Description

Advantages
Vyvanse lasts about 10-12 hours, so that multiple daily dosing is not
necessary. The abuse of amphetamine medications can be curtailed with Vyvanse because if snorted, it will
not be absorbed into the brain. However, the risk of abuse of stimulant medications in children with ADHD is low. It is usually covered by insurance.

Disadvantages
Vyvanse is nothing more than dextro- amphetamine, the same ingredient in multiple amphetamine medications. It is expensive and if it is not prescribed for its abuse reduction, it does not have much advantage over much less expensive medications. It takes longer to take effect in the morning.

Excerpt from the book: ADHD Medications: Does It Work and Is It Save? Available on Amazon

Vyvanse (lis-dextro-amphetamine) is an extended-release version of dextro-amphetamine that uses a novel technology to extend its effect for 10–12 hours. In addition, it is a medication that prevents some forms of inappropriate use or diversion to other students. Here’s how all of this is accomplished.
Adderall XR was developed by Shire Pharmaceuticals (now part of Takeda), and for about fifteen years it enjoyed patent protections and exclusivity (meaning that no generic of Adderall XR could be produced by another pharmaceutical company). It was one of the most frequently prescribed medications for the treatment of ADHD, but that was all about to change. Adderall XR was losing its patent protection, so that after January 2009, generic medications would be allowed to compete for Adderall XR’s market share.
Right after the beginning of the new millennium, Shire began working on a new concept for ADHD medications. A pro-drug is a medication that is inactive when ingested, but the body’s metabolic processes convert it into a medication with active properties.
Since the 1970s, it has been recognized that amphetamines can be abused. They are not usually abused by adolescents with ADHD, because when they take an amphetamine, they feel . . . well, normal. However, the more medication they take, the more it supresses their spontaneity, and most adolescents don’t like that feeling. So, they tend to resist taking their medication. This hardly sounds like a drug that would be abused.
However, it is not uncommon for adolescents or college-age students with ADHD to give or sell their medication to a friend or acquaintance who may not have ADHD. That friend will then use the amphetamine medication to help stay awake while studying late at night. This is called “diversion.” But some of those friends or acquaintances have learned that if you take an Adderall pill and crush it into a pow- der, you can snort Adderall, which delivers the medication to the brain quickly, allowing them to experience a high. Children with ADHD do not experience this high (at least at prescribed doses), because the medi- cation allows their brain to function more like other children function off medication.
However, if Vyvanse (lis-dextro-amphetamine) is snorted . . . noth- ing happens. If Vyvanse is taken orally, it gets into the brain and works the way it was designed to treat ADHD, but when it is snorted, it does not get into the brain at all and has no effect.
Amino acids are a group of about twenty small molecules that are the building blocks of proteins. Shire took dextro-amphetamine and joined it to one of these amino acids, lysine. Snorting Vyvanse won’t produce a high because the lysine attached to the dextro-amphetamine prevents its absorption into the brain.
On the other hand, if lis-dextro-amphetamine is swallowed, it is absorbed into the bloodstream, then into the red blood cells. Once inside the red blood cell, lysine is separated from dextro-amphetamine, and the remaining molecule is released from the red blood cell back into the bloodstream.
So, what’s left? Once lysine is separated from the molecule, the original dextro-amphetamine remains. This molecule easily crosses into the brain and acts on the neurons just as all the other amphetamine medications do. The dextro-amphetamine that gets into the brain from Vyvanse is exactly the same as the dextro-amphetamine that Bradley used in 1940 to produce the first positive effects of this medication in children. This medication, dextro-amphetamine linked to the lysine amino- acid, is Vyvanse. By altering the chemical structure of dextro-amphet-
amine, even temporarily, three things are accomplished:

  1. A new treatment for ADHD is created that dramatically limits the possibility of it being abused nasally, even though abuse at the low doses used for treating ADHD is extremely unlikely.
  2. Dextro-amphetamine lasts for about 3½–4 hours, but the whole process of having a medication absorbed by red blood cells, metabolized, and then released as dextro-amphetamine takes time. Shire Pharmaceuticals can then produce a medication that lasts up to 9–10 hours without using the coated beads that most other extended-release medications employ.
  3. Shire knew that it would be relatively easy to prove to the FDA that Vyvanse is safe and effective, because when Vyvanse gets to the brain, it becomes the same medication that is present in many other medications (Dexedrine, Dexedrine Spansule, Dextrostat, Zenzedi, Procentra, Evekeo, etc.). Yes, Shire was losing exclusivity for Adderall XR but was able to replace the lost revenue from Adderall XR with new revenue from Vyvanse. Vyvanse was approved by the FDA in 2007. By the time Adderall XR lost its patent protection and exclusivity in 2009, Vyvanse was already marketed as a better alternative to all these other medications.

I have a confession to make. Shortly after Vyvanse was approved, I was asked by Shire to attend a three-day conference where a new medi- cation for the treatment of ADHD would be introduced. I felt obligated to attend so that I could learn about this new medication that would be a big help for my patients. The fact that the conference was being held at the Atlantis Hotel in the Bahamas was further encouragement. Oh, and the fact that all travel, hotel, and food expenses would be paid by Shire didn’t hurt. Neither did it hurt that we were given a $1,000 stipend for other expenses.