The US shire site has the info in a pdf, which I coyld not quote on mobile. Missing some data graphs, The UK site has partly the same about Vyvanse studies (aka Elvanse) in adults:
Adult population
The effectiveness of Elvanse in the treatment of ADHD was established in a double-blind, randomised, placebo-controlled, parallel-group study conducted in 420 adult patients aged 18 to 55 years who met DSM-IV criteria for ADHD. Significant improvements in ADHD symptoms, based upon investigator ratings on the ADHD-RS with adult prompts total score, were observed for all Elvanse doses compared to placebo. Treatment with Elvanse significantly reduced the degree of functional impairment as measured by improvement on the CGI-I rating scale compared to placebo.
My interpretation:
Dosages was chosen ay random, not adjusted by symptoms.
All different dosages (30,50,70) increased measured function ability in their target group. Assuming most patients benefited, perhaps all, but that is not specified.
In addition, maintenance of effect was demonstrated in a double-blind, placebo-controlled, randomised withdrawal design study that enrolled adults (n=123) who met DSM-IV criteria for ADHD and who, at study entry, had been treated with Elvanse for a minimum of 6 months. A significantly lower proportion of patients treated with Elvanse met relapse criteria (8.9%) compared to patients receiving placebo (75.0%) in the double-blind randomised withdrawal phase. Relapse was defined as a ≥50% increase from randomisation in ADHD-RS-IV Total Score and a ≥ 2 point increase in CGI-S score relative to the CGI-S score at randomisation.
My interpretation:
Individual Optimized dose is not part of study. Given that patients had been on Vyvanse for at least 6 months, it is asumable that the patients had good effect of the Vyvanse. It is also asumable that it is patients that has had good effect within the doses 30-70 mg, as no studies have been done on patients finding optimized dose above 70 mg.
Selection criteria seems to be: adult, good effect on adhd symptoms of Vyvanse within range 30-70 mg.
Study tells us that these patients had a significant increase in ADHD symptoms when medicine was replaced with placebo.
Abuse liability studies
In a human abuse liability study, when equivalent oral doses of 100 mg lisdexamfetamine dimesylate and 40 mg immediate-release dexamfetamine sulphate were administered to individuals with a history of drug abuse, lisdexamfetamine dimesylate 100 mg produced subjective responses on a scale of “Drug Liking Effects” (primary endpoint) that were significantly less than dexamfetamine immediate release 40 mg. However, oral administration of 150 mg lisdexamfetamine dimesylate produced increases in positive subjective responses on this scale that were comparable to the positive subjective responses produced by 40 mg of oral immediate-release dexamfetamine and 200 mg of diethylpropion.
My interpretation :
Yeah, Vyvanse can get you high, but if you're given a choice you will prefer a different drug/stimulant to abuse.
I haven't read the full studies, but it's what I get from the overview.
There is also a study mentioned in the us info: adults with adhd using randomised doses to of placebo, 30,50 and 70 mg. Some 400 participants, study lasted 4 weeks. Meaning that they all started on 30 mg, and some went up 20 mg per week until they were on 50 or 70. Doses were chosen at random ( double blind study?). I belive mostly experience any increase in medication as pretty good the first week after. My doctor had me on a slower increase in dose, two weeks between, which I think was good. My point is: they all probably improved their symptoms in the study. Vyvanse side effects are very mild and neglible compared to the othet ADHD stimulants. But none of these studies say anything about patterns in indivudual adapted doses in adult ADHD patients.
Shire has excluded higher doses from the research, at least the ones they write about on Vyvanse pages. We just don't have the research.
Using knowledge from other Stimulant medication, and medication in general, I'm very open for the notion that adults may find they need larger doses than children. In Europe Shire express caution when exceeding 70 mg dose, due to lack of research. Not sure if they word it different from country to country, it could depend on local law or lawsuit practices (in the US).
Anecdotally I know a couple of adults on Vyvanse, both over 70 mg. Even I use 80 mg and I am a sensitive person in regard of medicine/drugs. I have a second diagnosis of ptsd, and it probably makes me need a higher dose due to interaction between diagnosis. Hope to reduce it over time.
Yes, I argue that many probably will benefit of a larger dose, but not myself. Perhaps that isn't too convincing...
I don't know if Vyvanse is less sensitive to mody mass than other medications (if positive effect follows a different curve than toxicity).
Some of you seem really gifted in this area, skilled in finding information. Really hope mote research comes through soon, and that you guys share it with the rest.
![:\](https://bluelight.org/xf/BL_Images/Orig_Emoji/wrygrin.gif "wry grin :\")
