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by ynonym00s 3093 days ago
A friend of mine who has ADHD takes Vyvanse instead. Does it have similar risks?
2 comments

(Disclaimer: I've studied pharmacokinetics, though I'm not a pharmacologist)

Vyvanse is a prodrug. That means it metabolizes into the d-enantiomer of amphetamine, whereas Adderall contains a 75-25 mixture of the d- and l-enantiomers. (Enantiomers are like left- and right-handed gloves: they have the same chemical structure, but one is the mirror image of the other. Usually two enantiomers will have similar but slightly different effects; occasionally, they can have incredibly different effects - see thalidomide for an example).

So, without further study, it's hard to know, but it's likely that Vyvanse has a similar long-term profile to Adderall, because the active ingredient (lisdexamfetamine) metabolizes into the active ingredient that makes up about 75% of Adderall.

But, it's possible that the effects described are caused by the l-enantiomer, in which case they won't apply to Vyvanse. It's also possible that lisdexamfetamine itself has its own set of effects which may either cancel out or exacerbate the effects reported by Adderall.

To give you an idea of how prodrugs can have different effects from the drug that they metabolize into: Vyvanse does have a rather nasty feedback loop for some people, because amphetamines suppress the appetite, but lisdexamfetamine is metabolized into the active ingredient using the digestive cycle[0]. For some people, this can cause a really wonky extended release cycle, where they have no appetite mid-day (due to the drug) and can't eat enough to metabolize enough dextroamphetamine to get them through the afternoon, resulting in an afternoon crash. After this wears off and they develop an appetite again (around dinnertime), they'll eat, and then the dosage that was supposed to kick in after lunch finally kicks in after dinner, causing issues sleeping.

[0] This is intentional, and it's why Vyvanse is marketed as an "abuse-resistant" alternative to Adderall, because it's theoretically harder to extract an acute dosage from it.

I think another important consideration might be that peak plasma concentrations on Vyvanse would be lower than on Adderall (because it's more spread out over time). Some effects only happen at certain plasma concentrations.
> I think another important consideration might be that peak plasma concentrations on Vyvanse would be lower than on Adderall (because it's more spread out over time).

Vyvanse is intended to be equivalent to Adderall XR, not IR, so the effects are intended to be spread out in both. If you're comparing to IR, you're no longer really comparing apples to apples anyway.

Sure, it's just [a prodrug to] dextroamphetamine.