Vyvanse: New Treatment for ADHD

 Vyvanse, the new ADHD medicine, has a unique prodrug delivery system developed to prevent abuse.  In addition to marked reduced abuse and misuse, studies have shown other major advantages over Adderall XR – the most prescribed medication for ADHD.  Vyvanse has been found to be more consistent in its effect, more effective, especially for attention, longer acting and to have less rebound symptoms in the afternoon.    

 How is Vyvanse different from Adderall?

  • Adderall is 75% dextroamphetamine (dexedrine) + 25% levoamphetamine (mostly effects norepinephrine) 
  • Vyvanse is 100% dextroamphetamine as the active ingredient but it is bound to an amino acid, L lysine.  Because the amino acid has to be removed by a protease enzyme located  primarily in the intestine before it works, it is designated as a "prodrug".

Note:  The additional norepinephrine effect of Adderall may help alertness and distractibility but it is also responsible for most of the risks and side effects of Adderall.  Many patients taking Adderall do better taking it with Tenex. test.askdrjones.com/  Men on Adderall XR are more likely to have erectile dysfunction and need Viagra type medication.  Some people, especially older men have trouble urinating when taking Adderall XR and may need Flomax.  Patients switching to Vyvanse have been less likely to have these side-effects. 

  Other side-effects related to norepinephrine include:

  • dry mouth
  • muscle tightness
  • nervousness
  • stomach aches
  • cardiovascular effect (so less risk of increasing blood pressure)

Vyvanse is much more consistent than Adderall XR from day to day and patient to patient.  Vyvanse consistently reaches peak blood levels in 3 1/2 to 5 hours at a concentration of 100-175 ng/ml for a 70mg capsule.  Adderall XR has 400% variability – it peaks anywhere from 3 to 12 hours at levels of 70-300 ng/ml for a 30mg capsule.

Acidity levels in the stomach and small intestine and levels of gastrointestinal motility significantly impact absorption of XR but not Vyvanse.  Food, especially fat in the stomach or intestine can delay Adderall XR up to 2 1/2 hours but maximum delay of Vyvanse absorption is less than an hour.  Since it takes 3 hours to digest a fatty meal, forgetting to take XR before eating can result in significant stretches of time with reduced focus and productivity.

Vyvanse may be more likely to increase insomnia, decrease appetite, and increase weight loss – probably because it has a longer duration of action.

In a study where patients took alternately Adderall XR and Vyvanse almost 75% did much better.  However, twice as many patients on Vyvanse did very much better.

"Effect size" is a statistical measure of efficacy when comparing different studies.  The effect size for Vyvanse was significantly higher than any other medication ever studied for ADHD.  Also, when tested in known stimulant abusers it was significantly less likable than oral or IV dexedrine which means it is less abuse prone.

I have tried Vyvanse in approximately 200 patients – these were mostly patients taking Adderall.  Almost everyone that switched prefers Vyvanse.  One woman said that Adderall made her nervous and jittery which caused her to smoke more.  On Vyvanse she’s not smoking.  I still have a few patients that prefer Adderall.  Some probably prefer the increased mood or likability effect.  Some probably need the norepinephrine effect.

My prediction:  Vyvanse will rapidly become the number one medication for ADHD.

 Related ADHD article: test.askdrjones.com/2007/09/06/only-13-of-adhd-kids-are-being-consistently-treated-why-are-we-not-taking-better-care-of-our-greatest-resource/

 

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4 Responses to “Vyvanse: New Treatment for ADHD”

  • Kat says:

    Do you have any conflicts of interest regarding Shire Pharmaceuticals?

    If the above statements are true, then surely you must have first considered a switch to the less expensive, generic, and more efficacious dextroamphetamine (either immediate-release or sustained-release)?

    • Dr. Jones reply: says:

      Thank you for your question. I have not had any conflicts of interest with Shire Pharmaceuticals in the recent past. When it first came out I was one of the clinical consultants to the company and a national speaker – which means I learned every nuance of the medication. I have never promoted a medication because of that reason. I try to find the right medication for each individual patient purely on the symptoms they present when I evaluate them.

      Vyvanse and Dexedrine have the exact same active ingredient – the majority of patients in my experience prefer Vyvanse (which lasts up to 12-14 hours). However, some patients like to extend their functional day by adding Dexedrine in the afternoon. Admittedly some patients prefer more immediate acting (but much briefer duration) because they like the better hour to hour control. When comparing generic dexedrine to Vyvanse you need to know that Vyvanse 70mg has only 21mg of active ingredient whereas Dexedrine 10mg has 7.5mg of active ingredient. Many generic dexedrines only have to be within 20% vs. brand medications have to be within 5%. Vyvanse is slower to kick in, but smoother and lasts 3-4 times as long. Food slightly delays absorption of Vyvanse. Other variables such as acid urine will significantly decrease duration of Vyvanse or Dexedrine, but Vyvanse is much less so in the first few hours after taking since it has to first be metabolized to its active form. Of course now Vyvanse is available everywhere, whereas generic dexedrine is hard to find in many pharmacies.

      Apparently the DEA is slow to increase approval of raw ingredients to the pharmaceutical companies and the pharmaceutical companies are preferencially making the expensive stuff – it’s America! Dr. Wayne Jones

  • Michelle says:

    I, too have taken both. I was diagnosed in college and started taking Adderall. Every doctor I’ve had has tried to switch me to Adderall XR, and each time I’ve tried it again at varying dosages with no success. I found that with XR, the medication would “run out” at around 5 hours and then I’d spend the rest of my day in a fog. On my most recent doctor change, I was switched to Vyvanse. I found that I would have a severe episode of gastrointestinal upset in the morning after taking my morning dose. I stayed on the medication and increased the dose several times after finding that it, too, would “run out.” We tried splitting the dose in half (take 1 part in the morning, 1 in the afternoon), and adding an additional faster acting stimulant tablet towards the end of the day, but all with no success. The bottom line for me was that after almost a year on Vyvanse, I was falling behind at work, showing up late, and my personal life was spiraling out of control. It did nothing for my distractability, which is why I’m taking medication in the first place.

    I recently switched back to Adderall. When I first started taking meds for my ADD I discovered that much of the frustration I had experienced in my childhood and teen years had come from me being very type A, but not capable of acting on it. As such, I much prefer to have control over my medication. Sometimes I need more, sometimes I need less. I know how long it will last and when it is wearing off. I know when I need to take it in order for it to be active when I need it. Having a sense of control is key for me, and Vyvanse couldn’t provide that in any dose (ranging from 40 – 100). I’ve been told by numerous doctors that Adderall, Vyvanse, Ritalin, and the like are “all the same”, but I can tell you that for me, even different manufacturers make a difference. God forbid Barr ever stops producing those little orange generic Adderalls. The pink pills (theoretically the exact same medication) don’t work and have awful side effects. I’m glad to see more choices on the market, but I hope that doctors and pharmaceutical companies continue to allow for personal differences.

  • Max Dunlap says:

    I’ve noticed subtle but noticeable differences between the two medications. They seem to begin working at roughly the same time when taken with a small mean 30-40 minutes, however Adderall seems to have a little shorter running-time as compared to Vyvanse. About 5 or 6 hours for me with a 50mg dosage of Vyvanse. The concentration effect is a bit different, Adderall feels like it just has that ‘no nonsense one dimensional JUST NEED TO STUDY kind of feel’ – Vyvanse tends to be a little more inward, I tend to concentrate more on my own thoughts, I feel I need to prioritize the things I want to do… because I get so many new ideas. As for the physical effects, Vyvanse defiantly give more dry mouth and sometimes I will experience a mild upset stomach that makes my stomach feel like its more acidic, because of the drug. Contrary to your findings, I’ve noticed that in comparison to Adderall, Vyvanse gives less of an appetite digression… I am able to eat normally. Muscle tension and mild jaw clenching are evident, but are expected with any sort of stimulant (IE Coffee). Lastly, the ‘come-down’ of Vyvanse is much MUCH better, I would feel a bit empty and anxious when Adderall was wearing off – especially after taking larger doses, with Vyvanse I’ve experienced virtually no negative comedown feelings, after normal usage. One complaint or warning I have about these drugs, is… despite the ‘pro-drug’ efforts Shire has taken. These stimulants are very easy to abuse, and its very easy to start counter-productive bad habits as well as well as develop an over dependence on the drug. Like saying “I don’t need to do any of my work now because I’ll take my meds and get it all done at the last minute” this drastically changes your schedule, because you are taking the drug at different times and not prioritizing things appropriately, because you feel you can do it all, it becomes VERY easy to give in to your distractions and focus completely on them, instead of the task at hand. It is the duty of the psychiatrist to explain proper usage and scheduling to the patient.