LISDEXAMFETAMINE DIMESYLATE

LISDEXAMFETAMINE DIMESYLATE
(lis-dex-am-fet'a-meen)
Vyvanse
Classifications: cerebral stimulant; amphetamine; anorexigenic;
Therapeutic: cerebral stimulant

Prototype: Amphetamine
Pregnancy Category: C
Controlled Substance: Schedule II

Availability

30 mg, 50 mg, and 70 mg capsules

Action

An isomer of amphetamine that has anorexigenic action; this is thought to result from CNS stimulation and possibly from loss of acuity of smell and taste. CNS stimulating effect is approximately twice that of racemic amphetamine.

Therapeutic Effect

In hyperkinetic children, amphetamines reduce motor restlessness by an unknown mechanism.

Uses

Treatment of attention-deficit hyperactivity disorder (ADHD).

Contraindications

Hypersensitivy to sympathomimic amines, or amphetamine; advanced arteriosclerosis; structural cardiac abnormalities, cardiomyopathy, cardiac arrhythmias, or symptomatic cardiovascular disease; moderate to severe hypertension; glaucoma; agitated states; patients with history of drug abuse; during or within 14 d of administering MAOIs; hyperthyroidism; history of depression or suicide; seizure disorders; tics or Tourette syndrome; pregnancy (category C); lactation; children <3 y.

Cautious Use

Controlled hypertension, heart failure, recent MI, or recent ventricular arrhythmia; preexisting psychotic disorder; bipolar disorder; history of aggressive or hostile behavior.

Route & Dosage

Attention-Deficit Hyperactivity Disorder
Child (6–12 y): PO 30 mg q.d. in a.m.; may increase to 50–70 mg q.d. at weekly intervals (max: 70 mg q.d.)

Administration

Oral
  • Give daily dose in the morning.
  • Capsule may be taken whole or opened and dissolved in a glass of water.
  • Store at 15°–30° C (59°–86° F) and protect from light.

Adverse Effects (≥1%)

Body as a Whole: Pyrexia. CNS: Affect lability, dizziness, headache, insomnia, irritability, somnolence, tic. GI: Abdominal pain, dry mouth, nausea, vomiting. Metabolic: Decreased appetite, weight loss. Skin: Rash.

Diagnostic Test Interference

Lisdexamfetamine can cause a significant elevation in plasma corticosteroid levels and may interfere with urinary steroid determinations.

Interactions

Drug: Chlorpromazine and haloperidol inhibit the CNS stimulant effects of amphetamines. Furazolidone decreases amphetamine metabolism and can increase adverse effects. Lithium may inhibit the effects of lisdexamfetamine. monoamine oxidase inhibitors will increase plasma levels of lisdexamfetamine. Propoxyphene can potentiate the CNS stimulation of lisdexamfetamine. Compounds that acidify the urine lower the plasma levels of lisdexamfetamine. Lisdexamfetamine inhibits the actions of adrenergic blockers. Co-administration of antihistamines with lisdexamfetamine can counteract desired sedative effects. Lisdexamfetamine may antagonize the hypotensive effects of antihypertensive agents. Lisdexamfetamine may delay the absorption of ethosuximide and phenytoin. Lisdexamfetamine may potentiate the actions of tricyclic antidepressants, meperidine and norepinephrine.

Pharmacokinetics

Absorption: Rapidly absorbed from GI tract. Peak: 1 h. Distribution: Extensive throughout body. Metabolism: Prodrug converted in liver to dextroamphetamine. Elimination: Urine (96%). Half-Life: 1 h (lisdexamfetamine) 6–8 h (dextroamphetamine).

Nursing Implications

Assessment & Drug Effects

  • Monitor children, adolescents, and adults for signs and symptoms of adverse cardiac reactions (e.g., hypertension, arrhythmias). Report promptly exertional chest pain or syncope.
  • Monitor closely growth rate in children.
  • Typically therapy is interrupted or dosage reduced periodically to assess effectiveness in behavior disorders.
  • Monitor children and adolescents for development of aggressive or abnormal behaviors.

Patient & Family Education

  • Do not drive or engage in other potentially hazardous activities until response to drug is known.
  • Report promptly any of the following: chest pain with activity, new or worse behavior or thought problems, psychotic symptoms (e.g., hearing voices, believing things that are not true).
  • Taper drug gradually following long-term use to avoid extreme fatigue, mental depression, and prolonged abnormal sleep pattern.

Common adverse effects in italic, life-threatening effects underlined; generic names in bold; classifications in SMALL CAPS; Canadian drug name; Prototype drug

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