What Makes Vyvanse So Special? Simple.

As time goes on, I become more fond of Vyvanse as a medication for my patients with ADHD.  As my loyal readers know, I am very hesitant to jump on the pharmaceutical bandwagon and I view all new products with great skepticism.  Especially when they are re-hashes of old medications as many of the “new” meds for ADHD are.  In recap, Vyvanse is just Dexedrine.  Dexedrine is one of the oldest products on the market for treating ADHD symptoms.  It fell into great disfavor (in certain circles) because of it’s abuse potential.  In the 1970’s and 80’s it was clearly the choice for too many people for weight loss, avoidance of needed sleep, and study-binges.  It’s use was frowned upon and it became unusual for psychiatrists to use it for their patients with focus and concentration issues. Which is a shame.  There is a segment of the population that only responds to and/or tolerates a dexedrine based product.  Those kids then received less than adequate treatment.   Over time, however, attitudes change and prescribing practices change and . . . most importantly . . . the pharmaceutical industry comes out with a new product.  Like Adderall.  

The wonder drug.  

(At least for Shire!)

With the advent of Adderall on the market, use of dexedrine based products shot up exponentially.  As you may remember, Adderall is a combination of four amphetamine salts (equal amounts of Dextro-amphetamine Saccharate, Dextro-amphetamine Sulfate USP, Amphetamine Aspartate Monohydrate and Amphetamine Sulfate USP).  It was followed quickly by the emergence of Adderall XR (imagine that) which is, to this day, my most commonly prescribed stimulant product.  Because it is good.  Works for most kids and adults (tho’ not all) and is very well tolerated (by most, but not by all).  In comparison, Vyvanse is a “simpler” medication.  It is a single agent (Dextro-amphetamine) attached to a lysine molecule (an amino acid) that is removed in the gut.  Once the lysine is removed, the Dexedrine can be absorbed.  Simple . . . simply ingenious . . . but simple.

In my arsenal of medication for ADHD, I use Vyvanse for those people who do well on Adderall but do not tolerate it due to mild to moderate side effects.  So those kids who’s appetite is too impaired, feel jittery and wired, feel “not themselves”, etc., often do quite well with a simplified product (which is what Vyvanse is).   The development of Adderall was, after all, a trick to get us to use dexedrine again.  It is nothing new.  Just a reformulation and a nifty delivery system.  The fact that it works comes as no surprise to me.  I guess I should be more surprised that more people don’t have difficulties with it.  It is bad enough when we give a single moiety to a patient, let alone a combination of four.  I think that it is the only product on the market that DOES come as a combination of four agents.  (There are lots of ‘double’ agents such as Symbyax, Vytorin, etc).  Seems to me it would increase the likelihood that a patient would not tolerate one of the agents.  By moving to Vyvanse, I am providing a significant simplification of the medication regimen to the patient.  The primary impediment to this is the insurance companies that want me to use something else that has been on  the market for a while before using Vyvanse (which is relatively new).  So I end up going to a Ritalin based product such as Concerta or Metadate.  Which is not the best for the patient . . . but something I do not control.  I certainly anticipate that, over time, there will be more use of Vyvanse as more docs become more comfortable with it as a product.  I know that my comfort level with it is quite high and I feel it is one of the better products out on the market at this time.

–Dan Hartman, MD