Generic Name

Lisdexamfetamine Dimesylate

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Classification

FDA Approved Indications

• ADHD in children and adults
• Moderate to severe binge eating disorder in adults

Mechanism of Action

Lisdexamfetamine is a prodrug that is converted to dextroamphetamine in the body. Dextroamphetamine increases the release of norepinephrine and dopamine in the CNS by reversing their transporters and inhibiting their reuptake, leading to increased concentration of these neurotransmitters in synaptic clefts.

Dosage and Administration

Adult: Initially 30 mg once daily in the morning. Dose may be titrated by 10–20 mg increments at weekly intervals to a maximum dose of 70 mg/day.

Pediatric: 6 to 17 years: Start with 20-30 mg once daily. Adjust in 10–20 mg increments as needed; max dose 70 mg/day.

Geriatric: Use with caution; start at lower end of dosing range due to potential for increased sensitivity and comorbidities.

Renal Impairment: Adjust dose based on severity; closer monitoring advised.

Hepatic Impairment: Use with caution; no specific dose adjustment guidelines established.

Pharmacokinetics

Absorption: Fast absorption; peak plasma concentrations in approximately 3.5 hours.

Distribution: Widely distributed; protein binding approximately 29%.

Metabolism: Converted to active dextroamphetamine; minimal hepatic metabolism.

Excretion: Primarily renal; unchanged in urine.

Half Life: Approx. 12 hours for dextroamphetamine.

Contraindications

• History of hypersensitivity to amphetamines or products containing similar compounds.
• Use of monoamine oxidase inhibitors (MAOIs) within 14 days.”],
• adverse_reactions/side_effects
• common

Precautions

• Use with caution in patients with a history of cardiovascular disease, hypertension, or mental health issues.
• Potential for dependence, abuse, and psychological dependence.
• Monitor for signs of cardiovascular or psychiatric adverse effects.
• Pregnancy Category C: Use only if clearly needed and benefit outweighs risk.
• Lactation: Discontinue if breastfeeding during treatment.

Adverse Reactions - Common

• Decreased appetite (Common)
• Insomnia (Common)
• Dry mouth (Common)
• Anxiety (Common)
• Increased heart rate (Common)

Adverse Reactions - Serious

• Cardiovascular adverse events (e.g., hypertension, tachycardia) (Less common)
• Psychosis, new or worsening (Less common)
• Circulatory collapse or sudden death (rare, mainly with misuse or overdose) (Rare)

Drug-Drug Interactions

• Monoamine oxidase inhibitors (MAOIs), within 14 days of use
• Other CNS stimulants, caution due to additive effects
• Antihypertensives, may diminish their effectiveness

Drug-Food Interactions

• Avoid acidic foods or beverages that may alter absorption

Drug-Herb Interactions

N/A

Nursing Implications

Patient/Family Teaching

• Take exactly as prescribed; do not exceed the prescribed dose.
• Notify healthcare provider if you experience chest pain, shortness of breath, or new/worsening mental health issues.
• Avoid alcohol and recreational drugs.
• Attend regular follow-up visits for monitoring.
• Store in a secure place out of reach of children.

Special Considerations

Black Box Warnings:

• Misuse of stimulant medications can cause sudden death and serious cardiovascular events.
• Potential for abuse and dependence.

Genetic Factors: Genetic variations may affect metabolism and response.

Lab Test Interference: May affect growth measurements in children, and interfere with urine drug testing.

Overdose Management

Signs/Symptoms: High doses may cause restlessness, tremors, hyperreflexia, hallucinations, panic states, or seizures.

Treatment: Supportive care, activated charcoal if within 1 hour of ingestion, sedation with benzodiazepines for agitation or seizures, and cardiovascular support as needed.

Storage and Handling

Storage: Store below 25°C (77°F) in a tight, light-resistant container.

Stability: Stable under recommended storage conditions; use before expiration date.