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. www.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: www.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/
February 15th, 2008 at 10:59 pm
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.