Why does Vyvanse make me sleepy

Elvanse Adult

Elvanse Adult is a long-acting drug with the active ingredient lisdexamfetamine (LDX) that has been approved for the treatment of ADHD in adulthood (after the age of 18) since February 2019 and is therefore reimbursable. As a prodrug, Elvanse Adult is characterized by its long duration of action of up to 14 hours.[1] The drug only needs to be taken once a day. The drug has been available in Germany since May 2019. Elvanse Adult is bioequivalent to Elvanse.

Admission in Germany and importance

Elvanse Adult 70mg capsules

After the preparation "Elvanse Adults" was approved in Austria in June 2017,[2] the manufacturer Takeda Pharmaceutical (formerly Shire plc) received approval for Elvanse Adult on February 26, 2019. Approval took place after a waiting period of almost fourteen years (application for approval in accordance with Section 21 AMG was submitted on October 30, 2005). Elvanse Adult is the first prodrug stimulant to be approved in Germany for adults with ADHD. Up to now, only the two methylphenidate preparations Medikinet Adult and Ritalin Adult have been available for adult patients.

Criteria for Therapy

The manufacturer gives a therapy with Elvanse Adult (with reference to Dittmann et al.)[3] the following criteria:

  • Residual symptoms with methylphenidate
  • Rebound problem under methylphenidate
  • Insufficient duration of action
  • Inconsistent symptom control with methylphenidate
  • It is difficult for the patient to swallow capsules, tablets or pellets
  • Lack of compliance with multiple doses of methylphenidate

Available dosages

Elvanse Adult is available in doses of 30 mg, 50 mg and 70 mg in a pack size of 30 capsules. The recommended starting dose is 1 x 30 mg in the morning. → See also: Medication conversion table.

Bioequivalence with Elvanse

Elvanse Adult is bioequivalent to Elvanse. This means that the preparations are identical in terms of their content. Also size, shape, color and lettering (S489 ...) of the capsules are identical in both variants, so that the preparations can only be distinguished by the product packaging.

Duration of action

The manufacturer specifies a daily operating time of 14 hours.[1] The prolongation of the clinical effect of lisdexamfetamine comes about through the prodrug effect - only after absorption in the gastrointestinal tract does the continuous breakdown into the metabolites lysine and the pharmacologically active dexamfetamine take place (especially on the erythrocytes). Lysine has no therapeutic effect.

Problems of the long duration of action

Difficulty falling asleep

Lisdexamfetamine is "very often" associated with sleep disorders. During the active time, which should last up to 14 hours, falling asleep can be completely prevented due to the effects of the medication. Therefore Elvanse Adult should not be taken in the afternoon if you are known to have sleep problems.[4] If the morning dose is missed, a shorter-acting prolonged-release preparation can be taken instead. Elvanse Adult can easily be continued the following day.

Loss of appetite

If the patient is aware of the side effects of persistent lack of appetite, Elvanse Adult should be taken in the morning with a substantial breakfast (solid food), as the patient runs the risk of not being able to eat or of only little eating into the afternoon or evening. Insufficient food intake while Elvanse Adult is active will impair the optimal effectiveness of the medication.

Ingestion

The micropellets contained in the capsules of Elvanse Adult can be taken independently of the capsule shell.

Dependence on food intake

Elvanse Adult can be taken regardless of food intake. After a high-fat meal, peak plasma levels may be delayed by about an hour.[5]

Properties of the powder

The active ingredient lisdexamfetamine is contained in the capsules of Elvanse Adult as lisdexamfetamine dimesilate. It is a white powder that can be taken independently of the capsule shell - so the capsule can be opened and the powder mixed with food (such as yoghurt) or dissolved in a glass of water or orange juice. Any particles that stick together can be crushed with a spoon.

abuse

The potential for abuse of Elvanse Adult is low, as the raw material it contains is not pharmacologically active - it is only in the gastrointestinal tract that it splits into the psychoactive metabolite dexamfetamine. Abusive applications (e.g. injecting, sniffing) are therefore not (directly) associated with psychotropic effects. With intranasal application (Sniff) an indirect effect can come into play, which does not occur through absorption through the nasal mucosa, but through the indirect reaching of the gastrointestinal tract through the esophagus. Other abuse results in an oral overdose of the drug.

Risk of addiction in the event of misuse

There have been reports of patients who have increased the dose of amfetamine to multiple times the recommended dose.[6] There is a risk of developing tolerance and developing a dependency disease. Abrupt withdrawal after long-term high-dose use leads to extreme tiredness and depressive moods.

Illegal availability

So far, supply and demand on crypto marketplaces appear low. Lisdexamfetamine is only available there at very high prices. The prices for a single dose of lisdexamfetamine 70 mg averaged 16 euros per capsule in May 2019. However, the offers are mostly variants of the US Vyvanse and intercontinental shipping is usually not offered. The portal streetRX lists Elvanse with a nationwide average street price of just under 22 euros per capsule.[7] Elvanse Adult has not yet been reported there (May 2019).

Side effects

Common and very common side effects of Elvanse Adult include decreased appetite, weight loss, diarrhea, dry mouth, nausea, abdominal pain, vomiting, anxiety, dizziness, headache, irritability, and insomnia.

In other countries

In 2015 Elvanse became an adult in the UK[8] and in Sweden (Elvanse Vuxen)[9] approved, in 2017 Shire launched the preparation Elvanse Adults on the Austrian market.[10] Furthermore Elvanse Adult is in Denmark (Aduvance), Finland, Iceland (Aduvance) and Spain (Elvanse Adultos) authorized.

More amphetamines

Web links

Technical article

Information from the manufacturer

Materials for doctors

More interesting articles

Individual evidence

  1. 1,01,1Neuromedizin.de (April 12, 2019): With Elvanse Adult®, Shire receives first-line approval for ADHD therapy in adults, (Archived May 5, 2019)
  2. ↑ https: //medikamio.com/de-at/medikamente/elvanse-erwachsene-70-mg-hartkapseln/pil
  3. ↑ Described as a criterion of inadequate response to MPH in: Dittmann RW et al. CNS Drugs 2013; 27 (12): 1081-92
  4. ↑ Shire plc (March 2019): Product Information Elvanse Adult®, accessed on May 5, 2019
  5. ↑ Otto Benkert et al .: Compendium of Psychiatric Pharmacotherapy. Springer 2016. ISBN 978-3-662-50333-1. P. 809f.
  6. ↑ cf. https://www.shire.de/-/media/shire/shireglobal/shiregermany/pdffiles/product%20information/fi-elvanse.pdf
  7. ↑ https: //streetrx.com/
  8. ↑ http: //www.pharmatimes.com/news/first_stimulant_for_adhd_in_adults_gets_uk_launch_971810
  9. ↑ https: //translate.googleusercontent.com/translate_c? Depth = 1 & rurl = translate.google.de & sl = auto & sp = nmt4 & tl = de & u = https: //lakemedelsverket.se/LMF/Lakemedelsinformation/%3Fnplid=D%cte%3D20111213000092 .26type%3D20111213000092 .26type%3D20111213000092 .26type% 17259,15700022,15700186,15700190,15700253,15700256,15700259 & usg = ALkJrhif8FO6T5wKeFqQ0epynAp_kN5Z3A
  10. ↑ https: //medikamio.com/de-at/medikamente/elvanse-erwachsene-70-mg-hartkapseln/pil