Vyvanse (Lisdexamfetamine) Information

It's very common for children with bipolar disorder to be diagnosed with attention deficit hyperactivity disorder (ADHD) as well. Adults with bipolar disorder also may be diagnosed with ADHD. Vyvanse (lisdexamfetamine) is one of the medications that may be prescribed to treat ADHD, and it is approved for use in children, adolescents, and adults.

Uses

Not only is Vyvanse used for the treatment of ADHD, in 2015 the U.S. Food and Drug Administration (FDA) also approved it for binge-eating disorder as well.

Why Treating ADHD With Bipolar Disorder Can Be Tough

Treating ADHD in someone who has bipolar disorder can be tricky. The Vyvanse label states, "Stimulants are not intended for use in patients who exhibit symptoms secondary to environmental factors and/or other primary psychiatric disorders, including psychosis." A doctor who is considering prescribing this drug needs to carefully evaluate the symptoms of the individual patient. Hidden bipolar or psychotic disorders can be triggered by stimulants, and known psychiatric conditions made worse, so the doctor must also monitor the patient closely for such symptom changes.

Treatment Guidelines

This once-a-day medication should be taken in the morning since taking it later in the day can lead to insomnia. It can be taken with or without food. A capsule can be opened and the powder inside dissolved in a glass of water, but not any other liquid. The manufacturer warns that in this case, the water with Vyvanse in it must be drunk immediately.

The recommended starting dose is 30 mg. This can be adjusted up to a maximum dose of 70 mg per day.

It's also recommended that long-term use of Vyvanse be interrupted at times to see whether ADHD symptoms return to a point where medical treatment is still necessary. Such interruption may also be a good idea if there are signs of a child or adolescent's growth being suppressed.

Potential Conflicts With Medications

This drug should not be taken at the same time as any monoamine oxidase inhibitors (MAOIs). In addition, you should wait 14 days between discontinuing an MAOI and starting to take Vyvanse, so that the MAOI has completely out of your system. Taking the two drugs together increases the risk of a dangerous hypertensive crisis.

Other problematic medications that are commonly used to treat bipolar disorder may include:

• Tricyclic antidepressants, especially Norpramin (desipramine) and Vivactil (protriptyline), which may cause a significant increase in the amount of Vyvanse in the body
• Haldol (haloperidol), which may make Vyvanse less effective
• Lithium, which may also make Vyvanse less effective

Warnings

• Vyvanse is a Schedule II controlled substance, meaning it has a strong potential for abuse and addiction, but also has legitimate medical uses. Misuse can lead to serious heart problems and sudden death. Psychosis is a common sign of continual intoxication.
• Patients should be screened for existing heart ailments before starting Vyvanse. There is a risk of a number of cardiovascular problems with this medication. Stroke, heart attack, sudden death, and high blood pressure have been reported.

• At proper doses in clinical trials, the emergence of psychotic symptoms or mania was rare, only 1/10th of 1%. However, the danger increases when the drug is abused.

Regarding bipolar disorder, the medication label states:

"Particular care should be taken in using stimulants to treat ADHD in patients with comorbid bipolar disorder because of concern for possible induction of a mixed/manic episode in such patients. Prior to initiating treatment with a stimulant, patients with comorbid depressive symptoms should be adequately screened to determine if they are at risk for bipolar disorder. Such screening should include a detailed psychiatric history, including a family history of suicide, bipolar disorder, and depression."

Common Side Effects

Common and less serious side effects include:

• Stomach pain, vomiting, nausea, diarrhea (mostly in adults), dry mouth
• Decreased appetite (very common), weight loss
• Insomnia (very common), irritability (mostly in children under 13), anxiety (mostly in adults)

Serious Side Effects

Other possible serious side effects include:

• Aggression
• Tics
• Visual disturbances
• Seizures
• Long-term suppression of growth

Vyvanse During Pregnancy

Vyvanse is in Pregnancy Category C, meaning it should only be used during pregnancy if the potential benefits outweigh the risk to the fetus. This medication is excreted in breast milk and should not be taken while nursing, as it may cause harm to the infant.

_Sources:

_{Masi, G., et al. "Attention-deficit hyperactivity disorder - bipolar comorbidity in children and adolescents." Bipolar Disorders. 2006 Aug;8(4):373-81.}

_{US Food and Drug Administration. "Approved Label for Vyvanse." 31 Jan 2012.}

_{"Lisdexamfetamine." MedLine Plus, U.S. National Library of Medicine (2015).}