Vyvanse for ADHD
Long-acting prodrug with smooth onset and lower abuse potential than traditional amphetamines
Overview
Vyvanse (lisdexamfetamine) is a prodrug — it is pharmacologically inactive until converted to d-amphetamine by enzymes in the body after absorption. This mechanism creates a smoother onset (no "rush"), longer duration (10–14 hours), and significantly reduced abuse potential compared to traditional amphetamine formulations.
How It Works
After oral ingestion, lisdexamfetamine is absorbed and converted to active d-amphetamine in the bloodstream. Because conversion is rate-limited by enzyme activity, the onset is gradual and the peak is blunted compared to standard Adderall. The active d-amphetamine then increases dopamine and norepinephrine in the prefrontal cortex, improving attention and executive function.
Available Formulations
- Vyvanse 20mg, 30mg, 40mg, 50mg, 60mg, 70mg capsules
- Vyvanse chewable tablets (same doses)
- No generic equivalent available in the US (branded only — cost is a consideration)
Side Effects & Monitoring
- ⚠ Appetite suppression (often less intense than IR formulations but longer duration)
- ⚠ Insomnia
- ⚠ Elevated heart rate and blood pressure
- ⚠ Dry mouth
- ⚠ Emotional blunting at high doses
- ⚠ Rarely: dysphoria or anxiety if dose is too high
- ⚠ Smoother wear-off than IR formulations (less rebound irritability)
Monitoring: Same monitoring parameters as other stimulants: blood pressure, heart rate, weight, sleep quality, and mood. Vyvanse's smooth pharmacokinetics often make monitoring simpler, as peaks and troughs are less pronounced.
Prescription Management With Direct Access
ADHD medication often requires adjustment in the first months of treatment — dose titration, formulation changes, timing adjustments. With Dr. Agresti's concierge model, you can text him directly when something isn't working. No 6-week wait for the next appointment to report that your medication stops working by 2 PM.
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