BSN Tracker

lisdexamfetamine

Brand: Vyvanse

⚠ BBW Prototype: methylphenidate
Drug Class: CNS stimulant
Drug Family: CNS stimulant
Subclass: prodrug amphetamine
Organ Systems: cns

Mechanism of Action

Prodrug: lisdexamfetamine (lysine-conjugated d-amphetamine) is inactive until enzymatic cleavage by peptidases in the blood releases d-amphetamine. This prodrug design slows conversion, extends duration, and reduces the rapid-onset euphoria that contributes to misuse potential — unlike standard amphetamine.

DAT (dopamine transporter)NET (norepinephrine transporter)VMAT2

Indications

  • ADHD (adults and children ≥6 years)
  • moderate to severe binge eating disorder (adults)

Contraindications

  • concurrent MAOI use
  • hyperthyroidism
  • structural cardiac abnormalities
  • arteriosclerosis

Adverse Effects

Common

  • decreased appetite
  • insomnia
  • dry mouth
  • headache
  • irritability
  • weight loss

Serious

  • cardiovascular effects (hypertension, tachycardia, sudden death risk)
  • psychiatric symptoms
  • growth suppression (children)
  • Raynaud's phenomenon

Pharmacokinetics (ADME)

Absorption well absorbed; food does not affect bioavailability but may delay peak
Distribution lisdexamfetamine protein binding <1%; d-amphetamine 15-40%
Metabolism hydrolysis of lysine in blood (by peptidases) to d-amphetamine; not CYP-dependent for activation
Excretion primarily renal (as d-amphetamine and hippuric acid)
Half-life <1 hour (lisdexamfetamine prodrug); ~12 hours (d-amphetamine)
Onset 1-2 hours for therapeutic effect
Peak 3.8 hours (amphetamine peak)
Duration 10-14 hours
Protein Binding <1% (prodrug)
Vd unknown for prodrug

Drug Interactions

Drug / Agent Mechanism Severity
MAOIs hypertensive crisis and serotonin syndrome contraindicated
alkalinizing agents decrease d-amphetamine excretion; increase levels moderate

Nursing Considerations

  1. Same cardiovascular and growth monitoring as other stimulants; baseline and periodic BP, HR, weight, and height.
  2. The prodrug design means the capsule contents can be dissolved and taken by mouth but cannot be injected for misuse — discuss this safety feature with patients concerned about diversion.
  3. FDA approved for binge eating disorder in adults; a unique indication among ADHD medications; clarify indication on medication reconciliation.
  4. Insist on reviewing PDMP database before prescribing/dispensing as a Schedule II agent.

Clinical Pearls

  • Lisdexamfetamine's prodrug design is a regulatory and clinical strategy: by requiring enzymatic activation in blood, it eliminates IV misuse potential (inactive if injected) and attenuates the euphoric rush associated with rapid oral dissolution.
  • Its approval for binge eating disorder represents the first pharmacological treatment for this condition; the mechanism likely involves dopamine-mediated reduction in compulsive reward-seeking behavior.

Safety Profile

Pregnancy avoid
Lactation avoid
Renal Adjustment Required
Hepatic Adjustment Not required
TDM Not required

Concordance Terms

Cross-referenced clinical concepts — click any term to see all content where it appears.

ADHD (adults And Children ≥6 Years) CNS Stimulant Moderate To Severe Binge Eating Disorder (adults)
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