TaperCommunitylisdexamfetamine
Boxed Warning
High potential for abuse and dependence — Schedule II. Misuse may cause sudden death or serious cardiovascular events.
Lisdexamfetamine is a prodrug of dextroamphetamine — inactive until enzymatically cleaved in the gut and bloodstream. Designed for once-daily dosing with reduced abuse liability vs immediate-release amphetamine. Schedule II.
10mg, 20mg, 30mg, 40mg, 50mg, 60mg, 70mg capsules; 10-60mg chewable
Capsules: 10mg, 20mg, 30mg, 40mg, 50mg, 60mg, 70mg; Chewable tablets: 10mg, 20mg, 30mg, 40mg, 50mg, 60mg
Category C
After cleavage, dextroamphetamine releases dopamine and norepinephrine, blocks reuptake, and inhibits VMAT2.
Step down by capsule strength over 1-3 weeks.
Same considerations as methylphenidate. The prodrug structure does not eliminate dependence — it slows abuse-pattern dosing.
1-2 days after stopping
3-7 days
1-3 weeks
Anhedonia and motivation deficits can persist 3-8 weeks
Toxicity
Same class effects as amphetamine: anorexia, insomnia, hypertension, tachycardia, anxiety, psychosis, growth suppression, abuse and dependence.
Pharmacokinetics
Hydrolyzed by red-blood-cell enzymes to dextroamphetamine, then hepatic.
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