What Is Lisdexamfetamine?
Lisdexamfetamine (often referred to by the brand name Vyvanse) is a prescription stimulant that is an effective treatment for attention deficit hyperactivity disorder (ADHD) and for the eating disorder called binge eating disorder.
There are concerns about the potential for abuse [1] of lisdexamfetamine, and if you are worried about yourself or someone you care for, remember you are not alone. Learning about the risks associated with lisdexamfetamine is the first step in using it safely or obtaining help.
Brand and Generic Names
Lisdexamfetamine is the drug generic name; “Vyvanse” is the most commonly used brand name.
Approved Uses
The FDA approves it for the treatment of the following:
- ADHD
- Moderate to severe binge eating disorder in adults
It is not approved as a weight-loss medication despite being recognised as a medication with appetite-suppressant effects.
Why It Is Classified as a Controlled Substance
All controlled substances have various criteria that define their classifications. Schedule II controlled substances are described as medications that possess a high potential for abuse [2] and may lead to severe psychological or physical dependence, yet have accepted medical uses in the US.
Because it is a Schedule II controlled substance, healthcare professionals will monitor the administration of the drug, so there is no automatic assumption of misuse or wrongdoing.
At a Glance
- Dosage: Capsules or Chewable Tablets
- Onset of action: Gradually, once converted to active medication by the body
- Duration of action: Generally lasts most of the day
- Schedule Classification: Schedule II
- Route of Administration: Oral only
Is Lisdexamfetamine Addictive?
Yes, this is a frequently asked question concerning this medication. It may be abused, mainly when misused.
Addiction vs Dependence vs Tolerance
Understanding these terms helps clarify confusion:
- Addiction: A condition involving compulsive drug use despite harm to the user.
- Dependence: When physical or psychological dependence occurs [3], if you stop taking the medication abruptly or reduce the dosage, you may experience withdrawal symptoms.
- Tolerance: When a person develops a tolerance to a substance, it means they require increasingly larger doses to experience the same effect as they did with their previous lower doses.
You may develop a dependence or a tolerance to Lisdexamfetamine without being addicted to the drug; however, it is also possible for a person to develop all three of these conditions.
When Prescribed Use Becomes Risky
Risk increases when lisdexamfetamine is taken in higher doses than prescribed, used more frequently, or used for any reasons other than that for which it was prescribed, such as weight loss or staying awake.
According to the National Institute on Drug Abuse, stimulants increase dopamine [4] and norepinephrine activity in the brain and spinal cord, which are involved in focus, motivation, and reward. At higher or non-prescribed doses, this effect can feel reinforcing and lead to repeated misuse.
How Lisdexamfetamine’s Abuse Potential Works
Prodrug Design Explained
Lisdexamfetamine is a prodrug, meaning it must be converted in the body into its active form, dextroamphetamine. This conversion happens gradually after oral ingestion. In practice, this design reduces [5] how quickly the drug takes effect compared to some immediate-release stimulants.
Why Manipulation Is Less Reinforcing
Because of its prodrug nature, crushing or altering the medication is less likely to produce an immediate spike in effects compared to some alternatives. Research indicates that this may reduce certain forms of misuse [6], but it does not eliminate risk.
What prodrug design does not prevent is high-dose oral misuse, frequent re-dosing, or using it together with alcohol.
How Does Its Abuse Risk Compare to Other Stimulants?
Lisdexamfetamine is considered to cause lower, immediate euphoric effects [1] compared to some of the immediate-release stimulants; however, misuse can still occur. When interpreting this, it is essential to recognize that ‘lower’ does not mean ‘low.’
| Medication |
Type |
Formulation |
Euphoric potential |
Common misuse patterns** |
| Lisdexamfetamine (Vyvanse) |
Amphetamine |
Prodrug |
Lower |
Study aid, weight loss |
| Adderall IR/XR |
Amphetamine salts |
Immediate-Release or Extended-Release |
Moderate to higher |
Performance enhancer, study aid, weight loss, euphoria |
| Dextroamphetamine Immediate-Release |
Amphetamine |
Immediate-Release |
Higher |
Recreational use |
| Methylphenidate |
Stimulant |
Immediate-Release or Extended-Release |
Higher |
Study aid |
| Methamphetamine/Cocaine |
Illicit stimulants |
Variable |
Very high |
Euphoria, overdose risk |
**Although different stimulants have particular patterns, all of the misuse patterns listed here apply to all substances in this category
Signs of Dependence and Addiction to Watch For
Examples of signs of dependence and addiction to lisdexamfetamine could include:
Signs of Dependence: Using a larger dose than what was prescribed to achieve the same or greater effect; using more than prescribed to ‘feel normal’; anxiety about when to refill or running out of their last refill.
Behavioral Signs: Getting drugs from other people without a prescription, neglecting responsibilities like school or work, doctor shopping (visiting multiple doctors in order to get multiple prescriptions of the same medication).[4]
Physical and Psychological Signs: Sleep disorder from using lisdexamfetamine; changes in appetite; increased agitation, mood swings, or anxiety.
Red Flags Noticed by Others: Personality changes; increased secrecy; financial problems, school problems, or work-related problems.
Withdrawal and Crash Symptoms
Symptoms of withdrawal can include fatigue, depression, changes in sleep patterns, increased appetite [7], malaise, and cravings. Do not abruptly discontinue or reduce your dosage of lisdexamfetamine without discussing it with your prescribing physician.
If you have been using lisdexamphetamine obtained illicitly, you can still feel safe seeking medical attention from a doctor, emergency department, or treatment center.
Seek medical attention immediately for severe depression, psychosis, or thoughts of self-harm.
Health Risks of Misuse (Short and Long Term)
Cardiovascular and Physical Risks: Misuse can strain the heart, elevate blood pressure, cause palpitations from taking larger doses than prescribed, and lead to overheating.
Mental Health Risks: High dose or prolonged misuse may increase anxiety [7], paranoia, or stimulant-induced psychosis, which may include hallucinations or delusions.
Overdose Risk: Call 911 immediately if an overdose is suspected; emergency symptoms [4] include chest pain, severe agitation, confusion, or loss of consciousness.
Treatment for Lisdexamfetamine Misuse or Addiction
Treatment for abuse and dependence involves different parameters and approaches based on the person requiring treatment.
Assessment: Typically, the first step is for clinicians to evaluate use patterns, mental health, and co-occurring conditions.
Detox and Stabilization: Medical detoxification may be used if acute withdrawal symptoms warrant medical supervision.[7]
Inpatient or Outpatient Care: Residential treatment is more appropriate for individuals with significant abuse and relapse risk or a dual diagnosis. Outpatient care may work for some with support.
Evidence-Based Therapies:
- Cognitive-behavioral therapy (CBT, a form of talk therapy that focuses on identifying and changing unhelpful thoughts and behaviors): Assists patients in identifying negative behavioral patterns and replacing them with positive ones.
- Dialectical behavior therapy (DBT) helps patients manage intense or highly charged feelings.
- Contingency Management: Strategies used with relapse prevention to support recovery.
