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INTRODUCTION

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lisdexamfetamine (lis-deks-am-fet-a-meen)

Vyvanse

Classification

Therapeutic: central nervous system stimulants

Pharmacologic: sympathomimetics

Schedule II

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Indications
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Management of attention deficit hyperactivity disorder (ADHD) (in adults and children).

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Action
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Blocks reuptake and increases release of norepinephrine and dopamine resulting in increased levels in extraneuronal space. Therapeutic Effects: Improved attention span in ADHD.

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Adverse Reactions/Side Effects
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CNS: behavioral disturbances, dizziness, hallucinations, insomnia, irritability, mania, psychomotor hyperactivity, thought disorder, tics. EENT: blurred vision, poor accommodation. GI: abdominal pain, ↓ appetite, dry mouth, nausea, vomiting. Derm: rash. Metab: ↓ weight. Misc: long-term growth suppression.

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PHYSICAL THERAPY IMPLICATIONS

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Examination and Evaluation
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  • Monitor attentiveness and behavior in patients with ADHD. Report any changes in attention and hyperactivity, and document whether this drug appears to be producing the desired effects.

  • Be alert for signs of excessive CNS stimulation, including increased activity, hallucinations, mania, irritability, tics, disordered thoughts, or behavioral disturbances. Report these signs to the physician.

  • Assess dizziness that might affect gait, balance, and other functional activities (See Appendix C). Report balance problems and functional limitations to the physician, and caution the patient and family/caregivers to guard against falls and trauma.

  • Assess growth rate in children receiving chronic therapy; report delayed or stunted growth to the physician.

  • Periodically assess body weight and other anthropometric measures (body mass index, body composition). Report a rapid or unexplained weight loss or decreased body fat.

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Patient/Client-Related Instruction
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  • Instruct patient and family/caregivers to report other troublesome side effects, including severe or prolonged sleep loss, vision disturbances, skin rash, or GI problems (nausea, vomiting, decreased appetite, abdominal pain, dry mouth).

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Pharmacokinetics
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Absorption: Rapidly absorbed and converted to dextroamphetamine, the active drug.

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Distribution: Unknown.

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Metabolism and Excretion: 42% excreted in urine as amphetamine.

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Half-life: <1 hr for lisdexamfetamine.

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TIME/ACTION PROFILE

ROUTE ONSET PEAK DURATION
PO rapid 1 hr 24 hr

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Contraindications/Precautions
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Contraindicated in: Hypersensitivity to lisdexamfetamine or other sympathomimetic amines; Advanced arteriosclerosis; Symptomatic cardiovascular disease, including known structural cardiac abnormalities (may increase the risk of sudden death); Moderate-to-severe hypertension; Glaucoma; Agitation; OB: Lactation; History of substance abuse; During or within 14 days of monoamine oxidase inhibitor therapy.

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Use Cautiously in: History of preexisting psychosis, bipolar disorder, aggression, tics, Tourette's syndrome or seizures (may exacerbate condition); OB: Use in pregnancy only if maternal benefit outweighs fetal risk.

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Interactions
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Drug-Drug: Serious adverse reactions, including hyperpyrexia and hypertension, may occur with monamine oxidase inhibitors; avoid use within 14 days. Concurrent use of other sympathomimetic amines may result in additive effects and ↑ risk of adverse ...

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