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ADHD affects an estimated 3% to 5% of children and adults in the U.S. Dr. Richard Sogn shares information and advice about attention deficit hyperactivity disorder, including its causes, diagnosis, and promising ADHD treatments

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Thursday, March 01, 2007

FDA Approves New ADHD Drug Vyvanse

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The U.S. Food and Drug Administration approved Vyvanse (lisdexamfetamine dimesylate) for the treatment of ADHD. Vyvance was designed to lower the potential for abuse. Stimulant medications are the first-line treatment for ADHD, but many clinicians are reluctant to prescribe stimulants because they are often misused in our society. However, children and adolescents with untreated ADHD are at an increased risk of developing a problem with substance use, and effective treatment of ADHD significantly decreases that risk.

The route of administration of a stimulant has a strong affect on abuse potential. Drugs that are rapidly absorbed and achieve higher blood levels can produce a euphoric effect. This effect is easier to obtain by crushing short acting tablets and snorting or injecting them. Longer acting tablets and capsules are not easily put into a form that can be snorted or injected, and thus have a less abuse potential.

Vyvanse is d-amphetamine (dextroamphetamine) that is linked or bound to a naturally occurring amino acid, l-lysine. This compound is inactive (is inert) until this bond is broken by enzymes (metabolized) in the GI tract (stomach and intestine), releasing the active drug, d-amphetamine.

Since there are no enzymes in the nasal passages that can break this bond, blood levels would be 96% lower if Vyvanse were snorted than if d-amphetamine were snorted, and 75% lower if it were injected. When given intravenously to adults with histories of stimulant abuse, Vyvanse produced less euphoric effects than d-amphetamine, and the effects were not significantly different than intravenous placebo.

Absorption of Vyvanse is delayed, compared to d-amphetamine, and without a quick onset, the intensity and "likability" (drug-seeking behavior) drops. When Vyvanse is taken orally, increasing doses produce increasing blood levels, but only up to a certain point (130 - 150 mg), beyond which higher doses will not produce higher blood levels, which might reduce abuse potential and toxicity from overdose.

Vynase is given once daily in the morning, and it is significantly effective until at least 6:00 PM. Its effectiveness, potential for side effects, and safety is comparable to Adderall XR. It does have the potential to reduce stimulant abuse or misuse, and may protect against toxicity from overdose.

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Posted by: Richard Sogn, MD at 12:52 AM


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