lisdexamfetamine dimesylate: prescribing and clinical use
Focused clinical detail for use alongside current product information, local policy and patient-specific assessment.
lisdexamfetamine dimesylate: clinical details
Prescribing considerations
- Initiate and supervise treatment through an appropriate ADHD specialist as part of a comprehensive programme.
- Confirm diagnosis and functional impairment through full developmental, psychiatric, medical and social assessment.
- Assess cardiovascular status, concurrent medicines, psychiatric comorbidity, family history of sudden cardiac death, weight and, in children, height and growth.
- Assess misuse, dependence and diversion risk; counsel on secure storage and disposal.
- Review ongoing benefit and tolerability, including whether pharmacotherapy remains appropriate.
Contraindications and cautions
- Hypersensitivity to sympathomimetic amines or an excipient
- Current or recent monoamine oxidase inhibitor treatment
- Hyperthyroidism or thyrotoxicosis
- Agitated states
- Symptomatic cardiovascular disease or advanced arteriosclerosis
- Moderate to severe hypertension
- Glaucoma
- Phaeochromocytoma
Monitoring
- Blood pressure and pulse, including after treatment changes
- Weight and appetite; also height and growth in children and adolescents
- New or worsening psychiatric symptoms, including mania, psychosis, aggression and suicidality
- Tics, seizures and visual symptoms where clinically relevant
- Adherence, response, adverse effects, misuse and diversion
Clinical pharmacology
An inactive prodrug absorbed from the gastrointestinal tract and hydrolysed mainly by red blood cells to active dexamfetamine. Dexamfetamine increases extracellular dopamine and noradrenaline through effects on monoamine release and reuptake.
Formulation and product differences
- Elvanse is supplied as hard capsules; capsule shell colour and colourants vary between strengths.
- The capsule may be swallowed whole or opened, provided the entire contents are immediately consumed after dispersion in a supported food or drink.
- The selected capsule formulation contains gelatine and is essentially sodium-free.
lisdexamfetamine dimesylate preparations and strengths
Capsule
Route: Oral
Strengths: 20 mg, 30 mg, 40 mg, 50 mg, 60 mg, 70 mg
lisdexamfetamine dimesylate interactions
Tell the prescriber and pharmacist about all medicines, supplements and non-prescription products. Important interactions include:
Monoamine oxidase inhibitors, including phenelzine, tranylcypromine and selegiline
The combination can cause a dangerous hypertensive reaction and is contraindicated during or shortly after MAOI treatment.
Serotonergic medicines, including SSRIs and SNRIs
Combining them can rarely cause serotonin syndrome.
Other sympathomimetics, including some decongestants and stimulants
They may add to effects on blood pressure, heart rate and the nervous system.
Sources
These sources were used to prepare and review this medicine page.
Prepared and reviewed by the iatroX editorial team.