Vyvanse is dextroamphetamine (brand names Dexedrine, Dextrostat, etc) that uses an unusual delivery system to get into a person's blood stream. How the new system was developed is interesting.
The more rapidly a stimulant gets into the blood stream, the higher and more excited, even high, a person can get on it. For most people, taking a stimulant by mouth gets medication into their blood stream fairly slowly, so few people get high on it. But some people grind up these medications, then sniff them or inject them into their veins. They got high, but they also can quickly became addicted and some have died of overdose. Scientists have searched for a way to prevent this from happening.
A few years ago, someone invented a process that makes medications inactive by attaching the amino acid lysine to them. If someone grinds up the medication attached to the lysine and sniffs or injects it, they would not get high. But if someone swallows it, intestinal enzymes break the bond between the medication and the lysine, and the medication becomes active.
Vyvanse is dextroamphetamine attached to lysine. When a Vyvanse pill is swallowed, the dextroamphetamine is slowly freed from the lysine and seeps into the blood stream. An unexpected benefit of this system is that the dextroamphetamine gets into the blood stream very steadily and over a period of ten hours or so after it is taken. This means it acts over a longer period of time than do other long acting ADD medications. In my experience, it also appears to have a slightly stronger effect than Adderall, which in turn has a slightly stronger effect than Ritalin or Concerta for many people. For these reasons, it is usually my first choice of medications to treat ADD.
The major downside of Vyvanse is that it is expensive. If your insurance covers all but a small co-pay, that may not be an issue. But some insurance companies require a larger co-pay for Vyvanse than for other stimulants, and some people don't have medication insurance coverage. In addition, because it is more expensive, some insurance companies require that the prescribing clinician submit a prior authorization request justifying its use and dosage.
Instructions to Give to a Patient Taking Vyvanse
It is impossible to predict what will be the best dose of Vyvanse for a particular patient. The best dose may be as little as 15 milligrams per day or over 200. The dose depends on how the patient absorbs, metabolizes, and uses the medication. The best approach to finding the right dose is to start with a low dose and gradually increase it until they find the right dose or encounter unacceptable side effects or find the medication is not effective, in which case another medication may be tried.
Patient instructions:
On days 1, 2, 3 take 1 pill (30 mg) a day in the morning. If there are no disturbing side effects and the dose is not effective...
On days 4, 5, 6 take 2 pills a day in the morning. If there are no disturbing side effects and the dose is not effective...
On days 7, 8, 9 take 3 pills a day in the morning. If there are no disturbing side effects and the dose is not effective...
On days 10 until the next visit take 4 pills per day in the morning
If the patient wants to change the dose by more or less than a full pill, he or she can open a capsule and pour it into a glass of water, where it will dissolve. They can drink part of the water to get a partial dose.
Most common side effects from the medication are mild and disappear after a few days. They may include minor nervousness, irritability (may occur as the beneficial effects wear off), mild difficulty sleeping, appetite loss, dry mouth, mild tenseness of the jaw, stomach ache, and headache, emotionality, and mood changes. Patients should not increase the dose if a side effect makes them uncomfortable. Suggest they contact you if they have any questions about how to take the medication.
If there are no bothersome side effects, they can keep increasing the dose as long as the most recent (higher) dose is having a better effect than the previous (lower) dose. If the effect is about the same, they should go back to the lower dose.
They should be reminded not take a dose any higher than the maximum amount prescribed. Remember: the effect from the medication that the patient is looking for is an improvement in their ability to focus, concentrate, and remember. While the medication helps some people feel less depressed, they should not judge their improvement solely on how it affects their emotional state but rather on how it helps you think, plan, and organize.
If they experience uncommon symptoms such as difficulty urinating, diarrhea, suspiciousness, over-talkativeness, moderate tenseness of your jaw, significant difficulty sleeping, or a significant increase in your blood pressure, they should stop taking the medication until they have a chance to talk to you.
Ask them to contact you or their personal physician if they have heart related problems, chest pain on exertion, faintness, paranoia, If this is not possible, they should contact the ER or call 911.
