Vyvanse side effects and how to avoid them

Vyvanse side effects | Vyvanse crash | Weight loss | Anxiety | Withdrawal | How long do side effects last? | Warnings | Interactions | How to avoid side effects

Vyvanse (active ingredient: lisdexamfetamine dimesylate) is a brand-name prescription drug that treats attention deficit hyperactivity disorder (ADHD) in adults and children older than 6 years. It’s also approved for binge-eating disorder (BED) in adults but is typically used as a second-line therapy. 

Vyvanse belongs to a class of central nervous system stimulants called amphetamines. Its primary effect is to speed up the brain. Unlike most other stimulant medications, Vyvanse is a prodrug, which means it has no effect until it’s metabolized by the body into its active form, dextroamphetamine. Like all stimulant medications, Vyvanse may not be right for everyone. Side effects, warnings, and drug interactions need to be discussed with a doctor before starting this medication. 

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Common side effects of Vyvanse

Vyvanse side effects will vary between patients. Stimulants reduce hyperactivity, inattentiveness, and impulsiveness in patients with ADHD, but may have the opposite effect in patients incorrectly diagnosed with ADHD. Someone who takes Vyvanse but doesn’t need it can experience anxiety, restlessness, agitation, nervousness, racing heartbeat, or excessive sweating.

When taken for ADHD, the most common side effects of Vyvanse are:

• Decreased appetite
• Loss of appetite
• Weight loss
• Diarrhea
• Nausea
• Vomiting
• Upper stomach pain
• Dry mouth
• Dizziness
• Insomnia
• Irritability
• Anxiety

When taken for binge-eating disorder, the most common side effects of Vyvanse are:

• Decreased appetite
• Constipation
• Dry mouth
• Increased heart rate
• Insomnia
• Anxiety
• Feeling jittery

Serious side effects of Vyvanse

All medications that alter the central nervous system can produce serious and even life-threatening side effects. Many severe side effects of Vyvanse are related to its effects on speeding up the brain and the nervous system.

The most serious side effects of Vyvanse include:

• Psychiatric problems such as anxiety, aggression, or mania
• Neurological disorders such as tics, seizures, or serotonin syndrome
• Heart problems such as rapid heartbeat, heart attack, and sudden death in people with heart problems
• Circulation problems such as high blood pressure, stroke, peripheral blood vessel damage, skin color changes, and Raynaud’s phenomenon
• Severe allergic reactions
• Dependence, drug abuse, and withdrawal symptoms if discontinued abruptly

Vyvanse crash

The effects of a morning dose of Vyvanse typically wear off by the afternoon or evening. When they do, some patients experience a “Vyvanse crash” characterized by fatigue, tiredness, depression, irritability, anxiety, nervousness, and mood swings. Symptoms of a Vyvanse crash are very similar to Vyvanse withdrawal. 

The Vyvanse crash can’t always be avoided, but it can be successfully managed:

• Plan your schedule: Plan the day’s most important activities during the hours that Vyvanse is most active in the body. Schedule a long break around the time of day the Vyvanse crash typically occurs.
• Avoid depressants: Vyvanse crash symptoms may worsen if you’re taking other substances that depress the central nervous system such as alcohol, sedatives, muscle relaxants, anticonvulsants, and sleep aids.
• Practice good sleep hygiene: Lack of sleep also contributes to the Vyvanse crash. There are several good habits you can use to ensure sufficient sleep at night such as engaging in relaxing activities before bedtime, going to bed at the same time every night, and eliminating distractions when you go to bed.
• Talk to your doctor: Vyvanse isn’t necessarily for everyone. Your healthcare provider may suggest alternatives such as modifying the dose, changing the dosing schedule, or switching to another medication.

Weight loss

Two pronounced side effects of Vyvanse are decreased appetite and weight loss. While decreased appetite is equally common among adults and children, weight loss is a more common side effect of Vyvanse in children. In the initial clinical trials of Vyvanse, almost 1 in 10 children taking Vyvanse for four weeks lost weight in proportion to the dose: the larger the dose, the greater the average amount of weight was lost. Children on Vyvanse also exhibit slower growth than other children.

Only 3% of adults taking Vyvanse for ADHD lost weight in a similar four-week period. However, when Vyvanse is taken for binge eating disorder, weight loss was experienced in 4% of patients. Later studies show that a clinically significant number of people with binge eating disorder lose weight when taking Vyvanse by reducing appetite and the number of binge eating episodes each week.

Because lowered appetite and weight loss are side effects of Vyvanse, some physicians prescribe Vyvanse off-label for severe obesity in children and adolescents.

Anxiety

In previous studies, 5% to 6% of adults report anxiety as a side effect of Vyvanse. Children experience anxiety as a Vyvanse side effect less often. In one study, anxiety and agitation was reported in less than 1% of children.

Normally, stimulants such as Vyvanse speed up and excite the brain, so alertness, energy, nervousness, restlessness, agitation, racing thoughts, and anxiety are common side effects. However, in people with ADHD, certain stimulants increase alertness, attention, and impulse control while reducing hyperactivity, anxiety, and restlessness. These stimulants increase certain chemicals in the brain—dopamine and norepinephrine. Because patients with ADHD do not produce enough of these chemicals, stimulants improve their ability to manage hyperactivity and attention.

Too much dopamine and norepinephrine, a chemical similar to adrenaline, overexcites the brain and causes high energy, inattention, nervousness, agitation, excitability, or euphoria. If a person with normal levels of dopamine and norepinephrine is experiencing anxiety, Vyvanse will probably worsen the anxiety. Side effects such as anxiety, jitteriness, and tension may be indications that either Vyvanse or the dose prescribed is inappropriate.

Withdrawal

Vyvanse is a Schedule II controlled substance, meaning it has a high potential for abuse and dependence. When used over a long period, Vyvanse can cause withdrawal symptoms if the dose is reduced or the drug is suddenly discontinued. These symptoms include:

• Fatigue
• Excessive sleeping
• Depression
• Mood swings
• Increased appetite
• Cravings

Most Vyvanse withdrawal symptoms resolve in five to seven days. The prescribing physician may use a tapering dose to prevent or reduce withdrawal symptoms. There are certain side effects such as serotonin syndrome or heart problems that will require that Vyvanse be immediately discontinued. 

How long do side effects last?

Vyvanse remains active in the body for eight to 14 hours, so side effects should fade in that time. Vyvanse withdrawal symptoms, however, can last as long as seven days. If side effects do not go away after discontinuing Vyvanse, talk to a doctor.

Vyvanse contraindications & warnings

Vyvanse is not the right medication for everyone. People with the following health conditions should not take Vyvanse:

• Hypersensitivity to amphetamines or any of the other ingredients in Vyvanse
• Pregnant or breastfeeding women
• Heart disease, heart defects, arrhythmias, or coronary artery disease

Other cautions exist.

People taking monoamine oxidase inhibitors (MAOIs), a class of drugs that includes some types of antidepressants, antibiotics, or drugs that treat Parkinson’s disease, will not be prescribed Vyvanse until they have stopped taking MAO inhibitors for at least 14 days.

Slowed growth in children

Vyvanse has been FDA approved as a safe treatment for ADHD in children between the ages of 6 and 17. However, Vyvanse suppresses growth in children, so height and weight need to be carefully monitored. Vyvanse therapy may need to be modified if growth suppression is too pronounced.

Pregnancy and breastfeeding

There’s not enough data available to determine the safety of Vyvanse use in pregnant or nursing mothers. Dextroamphetamine does cross the placenta and is present in small amounts in breast milk. However, if you have been taking Vyvanse, do not suddenly discontinue it without speaking to your healthcare provider.

Seniors

The safety of Vyvanse use in people older than 65 has not been well-studied. When deemed safe by a healthcare professional, seniors often start with a low dose of Vyvanse.

Vyvanse interactions

Vyvanse has clinically significant interactions with more than 200 drugs and other substances. Most of these interactions are not hazardous, but people may notice that either Vyvanse or other drugs are less effective when taken together.

MAO inhibitors

Vyvanse should never be taken within at least 14 days of taking monoamine oxidase inhibitors (MAOIs), including certain types of antidepressants, antibiotics, and Parkinson’s medications such as:

• Tranylcypromine
• Marplan (isocarboxazid)
• Nardil (phenelzine)
• Linezolid
• Selegiline
• Xadago (safinamide)
• Methylene blue injection

In combination with Vyvanse, the effects of these drugs can cause dangerously high blood pressure.

Stimulants

Vyvanse can enhance the effects of other CNS stimulants, including increased blood pressure and heart rate. CNS stimulants include:

• Caffeine, cocaine, or ginseng
• Other ADHD medications
• Certain nasal decongestants
• Appetite suppressants such as phendimetrazine
• Wakefulness agents that treat narcolepsy
• Steroids
• Sympathomimetic medications such as epinephrine or norepinephrine

Depressants

In general, combining stimulants with depressants is rarely advisable. Amphetamines such as Vyvanse usually blunt the effects of depressants, but some combinations of amphetamines and depressants can be hazardous. Vyvanse should not be used with depressants such as:

• Alcohol, marijuana, or cannabinoids
• Cough medications
• Narcotics
• Sedatives
• Barbiturates
• Anxiety medications
• Nerve pain drugs
• Anti-nausea drugs
• Anticonvulsants
• Some Parkinson’s disease medications

Antidepressants and serotonergic medications

Unless deemed safe by a healthcare provider, do not use Vyvanse in combination with any other drug that alters levels of serotonin. Antidepressants, some migraine medications, and certain appetite suppressants taken in combination with Vyvanse increase the risk of serotonin syndrome.

Blood pressure medications

Amphetamines such as Vyvanse raise blood pressure, so they block the effects of medications intended to lower blood pressure. Combining amphetamines with blood pressure medications will require close monitoring and possibly therapy modification. Amphetamines are also avoided in combination with medications that raise blood pressure.

Acidifying or alkylating agents

Drugs that increase (acidify) or decrease (alkylate) the acid content in the stomach or urine will reduce the body’s ability to absorb Vyvanse and interfere with the ability to eliminate Vyvanse. In particular, when taking Vyvanse, avoid antacids, acidic foods, citrates, and diuretics. Certain multivitamins should also be avoided. 

Ask a healthcare professional for a complete list of drug and food interactions.

How to avoid Vyvanse side effects

Stimulants such as Vyvanse commonly cause side effects. Because Vyvanse speeds up the brain, it’s not uncommon to experience side effects such as decreased appetite, insomnia, elevated blood pressure, fast heart rate, agitation, or restlessness. Some patients experience a “Vyvanse crash” similar to withdrawal when the drug wears off later in the day.

A few tips can help manage Vyvanse side effects:

• Take Vyvanse as directed. Don’t increase or decrease the dose. If the medicine does not seem to be working or side effects occur, talk to the prescribing physician about changing the dose or switching to a new medication. Always follow instructions on the medication guide.
• Take Vyvanse at the same time each morning. Vyvanse should be taken early in the morning. Pick a time that is at least one hour before alertness and focus is required and stick to that schedule. If you miss a dose, take it later in the morning. However, avoid taking a dose in the afternoon to avoid sleeplessness at bedtime. 
• Disclose all of your medical conditions and medications. This will prevent side effects and dangerous interactions from occurring.
• Find a coffee alternative. Other stimulants may increase the risk and severity of Vyvanse side effects, so it’s a good idea to avoid them. In addition to certain medications, stimulants also include caffeine. You may need to find an alternative pick-me-up to your daily cup of coffee.
• Practice good sleep hygiene. Difficulty sleeping is one of the most common side effects of Vyvanse. The first step in overcoming medication-induced sleeplessness is to practice good, daily sleep hygiene practices. Avoid TV or video games before bedtime, develop a nighttime relaxation routine, and go to bed at the same time every night.
• Take a medication holiday (if approved by your doctor). If side effects are a problem when taking ADHD stimulants, the prescribing doctor may suggest taking a “medication holiday” where the medication is discontinued or the dose reduced for a few days, weeks, or even months. 

Taking a medication holiday, however, is not for everyone. Patients with moderate to severe ADHD symptoms may need to keep to a rigorous dosing schedule. Taking a medication holiday for binge eating disorder will raise the risk of severe binge eating. Seek professional medical advice first; there may be alternative therapies with fewer side effects.

Resources:

• Binge eating disorder, StatPearls
• Vyvanse, Epocrates
• Vyvanse prescribing information, FDA 
• Review of lisdexamfetamine dimesylate in adults with attention deficit hyperactivity disorder, Journal of Central Nervous System Disease
• Vyvanse for binge eating disorder, Takeda
• Vyvanse for ADHD, Takeda
• Lisdexamfetamine in the treatment of moderate-to-severe binge eating disorder in adults, Neuropsychiatric Disease and Treatment
• Use of lisdexamfetamine to treat obesity in an adolescent with severe obesity and binge eating, Children
• Reduced risk of anxiety with psychostimulant treatment in children with attention deficit hyperactivity disorder, Journal of Child and Adolescent Psychopharmacology
• Are there risks of long-term damage from abusing Vyvanse?, American Addiction Centers
• Transfer of dexamphetamine into breast milk during treatment for attention deficit hyperactivity disorder, British Journal of Clinical Pharmacology