Key takeaways

Drug holidays, brief pauses in medication treatment, can be beneficial for managing side effects and drug tolerance, especially in long-term ADHD treatment.
Vyvanse, a stimulant for ADHD, is recommended for daily use, but taking breaks or “drug holidays” (under the supervision of a healthcare provider) can help manage tolerance and side effects.
Skipping Vyvanse on weekends may be safe and beneficial if agreed upon by a healthcare provider.
Stopping Vyvanse suddenly can lead to withdrawal symptoms; a tapering schedule under medical supervision is recommended for safely discontinuing use.

We all need more time on vacation, but what about a vacation from your medications? Although you should never abruptly discontinue medication or discontinue meds without seeking medical advice, there are other types of medications that may be beneficial to take a break from during long-term treatment. These breaks, or brief pauses in active medication treatment, are sometimes referred to as a “drug holiday.” A drug holiday is a period where an individual and their healthcare provider decide it is safe and helpful to stop taking a certain medication.

What is a drug holiday?

Depending on the medication, drug holidays are typically used to avoid unwanted side effects associated with the long-term use of a medication, in the management of drug tolerance, or in preparation for surgery or pregnancy. Drug holidays are often discussed in the context of attention-deficit hyperactivity disorder (ADHD) treatment, especially in children and adolescents. Many ADHD medications are stimulant medications. And while effective, these medications can cause serious side effects.

Examples of stimulant drugs used to treat ADHD include:

Adderall (dextroamphetamine amphetamine)
Concerta (methylphenidate hydrochloride)
Ritalin (methylphenidate hydrochloride)
Vyvanse (lisdexamfetamine dimesylate)

There are approximately 6 million US children who have ever been diagnosed with ADHD, and two-thirds of children currently carrying the diagnosis are taking stimulant medication for the disorder. Stimulant medications used in the management of ADHD in children and adolescents are often used for many years, with the implementation of drug holidays often being extremely variable and based upon the child’s history with the medication, the parent’s initiation or interest in a drug holiday, and the provider’s discretion. To make these decisions even more confusing, there is extremely limited data available comparing the risks and benefits of a drug holiday in the management of ADHD, and the data that is available is not comprehensive and of very low quality.

In this article, we will talk about drug holidays from Vyvanse, a central nervous system stimulant that has been approved by the Food and Drug Administration (FDA) for use in the treatment of ADHD in adults and children 6 years of age and older. Vyvanse is also used in the management of severe binge eating disorder (BED) in adults. Vyvanse is a federally controlled substance, so it has a significant potential for abuse and must be prescribed by a healthcare provider with an active DEA license.

Do you have to take Vyvanse every day?

As part of the treatment plan for both ADHD and BED, Vyvanse should be taken every day. Stimulant medications like Vyvanse typically have a rapid onset of action and begin working in the brain quickly. Lisdexamfetamine is a prodrug of dextroamphetamine. After taking the medication, lisdexamfetamine is rapidly absorbed by the gastrointestinal tract and converted to dextroamphetamine, which is the active form of the drug.

According to pharmacokinetic data, peak concentrations of Vyvanse can typically be found in serum after two to four hours. In some individuals, stimulant medications like Vyvanse filter through the body even faster, resulting in the medications losing their therapeutic effect sooner than may be desired. Therefore, the dose of Vyvanse taken may vary widely, based on the prescribing mental health professional’s desire to have the medication be as effective to the patient as possible while minimizing unwanted side effects of Vyvanse.

A typical Vyvanse dosage starts at 30 mg, taken once daily in the morning. The dose may then be increased by 10 to 20 mg per week until the most effective dose is reached. The maximum dose is 70 mg per day.

Signs you need a drug holiday

Taking a break from a stimulant medication like Vyvanse may be recommended in the following cases:

Signs of addiction or abuse are present
There is evidence the medication is no longer working
The harm or potential for harm outweighs the benefits of continuing treatment

By taking a scheduled break from stimulant medications like Vyvanse, it is possible to begin addiction treatment, prevent or stop tolerance to the medication from occurring, and/or halt and potentially reverse common side effects.

Stimulant abuse, addiction, or dependance

ADHD is very commonly associated with drug abuse and substance use disorder (SUD). Additionally, it has been reported that up to 35% of college age students taking stimulant ADHD medications intentionally misuse the medications. Individuals who are prescribed stimulant medications should be screened for a history of substance abuse or SUD prior to beginning treatment.

Behavioral signs of Vyvanse abuse or misuse include:

Having cravings for the medication
Needing to feel “high” or “energized” by your medication
Having too much energy
Lying about medication use or stealing medication
Seeing multiple doctors or trying to obtain more medication than prescribed
Being angry when asked about your medication use
Poor judgment or decision making
Mood swings

Physiological signs of Vyvanse abuse or misuse include:

Anxiety, nervousness
Racing thoughts, hyperawareness, inability to control thoughts
Hallucinations, delusions, paranoia, confusion
Sweating
Twitching or jitteriness
Decreased appetite
Rapid heart rate
Elevated blood pressure
Heart attack and even death

If you or a loved one are concerned about abuse or addiction to a stimulant medication, it is important to seek the help of a medical and/or mental health professional before discontinuing the medication. In these cases, abrupt discontinuation is not safe, and the medication should be tapered under medical supervision.

The Substance Abuse and Mental Health Services Administration’s (SAMHSA) National Helpline is a free, confidential, 24/7 service to get help. Call 1-800-662-HELP.

Vyvanse crash

As ADHD meds wear off, you may experience a paradoxical worsening of ADHD symptoms which is sometimes known as “ADHD medication rebound” or, in this case specifically, a “Vyvanse crash,” “rebound,” or “comedown.” This is very common in children and adolescents taking stimulants for ADHD. These medications are meant to be taken in the morning to help with cognition and attention during the school day. Symptoms of a crash often manifest in the afternoon or early evening, after school, when the levels of the medication in the body are sufficiently low. This crash may happen earlier in the day if tolerance has developed or in children who are “fast metabolizers” of certain medications.

Symptoms of a Vyvanse crash include:

A return of the symptoms of ADHD, sometimes worse than baseline
Excessive tiredness or sleepiness
Mood swings
Anxiety, irritability
Inattention
Hyperactivity
Impulsivity

Pediatric weight loss

In controlled trials of Vyvanse in children 6 to 12 years of age, there was evidence of pediatric weight loss and a slowing of the participant’s growth rate. This relationship was observed in a dose-dependent fashion, which means a high dose of medication demonstrated a greater weight loss than a low dose of medication. In many children, these effects eventually stabilized after several months of treatment and did not appear to affect the onset of puberty. Weight and height should be carefully and regularly monitored in children taking Vyvanse, and discontinuation of the medication may be considered in children who experience significant weight loss or growth delay.

Vyvanse tolerance

Drug tolerance occurs when the body becomes accustomed to the presence of a medication such that the medication no longer exerts a therapeutic effect, or the medication only exerts a therapeutic effect at increasingly higher doses. Drug tolerance typically develops when an addictive substance has been misused, in rapid metabolizers where the body eliminates a medication at the shorter end of its half-life, or when someone has been taking a high dose of the same medication for a long period of time. Medication tolerance happens with many types of medications and is not unique to ADHD treatment.

As many people begin taking ADHD medications in childhood and are likely to take them for long periods of time, one of the goals of treatment is to avoid tolerance if possible. One of the ways healthcare professionals recommend doing this is to take scheduled breaks from taking Vyvanse over the weekend or over school holidays.

Taking a break from an ADHD stimulant medication can partially reverse the physiological adaptive effects that result from chronic pharmacological stimulation and resensitize the neurons in the brain. One comprehensive literature review demonstrated evidence of a positive impact on childhood growth and weight gain, and improvement in insomnia and appetite by incorporating drug holidays as part of the medication management of ADHD in children.

As each child is different, drug holidays should only be scheduled if demonstrated to be beneficial to the child.

Can I skip Vyvanse on weekends?

Skipping Vyvanse on weekends is only okay if you and your healthcare provider have agreed that it is safe and beneficial to do so. There is limited data and no generally agreed upon consensus about exactly how and when a drug holiday should be initiated. The timing and duration of the drug holiday will be unique for each child and family.

What are the risks of stopping Vyvanse on weekends?

Stimulant medications are highly addictive with a high potential for abuse. Vyvanse can cause both physical and psychological dependance, especially at higher doses and with long-term use. Quitting for even short periods of time can cause very uncomfortable symptoms including excessive drowsiness and an inability to focus, even on small tasks. Even when taking medication correctly, abrupt discontinuation can lead to withdrawal. In individuals experiencing withdrawal who have been taking their medications as prescribed, withdrawal symptoms are usually minor and are not life-threatening.

Not all providers agree about how and when a Vyvanse drug holiday should be taken. In some cases, it may be better to taper off a medication with the assistance of a medical professional than to take scheduled breaks.

“I recommend that patients who are considering taking a break from Vyvanse [to] establish a tapering schedule,” Andrea Paul, MD, Internist and Medical Advisor to Illuminate Labs says. “This means that the patient would take lower doses of the medication over time until they reach a zero dose. This method has been shown to reduce uncomfortable symptoms, and physicians have the requisite knowledge and experience to guide the patient through this process.”

Ultimately, whether you or your loved one are considering a scheduled medication holiday, tapering medication use, or switching to a different medication altogether, a conversation should be had with the prescribing healthcare provider, where team-based, informed decision-making is used to determine what is best for each person.

Stopping Vyvanse safely

In order to safely and effectively stop taking ADHD medication like Vyvanse, it is critical to be under the care of a medical doctor and to follow medical advice during stopping periods.

Choose a day that will work well for the child and the family’s schedule. Inform your child about what a drug holiday is and when you will withhold their daily medication.
It is important to consider both the child and the family’s ability to care for the child when deciding to take a Vyvanse drug holiday. Some parents are better able to handle ADHD symptoms than others.
Adhering to drug holidays may be very difficult. Discuss as a family what a medication holiday would look like. Consider coping mechanisms and activities to deal with ADHD symptoms in a way that is loving and kind. Most children do very well with outdoor activities and exercise.
Consider trialing a drug holiday in older children. This allows older children to self-assess their ability to manage without medication and their need for longer-term treatment.
Talk to your healthcare provider about using a non-stimulant medication after discontinuing Vyvanse and how to incorporate behavior therapy for the child and the parents.
Have realistic expectations. Drug holidays may not work for every child and every family. Thankfully, these types of medications work relatively quickly. If stopping Vyvanse is not right for you or your child, people usually feel “normal” again shortly after re-starting their medication.

Sources:

The Pharmaceutical Development Group, Drug Holidays–Temporary Suspension of therapy; drug labeling consultant’s perspective
Pharmacokinetics and pharmacodynamics of lisdexamfetamine compared with D-amphetamine in healthy subjects
Trends in the parent-report of health care provider diagnosed and medicated ADHD: United States: 2003-2011
CDC, Data and statistics about ADHD
NICE Guideline, No. 87, Withdrawal from pharmacological treatment and drug holidays
Takeda, Vyvanse
FDA Highlights of Prescribing Information, Vyvanse
The complicated relationship between attention deficit/hyperactivity disorder and substance use disorders
The potential for misuse and abuse of medications in ADHD: a review
Wellness Resource Center, Stimulant addiction signs, symptoms, & effects
CDC, Symptoms and diagnosis of ADHD
Growth and puberty in a 2-year open-label study of lisdexamfetamine dimesylate in children and adolescents with attention-deficit/hyperactivity disorder
Drug holidays from ADHD medication: international experience over the past four decades
The dopamine dilemma–part II