lisdexamfetamine

(lis-dex-am-fet-a-meen) lisdexamfetamine,

Vyvanse

(trade name)

Classification

Therapeutic: central nervous system stimulants
Pharmacologic: sympathomimetics
Pregnancy Category: C

Indications

Management of attention deficit hyperactivity disorder (ADHD) (in adults and children).

Action

Blocks reuptake and increases release of norepinephrine and dopamine resulting in increased levels in extaneuronal space.

Therapeutic effects

Improved attention span in ADHD.

Pharmacokinetics

Absorption: Rapidly absorbed and converted to dextroamphetamine, the active drug.Distribution: Unknown.Metabolism and Excretion: 42% excreted in urine as amphetamine.Half-life: less than 1 hr for lisdexamfetamine.

Time/action profile

ROUTE	ONSET	PEAK	DURATION
PO	rapid	1 hr	24 hr

Contraindications/Precautions

Contraindicated in: Hypersensitivity to lisdexamfetamine or other sympathomimetic amines; Advanced arteriosclerosis; Symptomatic cardiovascular disease including known structural cardiac abnormalities (may ↑ the risk of sudden death); Moderate to severe hypertension; Glaucoma; Agitation; Lactation: Lactation; History of substance abuse; During or within 14 days of MAO inhibitor therapy.Use Cautiously in: History of pre-existing psychosis, bipolar disorder, aggression, tics, Tourette's syndrome or seizures (may exacerbate condition); Obstetric: Use only if maternal benefit outweighs fetal risk; Pediatric: Children <6 yr (safety and effectiveness not established).

Adverse Reactions/Side Effects

Central nervous system

behavioral disturbances
dizziness
hallucinations
insomnia
irritability
mania
psychomotor hyperactivity
thought disorder
tics

Cardiovascular

sudden death (life-threatening)
Raynaud's phenomenon

Ear, Eye, Nose, Throat

blurred vision
poor accommodation

Gastrointestinal

abdominal pain
↓ appetite
dry mouth
nausea
vomiting

Dermatologic

rash

Metabolic

↓ weight

Neurologic

paresthesia

Miscellaneous

long-term growth suppression

Interactions

Drug-Drug interaction

Serious adverse reactions including hyperpyrexia and hypertension may occur with monamine oxidase inhibitors ; avoid use within 14 days.Concurrent use of other sympathomimetic amines may result in additive effects and ↑ risk of adverse reactions.Urinary acidifying agents including ammonium chloride and sodium acid phosphate ↑ excretion and ↓ blood levels and may result in ↓ effectiveness.May ↓ effectiveness of adrenergic blockers.↑ risk of adverse cardiovascular reactions with tricyclic antidepressants.May ↓ sedating effects of antihistamines.May ↓ effectiveness of antihypertensives..Effects may be ↓ by haloperidol, lithium, or chlorpromazine.May ↓ absorption of phenobarbital or phenytoin.

Route/Dosage

Oral (Adults and Children 6–17 yr) 30 mg daily; may ↑ by 10–20 mg/day at weekly intervals, up to 70 mg/day.

Availability

Capsules: 20 mg, 30 mg, 40 mg, 50 mg, 60 mg, 70 mg Cost: 20 mg $531.93 / 90, 30 mg $566.90 / 90, 40 mg $509.91 / 90, 50 mg $514.34 / 90, 60 mg $529.67 / 90, 70 mg $500.01 / 90

Nursing implications

Nursing assessment

Assess child's attention span, impulse control, and interactions with others. Therapy may be interrupted at intervals to determine whether symptoms are sufficient to continue therapy.
Monitor BP, pulse, and respiration before administering and periodically during therapy. Obtain a history (including assessment of family history of sudden death or ventricular arrhythmia), physical exam to assess for cardiac disease, and further evaluation (ECG and echocardiogram), if indicated. If exertional chest pain, unexplained syncope, or other cardiac symptoms occur, evaluate promptly.
- Monitor growth, both height and weight, in children on long-term therapy.
- Monitor closely for behavior change.
- Lisdexamfetamine has the potential for dependence and abuse. Prolonged abuse may result in tolerance.
Lab Test Considerations: May cause ↑ plasma corticosteroid levels interfering with urinary steroid determinations.

Potential Nursing Diagnoses

Disturbed thought process (Side Effects)

Implementation

Oral: Administer in the morning without regard to meals. Afternoon doses should be avoided due to potential for insomnia. Capsules may be swallowed whole or opened and the entire contents dissolved in a glass of water. If solution method is used, consume immediately; do not store for future use. Do not divide capsules or take less than one capsule per day.

Patient/Family Teaching

Instruct patient to take medication as directed. Advise patient and parents to read Medication Guide prior to initiation of therapy and with each renewal of Rx refill. If more than prescribed amount is taken notify health care professional immediately. Instruct patient not to alter dose without consulting health care professional.
- Inform patient that sharing this medication may be dangerous.
- Advise patient to check weight 2–3 times weekly and report weight loss to health care professional. Pediatric: If reduced appetite and weight loss are a problem, advise parents to provide high calorie meals when drug levels are low (at breakfast and or bedtime).
- Inform patients starting therapy of risk of peripheral vasculopathy. Instruct patients to notify health care professional of any new numbness; pain; skin color change from pale, to blue, to red; or coolness or sensitivity to temperature in fingers or toes, and call if unexplained wounds appear on fingers or toes. May require rheumatology consultation.
- Advise parents to notify health care professional immediately if child has signs of heart problems (chest pain, shortness of breath, fainting) or if new or worsening mental symptoms or problems, especially seeing or hearing things that are not real, believing things that are not real, or are suspicious occur.
- May cause dizziness or blurred vision. Caution patient to avoid driving or activities requiring alertness until response to medication is known.
- Advise patient to notify health care professional if nervousness, restlessness, insomnia, dizziness, anorexia, or dry mouth becomes severe.
- Advise patient to notify health care professional of all Rx or OTC medications, vitamins, or herbal products being taken and to consult with health care professional before taking other medications.
- Inform patient that health care professional may order periodic holidays from the drug to assess progress and to decrease dependence.
- Advise patient to notify health care professional if pregnancy is planned or suspected, or if breastfeeding.
- Caution patients to inform health care professional if they have ever abused or been dependent on alcohol or drugs, or if they are now abusing or dependent on alcohol or drugs.
- Emphasize the importance of routine follow-up exams to monitor progress.
Home Care Issues: Advise parents to notify school nurse of medication regimen.

Evaluation/Desired Outcomes

Improved attention span, decreased impulsiveness and hyperactivity in ADHD.