The use of Elvanse (lisdexamfetamine) is not appropriate in a 27-year-old female with left bundle branch block, dyssynchrony, and heart failure with a left ventricular ejection fraction of 32%.
Lisdexamfetamine is contraindicated in patients with symptomatic cardiovascular disease, which includes heart failure and serious structural cardiac abnormalities such as left bundle branch block and the presence of dyssynchrony, especially with a significantly reduced ejection fraction of 32%.
Stimulant medications like lisdexamfetamine cause increases in heart rate and blood pressure, which can exacerbate pre-existing cardiac conditions including heart failure and arrhythmias. Additionally, the risk of sudden death, stroke, and myocardial infarction has been reported in adults with serious structural cardiac abnormalities taking stimulants at usual doses.
Lisdexamfetamine should be used with extreme caution or avoided in patients with cardiomyopathy or serious heart rhythm abnormalities, both of which are apparent risks given this patient’s cardiac status.
In line with NICE guidance, patients with such significant cardiac disease should be referred for a cardiology opinion before considering stimulant medications for ADHD, and generally such stimulants are not recommended in adults with symptomatic cardiovascular disease.
Moreover, initiation of lisdexamfetamine treatment is recommended only in secondary care by specialists, with continuation and monitoring possibly in primary care under shared-care protocols, emphasizing the need for specialist involvement especially in complex cardiac cases.