Vyvanse

There is no doubt that we need more options for the treatment of attention-deficit/hyperactivity disorder (ADHD), and though it would be nice to be able to treat everyone with a diet or some other approach, for many it is just not feasible.

Of the current medicines, most do not last quite long enough, and occasionally may need to be taken more than once a day. The trouble is that taking these medicines intermittently, or only having it in the circulation for a short time, plays havoc with the dopamine receptors in the brain.

One of the big problems with the current group of stimulant medicines is that they are amphetamines, and have enormous abuse potential. They are sold and re-sold and taken by mouth, inhaled, smoked and injected. In some parts of the United States abuse of ADHD medicines is the number one form of substance abuse.

So it would be a huge advantage to have long-lasting medicines with a much-reduced risk of abuse.

Vyvanse is an extremely interesting new treatment for ADHD that has just been approved by the FDA and should be available in the United States in the very near future. It is manufactured by Shire Pharmaceuticals that is getting a reputation as the company with the biggest interest in ADHD.

During development, Vyvanse was known as NRP104. Its main ingredient is lisdexamfetamine dimesylate. Vyvanse is unique in another way too: it is a prodrug or 'conditionally bioreversible derivative' of amphetamine, the main ingredient in Adderall and Adderall XR. This is a key point: unlike other stimulants it is conjugated to an amino acid, and has to go through the stomach and be digested before it can become active. Therefore there is a much reduced risk that it will be abused, since it cannot be snorted or injected like other ADHD medicines.

There was a great deal of new data presented at the In research presented this week at the 2007 Annual Meeting of the American Psychiatric Association in San Diego, California. The bottom line seems to be that the medicine is both effect and well tolerated. It is going to be a genuinely useful addition to the treatments that we can offer people with ADHD.

Comments

[elisa]

this drug is a life saver my son has been on it for 2 days and there is a huge differance! thank god !

[Richard Petty]

Dear Elisa,

I am so pleased for you.

No medicine, diet or computer program is gong to help everyone, so it is terrific if you have found just what you need.

Kind regards,

RP

[Richard Petty]

Dear Elisa,

Thank you so much for your comment.

I know that all of our readers will be pleased for you and hope that the improvement is maintained.

So far the reports that we are getting about Vyvanse seem to suggest that it is a real help in around two thirds of the people who take it: that is a very good batting average. It seems to be particularly good when used with some structuring techniques to help people get organized.

Good luck!

Kind regards,

RP

[Amy Potts]

I am a 34-year-old mother of 4 with ADD. My doctor would just suggested that I try Vyvanse for myself b/c it will become approved for adults soon enough. I currently take Adderall XR and it doesn't quite make it past dinner time. Are there any studies going on in the the Philadelphia area that I could participate in?
My 12 year old son currently takes Concerta and it doesn't measure up. What are the procedures to change him to Vyvanse? And is there a greater chance that the Adderall/vyvanse family will work for him better than the Concerta seeing that it works better in me? I failed a trial of Concerta before I switched to Adderall. I was wondering if we could have the same type of body chemistry that these meds would also work better on him.
And I haven't even mentioned my 3 year old daughter who is exactly like her brother, but that is a question for another day.

[Richard Petty]

Dear Amy,

Thank you very much for your letter.

I fell for you: it is hard to have both mom and kids with ADD. (Have you seen the recent book on Moms with ADD by Christine Adamec?)

Though I would not presume to make specific comments about someone whom I have not seen, I can certainly make some comments.

1. One of the reasons why Vyvanse is often helpful is for the reason that you say: duration of action. Your doctor may also be aware of a new trend, which works in some people, and that is to take the XR in the morning and a small dose of regular Adderall in the afternoon. Some kids are even being given it at bedtime, and odd as it sounds, it can help sleep.

2. The trials question is a good one. For anyone who needs to know about clinical trials anywhere in the country, the place to look them up is:
http://clinicaltrials.gov/
I could not see any Vyvanse trials in Philadelphia. I believe that they all wrapped up some time ago, so that the company could analyze the adult data before they filed for an extended indication with the FDA. That application has already gone in, so the FDA will likely be giving its decision within months.

3. Switching medications is always highly individualized to the child or adult, It is usually pretty straightforward, and most experts do what is known as a fast cross-titration. The company actually studied switching techniques for Adderall to Vyvanse and it was quite simple. There have not yet been any published Concerta to Vyvanse switch studies, but the principles should be similar.

4. The other point about whether your son might do better with something that works for you is very interesting. SInce he has half of you genes the answer is usually "Yes." With antidepressants, antipsychotics and psychostimulants, most doctors ask what has worked for someone else in the family. It is certainly not a 100%, but it is often a good guide, and is one the things that we factor into the equation when deciding where to start.

I do hope that helps, and I wish you and your family the very best,

Kind regards,

RP

[Pamela devine]

My 16 year old has ADHD with high impulsivity (especially that crowd mentality). He metabolizes everything so fast. Currently he takes Focalin XR 20 mg w/breakfast & with lunch. All the long acting meds have worn off with in 5-6 hours. The Ritalin's give him a rebound hyperactivity phase. Adderall made him the most focused of all, XR only lasted 4-5 hours. He was not hyper coming off but was more angry & moodier. We have had to keep him on Welbutrin along with whatever stimulant he's on to take away the edge. Off meds he is a very happy but hyper kid. Has a genuis IQ but so disorganized & struggles with fluency in completeing tasks. Homework is a nightmare at times. Wondering how Vynase would work for him?

[Richard Petty]

Dear Pamela,

Than you very much for your comment.

Your son's rapid metabolism is quite a common problem, and often plays havoc with young peoples' sleep patterns.

It is also remarkable how many people of all ages who have ADHD also have a high IQ.

People are so very different in how they react to different medicines. People are already getting a lot of experience with Vyvanse and working out where and when it fits in. I would imagine that your physician will have the information about it, and will be able to discuss you about the pros and cons.

I do wish you well: I know from personal and professional experience just how hard ADHD can be on everyone.

Kind regards,

RP

[CM]

Hi Doctor,

I have recently begun taking Vyvanse and it has worked wonders for my symptoms. Prior to Vyvanse 50 mg. I was taking Adderall XR 20 mgs. and made the transition over with no problems. However, after a couple of weeks, one day I experienced a side effect that consisted of blurred peripheral vision (spotty, zig-zaggy)in one eye and a sense that my vision was "narrowing" (loss of periphery on both eyes). It subsequently resolved in 10 minutes with no recurrence. I am wondering if you have heard of this and do you feel that this symptom is indicative of a serious problem that would warrant total discontinuation of the Vyvanse.(stimulants?) I only had this one time and have really experienced no other negative symptoms. I plan on discussing this with my doctor as well, but would appreciate your opinion!

Thank you,

CM

[Amy]

My 6 year old has been taking Vyvanse for over a month now. He started out w/ 30 mg and is now up to 50 mg. He says that he feels like bugs are crawling all over him & he seems so scared of everything. He has never been like this before. Also, he is extremely irritable. Does this seem medicine related?

[Max]

Ugh, 6 years old, really? At six years old pretty much every kid has the ADHD symptoms (which in my opinion are very broad) like not wanting to focus and stuff.
I don't think kids should be on stimulants like this. Kids at this age don't know how to react to new sensations, and don't have a firm grasp on explaining the way they feel; simply because they don't have as much experience as adults do. This would most likely explain the sensations your son is complaining of. I am 20 years old and have been taking 50mg of Vyvanse and I am 170lbs. So that dosage is probably too much for them.

I am not questioning your parenting but if you do believe your children should be on Vyvanse 30mg would be best. And before considering 'upping' the dosage. You should, try the equivalent in body weight of the drug that your child is taking for yourself. So that you know what the effects are like, it may help you have some insight into what your child is feeling. Cheers.

[Amanda]

I'm 22 now and have been on adderall since i was 14. I can't seem to come off of it and when my doctor tried to switch me to this medication to make it easier to then step down off of it my vision got blurry. I took it for a week and a half, the last day I got a severe migraine (i never had had one until then and I never had problems with my vision until then) and I stopped taking it and went back to Adderall. My vision has never gone back to normal. It isn't just blurry vision, sometimes everything appears to be slightly moving as well and I have chronic migraines. :( Needless to say I didn't like this medication and I don't think my eyes will ever go back to normal or that I will stop having these headaches.

[des97cass99]

My 8 year old has been on Vyvanse 30 mg per day for just a bit over a month. She was previously on Adderral XR. Vyvanse seems to be working, when she was in school it helped tremendously. Problem is she doesn't eat. She was a picky eater to begin with and now she's worse. Any suggestions?