Stimulant-associated decreased appetite with lisdexamfetamine (Vyvanse)
Decreased appetite is a known adverse effect of lisdexamfetamine and can lead to decreased weight. [2] Management is based on meal/administration timing, objective monitoring of weight (and growth parameters in children), and adjustment of ADHD pharmacotherapy when weight change persists. [1], [2]
Administration timing and related behavioral factors
Lisdexamfetamine should be taken in the morning with or without food. [2] Afternoon dosing should be avoided due to the potential for insomnia, which can indirectly worsen appetite and nutritional intake. [2]
Objective monitoring of weight and growth
Weight and height should be monitored at appropriate intervals in pediatric patients receiving lisdexamfetamine. [2] BMI should be monitored in adults with ADHD if weight change results from treatment, and medication should be changed if weight change persists. [1]
Dose titration strategy for adverse effects
Dose titration should be guided by ADHD symptoms, impairment, and adverse effects recorded at baseline and at each dose change. [1] Dose should be adjusted until dose optimization is achieved with tolerable adverse effects. [1]
Medication change when weight change persists
Changing the ADHD medication is recommended when weight change persists despite treatment adjustments. [1] For children and young people who cannot tolerate stimulants, atomoxetine or guanfacine should be offered after trials of available stimulant options are considered. [1] For adults who cannot tolerate stimulants, atomoxetine should be offered. [1]
Pediatric growth-specific adjustments
When height over time is significantly affected by medication in children and young people, a planned break in treatment over school holidays should be considered to allow catch-up growth. [1]
Expected frequency of appetite suppression
Decreased appetite occurs in a substantial proportion of patients in short-term trials and is reported more frequently than placebo across age groups (for example, 39% vs 4% in children 6–12 years and 27% vs 2% in adults with ADHD in a 4-week controlled trial). [2]
When to escalate care
Escalation should occur when weight change persists or growth parameters are significantly affected, because medication adjustment and/or switching is recommended in those scenarios. [1], [2]
Sources for clinicians
Full prescribing information for lisdexamfetamine describes decreased appetite as a common adverse reaction and provides administration and monitoring recommendations. [2] The NICE guideline for ADHD provides monitoring and medication-adjustment recommendations based on adverse effects, including weight change. [1]