nearest emergency department immediately. Take the medicine packaging with you.
Signs of overdose may include:
- Restlessness, tremors, increased uncontrolled movements, muscle twitching
- Rapid breathing, confusion, tendency to aggression
- Hallucinations, panic, high fever
- Nausea, vomiting, diarrhoea, abdominal cramps
- Changes in heart rate (fast, slow or irregular), high or low blood pressure
- Seizures, loss of consciousness
Fatigue and depression may follow as the effects of the overdose wear off.
Do not suddenly stop taking lisdexamfetamine without first consulting your doctor. Abrupt discontinuation can cause ADHD symptoms to return. Your doctor may recommend a gradual dose reduction. If you have been on treatment for more than one year, your doctor should periodically reassess whether the medication is still needed, often by scheduling a brief treatment break (e.g. during a school holiday for children).
Monitoring during treatment
Your doctor will carry out regular check-ups at least every six months (and whenever the dose is changed), including:
- Appetite assessment
- Height and weight measurements (children and adolescents)
- Blood pressure and heart rate
- Mood, mental state, and any unusual feelings or behaviours
What Are the Side Effects of Lisdexamfetamine?
Like all medicines, lisdexamfetamine can cause side effects. The most common are decreased appetite, insomnia, dry mouth, and headache (affecting more than 1 in 10 people). Serious but less common side effects include irregular heartbeat, chest pain, psychiatric symptoms, and allergic reactions. Contact your doctor immediately if you experience any serious side effects.
Not everyone who takes lisdexamfetamine will experience side effects. Many side effects are mild and may improve as your body adjusts to the medication during the first few weeks. However, some side effects are serious and require immediate medical attention.
- Palpitations or irregular heartbeat, or chest pain (may indicate heart problems)
- Hallucinations, paranoia or delusions (psychotic symptoms)
- Signs of severe allergic reaction: sudden drop in blood pressure, difficulty breathing, hives/itching
- Seizures (convulsions)
- Yellowing of eyes and/or skin (may indicate liver inflammation)
- Skin swelling or severe blistering rash (angioedema or Stevens-Johnson syndrome)
- Shortness of breath or leg swelling (may indicate cardiomyopathy)
Very Common
- Decreased appetite
- Insomnia (difficulty sleeping)
- Dry mouth
- Headache
Common
- Agitation, shakiness, anxiety, depression, irritability, mood swings
- Fatigue or restlessness
- Dizziness, tremor, hyperactivity
- Tics (involuntary repetitive movements or sounds)
- Fast or irregular heartbeat (tachycardia, palpitations)
- Elevated blood pressure
- Nausea, vomiting, diarrhoea, constipation, stomach pain
- Weight loss
- Excessive sweating
- Difficulty breathing
- Teeth grinding (bruxism)
- Erectile dysfunction or changes in libido
Uncommon
- Mania (feeling unusually elated, overactive or uninhibited)
- Allergic reaction (hypersensitivity)
- Fever, excessive talkativeness
- Dysphoria (feeling depressed, uneasy or low)
- Euphoria (feeling excessively high or excited)
- Compulsive skin picking
- Abnormal drowsiness
- Blurred vision, metallic taste or altered taste
- Itching, rash, urticaria (hives)
- Fainting, nosebleed
Rare / Not Known Frequency
- Anaphylactic reaction (severe, life-threatening allergy)
- Psychotic episodes (hallucinations, paranoia, delusions)
- Worsening of Tourette syndrome
- Seizures (convulsions)
- Life-threatening irregular heart rhythm (visible on ECG)
- Eosinophilic hepatitis (allergic liver inflammation with possible jaundice)
- Angioedema (tissue swelling) or Stevens-Johnson syndrome (severe skin reaction)
- Cardiomyopathy (heart muscle disease — shortness of breath, leg swelling)
- Significantly dilated pupils
- Aggression
- Raynaud's phenomenon (poor circulation causing numb, pale fingers and toes)
Some side effects occur at different frequencies in younger patients. In children and adolescents, weight loss and stomach pain are very common (rather than just common). Fever, drowsiness, and rash are common (rather than uncommon). High blood pressure, Raynaud's phenomenon, and dilated pupils are uncommon (rather than rare). Hallucinations are uncommon in children, and cardiomyopathy is uncommon in adolescents.
How Should You Store Lisdexamfetamine?
Store lisdexamfetamine below 25°C (77°F). Keep it out of the sight and reach of children and in a secure location, as it is a controlled substance. Do not use capsules that appear damaged. Check the expiry date regularly.
Proper storage of lisdexamfetamine is important both for maintaining the medication's effectiveness and for safety reasons, since it is a controlled substance with potential for misuse.
- Temperature: Store at or below 25°C (77°F). Do not freeze.
- Keep out of reach of children: Store in a secure location where others cannot access it.
- Safety: Keep this medicine in a safe place. It can cause serious harm to people for whom it has not been prescribed.
- Expiry: Do not use after the expiry date printed on the container and carton (after “EXP”). The expiry date refers to the last day of that month.
- Condition: Do not use capsules that appear damaged in any way.
- Disposal: Do not throw unused medicines in household waste or down the drain. Return unused capsules to your pharmacy for safe disposal.
What Does Lisdexamfetamine Contain?
Each capsule contains lisdexamfetamine dimesylate as the active ingredient, equivalent to a specific amount of dextroamphetamine depending on the strength (20–70 mg). Inactive ingredients include microcrystalline cellulose, croscarmellose sodium, magnesium stearate, gelatin and titanium dioxide.
Lisdexamfetamine capsules are available in six strengths. The active substance content and equivalent dextroamphetamine dose for each strength are:
| Capsule Strength | Dextroamphetamine Equivalent | Capsule Appearance |
|---|---|---|
| 20 mg | 5.9 mg | Ivory body and ivory cap, marked “S489” and “20 mg” |
| 30 mg | 8.9 mg | White body and pink cap, marked “S489” and “30 mg” |
| 40 mg | 11.9 mg | White body and blue-green cap, marked “S489” and “40 mg” |
| 50 mg | 14.8 mg | White body and blue cap, marked “S489” and “50 mg” |
| 60 mg | 17.8 mg | Turquoise blue body and cap, marked “S489” and “60 mg” |
| 70 mg | 20.8 mg | Blue body and pink cap, marked “S489” and “70 mg” |
Inactive ingredients (excipients)
- Capsule contents: Microcrystalline cellulose (E460), croscarmellose sodium (E468), magnesium stearate (E572)
- Capsule shell: Gelatin and titanium dioxide (E171). Depending on the strength, capsules may also contain yellow iron oxide (E172), erythrosine (E127), or brilliant blue FCF (E133).
- Printing ink: Shellac (E904), potassium hydroxide (E525), black iron oxide (E172), propylene glycol (E1520), concentrated ammonia solution (E527)
This medicine contains less than 1 mmol (23 mg) sodium per capsule, meaning it is essentially sodium-free.
Frequently Asked Questions About Lisdexamfetamine
Medical References and Sources
This article is based on current regulatory documents, clinical guidelines, and peer-reviewed research. All claims are supported by scientific evidence.
- European Medicines Agency (EMA). "Elvanse — Summary of Product Characteristics (SmPC)." Official EU product information for lisdexamfetamine dimesylate.
- U.S. Food and Drug Administration (FDA). "Vyvanse (lisdexamfetamine dimesylate) — Prescribing Information." FDA-approved prescribing information including clinical pharmacology and safety data.
- National Institute for Health and Care Excellence (NICE) (2024). "Attention deficit hyperactivity disorder: diagnosis and management. NICE guideline [NG87]." UK clinical guideline for ADHD management, including pharmacological treatment recommendations.
- Cortese S, et al. (2018). "Comparative efficacy and tolerability of medications for attention-deficit hyperactivity disorder in children, adolescents, and adults: a systematic review and network meta-analysis." The Lancet Psychiatry, 5(9), 727–738. Landmark meta-analysis comparing ADHD medication efficacy. Evidence level: 1A.
- Coghill DR, et al. (2017). "A systematic review of the safety of lisdexamfetamine dimesylate." CNS Drugs, 31(8), 647–669. Comprehensive safety review of lisdexamfetamine across clinical trials.
- World Health Organization (WHO) (2023). "Model List of Essential Medicines — 23rd List." WHO guidance on essential medicines for global health systems.
- British National Formulary (BNF). "Lisdexamfetamine mesilate: drug monograph." UK prescribing reference with dosage, interactions and side effects.
Evidence grading: This article uses the GRADE framework (Grading of Recommendations Assessment, Development and Evaluation) for evidence-based medicine. Drug information is sourced from official regulatory documents (EMA SmPC, FDA PI) and supported by systematic reviews of randomised controlled trials (evidence level 1A).
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