Patient Instructions for Taking Vyvanse

It is impossible to predict what will be the best dose of Vyvanse for you. The best dose may be as little as 15 milligrams per day or over 200. The dose depends on how your body 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 we find what’s right for you. Or this medication may have too many side effects or not be effective for you in which case we may need to try another medication.

Days 1, 2, 3 1 pill (30 mg) a day in the morning. If you want to try a higher dose and you don’t have any disturbing side effects...

Days 4, 5, 6 2 pills a day in the morning. If you want to try a higher dose...

Days 7, 8, 9 3 pills a day in the morning If you want to try a higher dose...

Days 10 until our next meeting 4 pills per day in the morning

If you want to change the dose by more or less than a full pill, you can open a pill and pour it into a glass of water, where it will dissolve. You can drink part of the water to get a partial dose.

Most common side effects from the medication are mild and often disappear after a few days. They may include minor nervousness, irritability (may occur as the beneficial effects wear off), mild difficulty sleeping, appetite loss, stomach ache, and headache, emotionality, cold fingers or toes, and mood changes.  The patient should not increase the dose if a side effect makes them uncomfortable.

Side effects that tend to remain: dry mouth, nervousness, mild difficulty urinating, feeling of tenseness sometimes most marked in the jaw muscles, decrease in sexual functioning or feeling, semen in urine (causing cloudy urine), blue feet (probably from vaso-constriction.)  Some patients experience over-seriousness, with a loss of sense of humor, and excessive work orientation.  This can usually be relieved by reducing the dose. 

If patients experience uncommon symptoms such as difficulty urinating, diarrhea, suspiciousness, over-talkativeness, moderate to severe tenseness of your jaw, significant loss of sleep, or a significant increase in blood pressure, they should stop taking the medication until they have a chance to talk to you.  

Unusual or rare side effects that suggest the medication should be stopped: suspiciousness, paranoia, unusual heart rhythms, very fast heart rate, consistently elevated blood pressure, more than mild difficulty urinating (men), panicky feelings (may be controlled by anti-anxiety medication), manic behavior (overly elevated mood, excitability, poor judgment, sleeplessness, strange behavior).   If they have heart related problems or chest pain on exertion or faintness, they should contact you, another physician, the ER, or 911.

While fatalities among patients taking stimulants is very rare given the large number of patients who have taken these medications, a small number of deaths have been reported.  These have largely been in patients with pre-existing heart conditions, some of which were unrecognized, and patients with a family history of early death from heart disease.  Another population at risk are those who engage in heavy physical activity in hot conditions, for example football players.  Under these circumstances, fatal or non-fatal rhabdomyolisis may occur.  I share this information about potential fatality with all patients that are considering taking stimulants.

If there are no bothersome side effects, have the patient 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.

Tell patients not to take a dose any higher than the maximum amount prescribed.  Remember: the effect from the medication that you and the patient are looking for is an improvement in their ability to focus, concentrate, and remember. While the medication helps some people feel less depressed, do not judge their improvement solely on how it affects their emotional state but rather on how it helps them think, plan, and organize.