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ADHD Medication

Lisdexamfetamine Dimesylate

Brand Name:
Elvanse

Lisdexamfetamine dimesylate is a stimulant medication used to help manage symptoms of ADHD. It can help with attention and concentration and may reduce impulsivity and hyperactivity.

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Your dose

Your clinician will agree your starting dose with you and increase it gradually if needed

The usual starting dose is 30 mg once a day in the morning. Your clinician may recommend starting with 20 mg once a day if a lower initial dose is more appropriate.

The dose may then be increased by 10 mg or 20 mg at approximately weekly intervals, depending on how well the medication is working and whether you experience side effects.

The maximum recommended dose is 70 mg a day.

The aim is to find the lowest dose that gives you good symptom control with manageable side effects.

Always take lisdexamfetamine exactly as prescribed. Do not change your dose without speaking to your prescribing clinician.

Lisdexamfetamine should be taken in the morning. It can be taken with or without food.

The capsule can be swallowed whole, or opened and the entire contents mixed with soft food such as yoghurt, water or orange juice. The full mixture should be taken immediately and should not be stored for later.

Do not divide the contents of a capsule into smaller doses.

Before taking Lisdexamfetamine

Tell your clinician about all physical and mental health conditions you have, even if they are well controlled or you have experienced them in the past.

Certain medical conditions may mean that lisdexamfetamine is not suitable for you. Others may require additional assessment, specialist advice or closer monitoring before treatment can begin.

It is particularly important that your clinician knows if you have, or have previously had:

  • Heart problems, heart disease or an irregular heart beat
  • High blood pressure
  • Narrowing or hardening of the blood vessels
  • A history of stroke
  • A family history of sudden or unexplained death
  • An overactive thyroid
  • Glaucoma
  • Phaeochromocytoma, a rare tumour of the adrenal gland
  • Kidney problems
  • Epilepsy or seizures
  • Tics or Tourette's syndrome
  • Bipolar disorder
  • Hallucinations, delusions or psychosis
  • Paranoia
  • Significant anxiety, agitation or tension
  • Depression
  • Aggressive or hostile behaviour
  • A history of alcohol, prescription medicine or recreational drug dependence or misuse

Important:

Lisdexamfetamine must not be used in certain medical conditions, including some serious heart conditions, moderate to severe high blood pressure, hyperthyroidism, glaucoma, phaeochromocytoma and severe states of agitation.

 

If you have any of these conditions, your clinician will need to assess your medical history carefully and determine whether lisdexamfetamine is appropriate for you.

Do not start taking lisdexamfetamine until your clinician has reviewed your medical history and confirmed that it is appropriate for you.

Other medicines

Lisdexamfetamine can interact with other medicines, sometimes causing serious side effects.

Tell your clinician about everything you take, including prescription medicines, over-the-counter medicines, vitamins, supplements, herbal remedies such as St John’s wort, and recreational drugs.

This is particularly important for:

  • Certain antidepressants

  • Medicines used to treat serious mental health conditions

  • Medicines that increase or reduce blood pressure

  • Other stimulant or ADHD medicines

  • Some strong painkillers

  • Some cough and cold remedies

  • Medicines or supplements that alter the acidity of your urine

  • Medicines used during surgery or medical procedures

Some medicines called monoamine oxidase inhibitors (MAOIs) must not be taken with lisdexamfetamine or within 14 days of taking lisdexamfetamine.

MAOIs include medicines such as phenelzine, tranylcypromine, isocarboxazid, selegiline and rasagiline.

If you are unsure whether something is safe to take, check with your clinician or pharmacist first.

Full list of medicine interactions

Apraclonidine 

Atomoxetine 

Bupropion 

Chlorpromazine 

Citalopram 

Clomipramine 

Dapoxetine 

Duloxetine 

Escitalopram 

Fenfluramine 

Fentanyl 

Fluoxetine 

Fluvoxamine 

Imipramine 

Isocarboxazid 

Levomepromazine 

Linezolid 

Methadone 

Methylthioninium chloride 

Moclobemide 

Nabilone 

Nirmatrelvir 

Paroxetine 

Pentazocine 

Pericyazine 

Pethidine 

Phenelzine 

Prochlorperazine 

Promazine 

Rasagiline 

Ritonavir 

Safinamide 

Selegiline 

Sertraline 

Sevoflurane 

St John’s wort 

Tapentadol 

Tramadol 

Tranylcypromine 

Trazodone 

Trifluoperazine 

Tryptophan 

Venlafaxine 

Vortioxetine 

Surgery and anaesthesia

If you are due to have an operation or medical procedure, tell your surgeon and anaesthetist that you are taking lisdexamfetamine.

Lisdexamfetamine can interact with some medicines used during surgery.

Your medical team will advise you whether you should take your medication on the day of your procedure.

Always follow the instructions given by your surgical or anaesthetic team.

Serotonin syndrome – important safety information

Lisdexamfetamine affects chemicals in the brain and, when taken with certain other medicines, can rarely contribute to serotonin syndrome.

The risk may be increased when lisdexamfetamine is taken with medicines that increase serotonin, including some antidepressants and certain strong painkillers.

Always tell your clinician about every medicine, supplement or herbal remedy you take.

Recognising the symptoms

Early symptoms of serotonin syndrome may include:

  • Agitation or confusion

  • Sweating or shivering

  • A high temperature

  • Tremor or muscle twitching

  • Overactive reflexes

  • Diarrhoea

  • A fast heartbeat

Seek urgent medical advice if you develop symptoms that could indicate serotonin syndrome.

When to call 999

Call 999 immediately if symptoms are severe, particularly if you develop a very high temperature, seizures, an irregular heartbeat, severe confusion or loss of consciousness.

Side effects

Like all medicines, lisdexamfetamine can cause side effects. Not everybody will experience them.

Side effects are often most noticeable when treatment starts or when your dose changes.

Tell your clinical team if side effects are bothering you, getting worse or affecting your day-to-day life.

Reduced appetite

Difficulty sleeping

Feeling anxious or jittery

Headache

Dry mouth

Nausea or stomach discomfort

Increased heart rate

Changes in blood pressure

Weight loss

Full list of Side Effects

Very common

Reduced appetite
Difficulty sleeping
Dry mouth
Headache

Common 

Agitation
Anxiety
Mood changes
Restlessness
Feeling unusually active
Grinding your teeth
Reduced sex drive
Dizziness
Tremor or shaking
Fast heartbeat
Palpitations
Shortness of breath
Diarrhoea
Constipation
Stomach pain
Nausea
Excessive sweating
Erectile dysfunction
Chest pain
Irritability
Fatigue
Feeling jittery
Increased blood pressure
Weight loss

Uncommon

Allergic reaction
Depression
Talking excessively
Feeling unusually low or uneasy
Feeling unusually happy or excited
Mania
Skin picking
Tics
Uncontrolled movements
Feeling unusually sleepy
Fainting
Blurred vision
Changes in taste
Nosebleeds
Vomiting
Rash or hives
Fever

Frequency not known

Severe allergic reaction
Hallucinations
Delusions or psychosis
Aggressive behaviour
Worsening of Tourette’s syndrome
Seizures
Dilated pupils
Abnormal heart rhythm
Cardiomyopathy
Raynaud’s phenomenon
Allergic liver injury
Angioedema
Stevens-Johnson syndrome

Get urgent medical help:

Seek urgent medical advice if you develop serious or unexpected symptoms, including:

  • Chest pain
  • A fast or irregular heartbeat
  • Hallucinations, paranoia or symptoms of psychosis
  • Feeling unusually excited, overactive or uninhibited
  • A seizure
  • Severe shortness of breath
  • Unexplained swelling of your legs
  • Yellowing of your skin or the whites of your eyes
  • A severe or blistering skin rash
  • Swelling of your face, lips, tongue or throat
  • Difficulty breathing or swallowing

Call 999 if you think you are experiencing a medical emergency.

A full list of possible side effects is available in the Patient Information Leaflet supplied with your medication.

 

Reporting side effects

If you experience any side effects while taking lisdexamfetamine, speak to your clinician or pharmacist. This includes possible side effects not listed on this page or in the Patient Information Leaflet supplied with your medication.

You can also report suspected side effects directly to the Medicines and Healthcare products Regulatory Agency through the Yellow Card scheme.

Reporting suspected side effects helps improve the safety of medicines.

Taking the medication

If you miss a dose

Do not take a double dose.

If you forget to take your dose, skip it and take your usual dose the following morning.

Do not take a missed dose in the afternoon or evening because this may make it difficult to sleep.

If you take too much

Taking too much lisdexamfetamine can be serious and may require emergency medical treatment.

Signs of an overdose may include: 

  • Severe restlessness or agitation
  • Shaking or tremor
  • Muscle twitching
  • Confusion
  • Panic
  • Hallucinations
  • Rapid breathing
  • A very high temperature
  • Nausea, vomiting, diarrhoea or stomach cramps
  • A fast, slow or irregular heartbeat
  • High or low blood pressure
  • Seizures
  • Severe headache
  • Changes in vision
  • Collapse or loss of consciousness

If you take more lisdexamfetamine than you have been prescribed, seek medical advice immediately, even if you feel well.

When to call 999

Call 999 immediately if you or someone else develops severe symptoms following a suspected overdose, including seizures, chest pain, collapse, loss of consciousness or difficulty breathing.

Do not drive yourself to hospital. Take your medication packaging with you if possible.

Stopping Lisdexamfetamine

Do not stop taking lisdexamfetamine without discussing it with your prescribing clinician.

Your ADHD symptoms may return when treatment is stopped.

If you are considering stopping treatment or are experiencing problems with your medication, speak to your clinician. They can advise you on the safest approach and monitor how you respond.

Alcohol

There is limited information about the interaction between lisdexamfetamine and alcohol.

Alcohol may make some side effects worse, particularly those affecting your judgement, concentration, heart rate and nervous system.

We recommend avoiding alcohol while you are starting treatment or changing dose, and being cautious about alcohol throughout treatment.

Speak to your clinician if you have questions about alcohol and your medication.

Driving

Lisdexamfetamine can affect your ability to drive safely, particularly if it causes dizziness, drowsiness, blurred vision or problems with concentration.

Do not drive until you know how the medication affects you. You must not drive if your ability to drive safely is impaired.

Driving and the law

Lisdexamfetamine is a controlled drug and may produce a positive result on a roadside drug screening test.

It is an offence to drive with certain controlled drugs above specified limits in your body. However, a statutory medical defence may apply if:

  • The medication has been prescribed for you
  • You have taken it according to your prescriber’s instructions and the information supplied with the medicine
  • It is not affecting your ability to drive safely

It is advisable to carry evidence that the medication has been prescribed for you.

You must inform the DVLA if your ADHD or your medication affects your ability to drive safely.

Pregnancy and breastfeeding

If you could become pregnant, discuss contraception and pregnancy planning with your clinician.

If you become pregnant while taking lisdexamfetamine, contact your clinician as soon as possible. Do not stop taking your medication without medical advice.

Possible risks during pregnancy

Available evidence does not suggest an increased overall risk of congenital malformations following exposure to amfetamines during the first trimester, but there may be an increased risk of pre-eclampsia and premature birth.

Babies exposed to amfetamine medicines during pregnancy may also experience withdrawal symptoms after birth.

Lisdexamfetamine should only be used during pregnancy where your clinician considers that the potential benefit justifies the potential risk.

Breastfeeding

Lisdexamfetamine is converted to dexamfetamine in the body, and amfetamines can pass into breast milk.

Lisdexamfetamine should not be used while breastfeeding. Speak to your clinician about the treatment and feeding options available to you.

Drug screening and laboratory tests

Drug screening

Lisdexamfetamine may produce a positive result on workplace, sporting or roadside drug screening tests.

If you are required to undergo drug testing, tell the relevant healthcare professional or testing provider that you are taking prescribed lisdexamfetamine.

Laboratory tests

Amfetamine medicines can affect the results of some laboratory tests.

Tell your clinician that you are taking lisdexamfetamine before undergoing blood or urine tests.

Instructions

Lisdexamfetamine is a Schedule 2 controlled drug

Your pharmacy may ask you to provide proof of identity when you collect it, so we recommend taking photo ID with you.

Keep your medication somewhere safe and secure.

Never give your medication to anyone else, even if they have similar symptoms.

Do not take more than the amount prescribed to you.

Keeping treatment safe

While taking lisdexamfetamine, you will need regular reviews. Your clinical team may monitor:

  • your blood pressure

  • your pulse

  • your weight

  • your appetite

  • how well the medication is working

  • any side effects

  • your mental health and wellbeing

These checks help your clinician decide whether your dose remains safe and effective.

FAQs

When can I expect to notice a difference with lisdexamfetamine?

Lisdexamfetamine is a long-acting stimulant and can begin to affect ADHD symptoms from the first day you take it.

The effects build after your morning dose and may continue throughout much of the day. Clinical studies have found effects continuing for up to around 14 hours in adults, although this varies between individuals.

Finding the right dose can take several weeks because your clinician will usually increase your dose gradually while monitoring your symptoms and side effects.

If you do not notice an improvement, speak to your clinician rather than changing the dose yourself.

Lisdexamfetamine can reduce your appetite and may cause weight loss. Your clinician will monitor your weight and appetite during treatment.

It can also increase your heart rate or blood pressure, which is why your pulse and blood pressure are checked during titration and ongoing treatment.

Dry mouth is also common. Good oral hygiene, regular dental check-ups and drinking water regularly can help protect your teeth and gums.

Everyone responds differently to medication. Speak to your clinician if you notice physical changes that concern you.

It is your decision whether to tell family members, friends or colleagues that you are taking lisdexamfetamine.

However, it can be useful for someone you trust to understand your treatment, particularly while you are starting medication or changing dose. They may notice changes in your behaviour, mood, appetite or sleep that you have not noticed yourself.

You should tell relevant healthcare professionals that you take lisdexamfetamine, particularly before surgery or when another medicine is being prescribed.

Yes. Lisdexamfetamine is a stimulant and can make it more difficult to fall asleep.

This is why it should normally be taken in the morning and missed doses should not be taken later in the afternoon or evening.

Some people find that improved control of their ADHD symptoms helps their overall sleep routine.

If you experience ongoing sleep problems, speak to your clinician before changing your dose or when you take your medication.

There is limited information about the interaction between alcohol and lisdexamfetamine, and alcohol may make some side effects more difficult to recognise or manage.

Recreational drugs, particularly stimulants such as cocaine, MDMA or other amfetamines, can interact dangerously with lisdexamfetamine and place additional strain on your heart and nervous system.

Other recreational drugs may also cause serious interactions.

Speak to your clinician if you have questions or concerns about alcohol or recreational drug use while taking your medication.

Yes. Some medicines can interact with lisdexamfetamine.

This includes certain antidepressants, medicines for blood pressure, medicines used to treat mental health conditions, some painkillers, cold and flu remedies, and some supplements or indigestion remedies.

Lisdexamfetamine must not be taken alongside a monoamine oxidase inhibitor (MAOI), or within 14 days of taking one.

Always tell your clinician about prescription medicines, over-the-counter treatments, vitamins, supplements and herbal remedies you are taking.

Check with your clinician or pharmacist before starting a new medication.

Elvanse capsules contain ingredients in addition to lisdexamfetamine, including gelatine.

Different capsule strengths can also contain different colouring agents.

If you have allergies, food intolerances, dietary requirements or need to avoid animal-derived ingredients, speak to your pharmacist.

Your pharmacist can check the ingredients in your prescribed strength and advise you appropriately.

Lisdexamfetamine may cause dizziness, drowsiness, blurred vision or problems with concentration.

Do not drive until you know how the medication affects you, and never drive if you feel that your ability to drive safely is impaired.

Lisdexamfetamine is also covered by UK drug-driving legislation. A medical defence may apply when the medication has been prescribed to you, you are taking it as directed and your driving is not impaired.

Speak to your clinician or pharmacist if you are unsure whether it is safe for you to drive while taking lisdexamfetamine.

Yes. Lisdexamfetamine can affect sexual function in some people.

Possible effects include:

  • Reduced interest in sex
  • Erectile difficulties
  • Changes in sexual function or performance

These effects do not happen to everyone and may change as your body adjusts to the medication or your dose changes.

If you notice changes to your sex drive or sexual function that are bothering you, speak to your clinician. Do not change or stop your medication without discussing it with them first.

Yes. Most people can continue to exercise while taking lisdexamfetamine.

However, stimulant medication can increase your heart rate and blood pressure, and exercise can increase these further. Your clinician will therefore monitor your pulse and blood pressure during treatment.

When you start medication or increase your dose, pay attention to how you feel during exercise.

Stop exercising and seek medical advice if you develop:

  • Chest pain
  • Fainting or feeling as though you may faint
  • A very fast or irregular heartbeat
  • Unusual or severe shortness of breath
  • Dizziness that does not settle

Keep well hydrated, particularly during strenuous exercise or hot weather.

If you regularly take part in high-intensity or competitive sport, or you have a heart condition or significant family history of heart problems, discuss this with your clinician.

Questions or concerns

If you are experiencing side effects, are unsure how to take your medication or have questions about another medicine, contact the HG Mind Works clinical team before making changes to your treatment.

Speak to the clinical team