Lisdexamfetamine is a prescription medication approved by the U.S. Food and Drug Administration (FDA) in 2015 for treating moderate to severe Binge Eating Disorder (BED) in adults. It is specifically indicated for BED and not for general weight loss or obesity without BED. Lisdexamfetamine is a controlled substance, requiring careful medical supervision.
How Lisdexamfetamine Addresses Binge Eating
Lisdexamfetamine functions as a central nervous system (CNS) stimulant, increasing levels of certain neurotransmitters in the brain. It is a prodrug, inactive until metabolized within the body. Once ingested, lisdexamfetamine converts to dextroamphetamine, its active form, primarily by enzymes in red blood cells.
Dextroamphetamine blocks the reuptake of norepinephrine and dopamine into presynaptic neurons, increasing their concentrations between nerve cells. Dopamine and norepinephrine play roles in impulse control, reward processing, and attention, all of which can be affected in individuals with BED. By modulating these systems, lisdexamfetamine helps manage urges and behaviors associated with binge eating episodes, reducing their frequency and severity, and decreasing food-related obsessions.
Prescription and Usage Guidelines
For moderate to severe BED, the typical starting dose is 30 milligrams (mg) once daily in the morning to avoid sleep disturbances. The dosage is gradually increased by a healthcare professional in increments of 20 mg at approximately weekly intervals. The target dose usually ranges from 50 mg to 70 mg per day, with 70 mg as the maximum recommended daily dose. If significant improvement does not occur, the medication may be discontinued. Lisdexamfetamine can be taken with or without food; capsules can be swallowed whole or opened and mixed with water, yogurt, or orange juice for immediate consumption. Consistent daily use under medical supervision is important due to its potential for abuse and dependence.
Potential Side Effects and Safety Considerations
Lisdexamfetamine can lead to various side effects. Common effects include dry mouth, insomnia, decreased appetite, increased heart rate, constipation, anxiety, and jitteriness. These effects are generally mild to moderate and may diminish over time.
More serious, though less frequent, adverse reactions can occur. These include psychiatric symptoms, such as psychotic or manic episodes, even in individuals with no prior history. Patients should be screened for risk factors like bipolar disorder before starting treatment. Cardiovascular problems are also a concern, with reports of sudden death, stroke, and heart attack in adults, particularly those with pre-existing heart conditions.
Lisdexamfetamine should be avoided in individuals with known structural heart abnormalities, cardiomyopathy, serious heart arrhythmias, or coronary artery disease. Blood pressure and heart rate should be monitored regularly throughout treatment.
Other safety considerations include potential circulation problems in the fingers and toes, characterized by numbness, pain, or skin color changes. Individuals should seek immediate medical attention if they experience symptoms such as chest pain, trouble breathing, pounding heartbeats, hallucinations, new behavioral problems, or signs of circulatory issues. The medication is also contraindicated for those taking monoamine oxidase inhibitors (MAOIs) due to the risk of a hypertensive crisis.