Lisdexamfetamine

Medication name

Lisdexamfetamine (‘LIS-dex-AM-fet-a-MEAN’)
Brand names

Elvanse

Elvanse Adult
Medication type

Central nervous stimulant

Capsules: 20mg, 30mg, 40mg, 50mg 60mg and 70mg strengths

If you are aged six and over, the doctor can prescribe lisdexamfetamine for you as a licensed medicine for treatment of attention deficit hyperactivity disorder (ADHD).

If you started treatment when under 18 years old, this can be continued when you become an adult if you are still benefiting from the medication.

Lisdexamfetamine may be prescribed to adults for ADHD where symptoms started in childhood, even if treatment wasn’t prescribed before the age of 18.

Read our guide to ADHD and mental health

About lisdexamfetamine

Lisdexamfetamine is an inactive ‘prodrug’ of dexamfetamine. After taking lisdexamfetamine, it is absorbed from the stomach into the blood, where red blood cells then change it into dexamfetamine.

Lisdexamfetamine is a central nervous stimulant (CNS). It can also be called a dopamine and noradrenaline reuptake inhibitor. This describes how it works in the brain.

Lisdexamfetamine stimulates parts of the brain that are underactive in people with ADHD, like the bits involved with concentration. It might seem odd that you would use a stimulant as a treatment for hyperactivity, but in people with ADHD, stimulant medicines do not make them more active as they do in other people. Instead, these medicines will help to improve concentration, ability to focus, and help with behaviour and other activities such as the ability to plan, organise time, manage emotions and make decisions.

Dopamine and noradrenaline are a naturally occurring chemical messengers (or ‘neurotransmitters’) that have an important role in areas of the brain that control mood, thinking, feelings, emotions, and perception. Lisdexamfetamine works by blocking noradrenaline and dopamine from being taken back up into the nerve cells in the brain after being released.

Lisdexamfetamine (once converted to dexamfetamine) also mimics the action of these two chemicals, acting as a substitute. This results in higher levels of noradrenaline and dopamine between the nerve cells and allows these chemicals to hang around for longer.

With higher levels of noradrenaline and dopamine in the brain, many other effects occur in different parts of the body, including the heart, the gut, and the lungs. Overall, this leads to the good effects of the medicine, but can also produce unwanted side effects.

Lisdexamfetamine is a 'controlled drug'

This is because there is an increased risk of the medicine being supplied or sold illegally and misused.

Lisdexamfetamine is a stimulant, so some people want to use it as a drug to get high or as a ‘performance-enhancer’ to help them work harder or revise for exams. There is little or no evidence to show that this works, and it could cause serious side effects if taken by people who are not prescribed this medicine.

Sometimes people taking lisdexamfetamine from their doctor may be targeted at school and bullied to give away or sell their medicine.
If someone is asking you to give away or sell your medicine, please ask your parent, teacher or doctor to help you. Never share (or sell) your medicine to anyone else- this is dangerous and illegal.

If you must take it to school, check with your teachers how to keep your medicine safe until you need it.

There are special rules and laws for how controlled drugs are prescribed.

The doctor must write extra information on the prescription, like the total amount needed in words and figures to make it harder for a genuine prescription to be altered.
A prescription for lisdexamfetamine must be dispensed by the pharmacy and collected within 28 days of the prescription being written. Other prescriptions for medication that isn’t a controlled drug are valid for up to six months.
You cannot get an emergency supply of lisdexamfetamine without a prescription.

Lisdexamfetamine and everyday life

Lisdexamfetamine can start to work after the first dose, but it may take a few weeks to feel the full effect.

You should see improvements in your concentration and other symptoms within one month of starting the medicine, usually within the first week of taking it.

Your doctor might start you on a low dose and then increase it slowly over two to four weeks, sometimes longer. The doctor will monitor your symptoms and find the dose that works best for you.

Lisdexamfetamine can make you want to eat less, so you may lose weight while taking. Weight gain has also been reported, but weight loss is more common.

Lisdexamfetamine can also affect your growth.

Your doctor will check your weight and height at least every six months while you are taking lisdexamfetamine. If you are not growing as fast as your friends, the doctor may stop the lisdexamfetamine for a while to let your growth recover.

It is not possible to predict how it will affect each person who takes it. Talk to your doctor before starting this medication if you have concerns about how it might affect your weight and growth.

A common side effect of lisdexamfetamine is a dry mouth. Over a long time, this can increase your risk of developing tooth decay or gum disease. Make sure you brush your teeth well and have regular dental check-ups. Speak to your dentist, doctor or pharmacist about things you can do to help.

You may want to let your family and friends know you are taking lisdexamfetamine so they can support you and help you look out for side effects.

For guidance on this, check out our page on getting support with your medication.

Lisdexamfetamine is a stimulant so it can affect your sleep by keeping you awake. Talk to your doctor about this if it is a problem for you.

You will usually take lisdexamfetamine once a day, usually first thing in the morning with or just before breakfast. If you take it later in the day, there is a chance it will disrupt your sleep.

Depending on your lifestyle, studying or work, you may find taking your medication later in the day manages your symptoms better in the evening and helps you more. Discuss this with your doctor to work out what works best for you.

If the medication helps to improve your ADHD symptoms, this may also help to improve your sleep.

Alcohol

Drinking alcohol while taking lisdexamfetamine can increase the effects of the medication, which may give you side effects similar to if you had taken too much of it.

It is recommended that you don’t drink alcohol until you know how the medicine affects you.

If you decide to drink alcohol, only drink in small amounts and see how it affects you.

When combined, lisdexamfetamine and alcohol can cause unpredictable effects. The combination may increase your blood pressure and heart rate. Lisdexamfetamine can also reduce the effects of alcohol which may mean you end up drinking more than you realise which could be very dangerous.

It is advisable not to drink alone, so that there is someone else there to help you if you need it.

Drinking alcohol every day, or in large amounts, can make your symptoms worse and may mean you won’t get the maximum benefit from your medication.

Remember that some foods also contain alcohol.

Street drugs

Lisdexamfetamine is dangerous to take with cocaine or ecstasy or other amfetamines. This is because they are all stimulants and may together put too much pressure on your heart and the blood vessels in your brain.

Mixing methadone with lisdexamfetamine can cause serious heart problems and may trigger a dangerous condition known as serotonin syndrome.

Lisdexamfetamine may add to the pain-killing effects of heroin. You might hurt yourself and not feel enough pain to get help.

Lisdexamfetamine is also known as a street drug as it’s a stimulant, so some people use it to get ‘high.’

People taking lisdexamfetamine from their doctor can be targeted at school and bullied to give away or sell their medicine. If this happens to you, ask your parent, teacher or doctor to help you. Never share or sell your medicine to anyone else – this is dangerous and illegal.

This medicine may give a positive result when testing for drug use. Talk to your doctor if this is a problem for you.

There are many other street drugs, but we don’t know what effect taking them with lisdexamfetamine will have, so it’s best to be cautious. There is no regulation of street drugs or ‘legal highs’, so even if there are no known issues with the medication you take, the supply you receive might be mixed with other substances that could be dangerous.

Get more advice on drugs and alcohol.

Lisdexamfetamine does not mix well with some other medicines and herbal remedies. The combination may affect how they work or could cause more side effects.

Do not take lisdexamfetamine if you have taken a monoamine oxidase inhibitor antidepressant (MAOI) like moclobemide, phenelzine, isocarboxazid or tranylcypromine in the last 14 days.

Taking a MAOI with lisdexamfetamine may cause a sudden and dangerous increase in your blood pressure.

If you are taking other medicines, lisdexamfetamine may affect how well they work or may cause side effects. Tell your doctor about these before you start your treatment.

Talk to your pharmacist if you buy any medications over the counter to treat common illnesses like colds and flu, or medications that you put on your skin.

Look at the leaflet inside your medicine box for more information about other medicines that can interact with lisdexamfetamine. With some medicines your doctor may need to adjust the dose of your medicines if you take them together. Ask a doctor or pharmacist for more information if you have any questions.

Lisdexamfetamine capsules contain gelatine. The capsules also contain colourants (these vary depending on the strength of the capsule).

If you need to avoid animal products such as gelatine, please note that this is often found in capsules but also in some tablet formulations. Ask your pharmacist if you have any questions about the ingredients.

Further information about practical considerations for medicines if you need to avoid animal products can be found on the Vegan Society website.

Always let your pharmacist know if you have any food allergies or intolerances, and always check with them if you’re concerned about any of the ingredients in your medication.

Taking lisdexamfetamine may give you blurred vision, can make you feel drowsy or dizzy, make it difficult to concentrate, or affect your focus when you start taking it.

It may be best to stop doing things like driving a car, riding a bike, or anything else that needs a lot of focus for the first few days until you know how it affects you.

Most people drive as normal while taking lisdexamfetamine. If you are worried about this or have any concerns you would like to discuss, speak to your doctor or pharmacist.

You must tell DVLA if your ADHD or your ADHD medication affects your ability to drive safely. You do not need to tell DVLA about your condition unless you think that it may affect your ability to drive safely. If you think your driving might be affected by your ADHD or your medication, don’t drive and speak to your doctor.

It is illegal to drive with medication in your body if it impairs your driving. You may also have to prove that you have been given lisdexamfetamine on prescription, so you should keep your repeat prescription slip or get a letter to explain it from your doctor.

Pregnancy

There is no evidence to suggest that taking lisdexamfetamine while you are pregnant is harmful, but there is not much information available. Some data says that there might be an increased risk of preeclampsia (high blood pressure) or premature birth.

If you become pregnant while you are on lisdexamfetamine, you should carry on taking it and make an appointment to see your doctor as soon as possible. They can discuss the benefits and risks of continuing lisdexamfetamine and help you to make a decision that is best for you and your baby.

They may refer you to a specialist perinatal mental health team to support you with this decision.

You can find out more information about taking lamotrigine during pregnancy at Bumps (Best Use of Medicines in Pregnancy).

Decisions about stopping or avoiding medication when you are pregnant need to be discussed carefully with your doctor. If you and your doctor agree that it is best for you to continue taking lisdexamfetamine while pregnant, you should tell your midwife. If you are planning on to get pregnant, it is recommended to you take folic acid while you are trying for a baby and during pregnancy. It is safe to take this together with lisdexamfetamine.

Post-natal

Some newborn babies whose mothers take lisdexamfetamine during pregnancy can get withdrawl symptoms at birth or soon after, like having problems with sleeping, being restless or having feeding difficulties.

Tell your midwife if you are taking lisdexamfetamine, so that they can help if the baby has any symptoms after birth. Your baby might need some additional observations after delivery, which you can discuss as part of your birth plan.

Breastfeeding

Lisdexamfetamine is passed to the baby in breastmilk in varying amounts.

If your baby was born early, then breastfeeding while you are taking lisdexamfetamine may not be recommended. Talk to your midwife and doctor about feeding options.

If you breastfeed while taking lisdexamfetamine, seek urgent medical advice if your baby comes restless, very sleepy or develops feeding problems.

Sex

Lisdexamfetamine can have side effects that might affect your sex life. These include:

problems getting an erection
losing weight (if this affects your body confidence)

Most side effects occur when you first start medication and improve over time. Talk to your doctor is you get these symptoms.

Untreated ADHD can have a negative effect on your sex life, so if lisdexamfetamine helps you, it may have affect on your sex life as your symptoms settle, and you can concentrate on your relationships.

Fertility

There is currently no evidence to suggest that lisdexamfetamine affects fertility.

Talk to your doctor about your lisdexamfetamine if you are trying to get pregnant or planning a family.

Lisdexamfetamine is a banned substance in competitive sports. It is a stimulant included in the World Anti-Doping International Standard Prohibited List for Sports. If you play sport to a high level and want to compete where testing will happen, you need to make sure you let the regulators know. You cannot take lisdexamfetamine if you are competing.

Most people play sports as normal while taking lisdexamfetamine, but if lisdexamfetamine affects your concentration, eyesight or co-ordination, then you may want to wait to see if those effects go away before playing sports that need a lot of focus. If you have any concerns, discuss this with your doctor.

Lisdexamfetamine may affect your concentration, give you blurred eyesight and make you feel dizzy and tired.

Ideally, it is best not to take lisdexamfetamine for the first time just before your exams.

It is not possible to predict how the medication will make you feel, and if you do get any side effects, these are more likely to occur when you first start taking lisdexampetamine.

You should talk to your doctor about any future exams if you are starting lisdexamfetamine. You might decide together to delay starting it until you have done them.

If they are more than a month away, however, you might find that it is better to start lisdexamfetamine to improve your sleep, motivation and ability to study.

Most people take exams as normal while taking lisdexamfetamine, but if you have any concerns, discuss this with your doctor.

Information and safety considerations

Your doctor will consider any other medical conditions or symptoms you have before recommending a medicine for you.

Your medicine will come with a ‘patient information leaflet’. It’s important that you read this information. Speak to your pharmacist if:

you’re not given a leaflet
you don’t understand the information
you need it in a different format or language
you’re concerned about something you’ve read

The information leaflet also includes a list of warnings and precautions to consider before you take the medicine. If you think that any of these apply to you and are concerned that your doctor is not already aware of them, check with your doctor or pharmacist before you start to take your medication (or as soon as possible if you are already taking it).

Uses, warnings, safety and side effects

Taking lisdexamfetamine

It is likely that you will take it for several years or more. If you start this medicine when you are under 18 years old, it may still help you when you are an adult.

Your specialist doctor should review your treatment regularly with you (at least once a year) and discuss whether you think the medicine is still helping you.

You and your doctor may agree to try a break in treatment (sometimes called a ‘drug holiday’) to see how you feel. This can help you decide whether it would be best to continue with your medicine or not.

You will get the best effect from your lisdexamfetamine if you take it regularly at the dose prescribed by your doctor. This is usually once a day in the morning.

You can take lisdexamfetamine with or without food.

The capsules of lisdexamfetamine should be swallowed whole and not chewed.

Alternatively, capsules can be opened and the contents mixed with a soft food like yogurt or in a glass of water or orange juice. After mixing the dose, it should be taken immediately.

If your medication helps you but you feel like the benefits wear off during the day, talk to your specialist doctor about how to manage this.
Do not alter the dose of your medication yourself. Always speak to your doctor if you don’t think your medicine is working as well for you.

Once you remember, take it as soon as possible. If you don’t remember until after lunchtime, you may want to wait and start taking your medication again the next day.

If you do not remember to take it before the next dose, just leave it and take the next dose. Do not try and catch up by taking a double dose.

If you forget to take it for a few days, your symptoms may come back. You may get an unwanted effect of feeling very low as the chemicals in your brain change their balance, with less noradrenaline and dopamine around. You may also feel very tired.

If you miss doses, even if you didn’t mean to, it is helpful to record how you managed during the day and how you felt. This will be useful to share with your doctor when they next review your medication with you.

You can stop taking lisdexamfetamine safely and gradually with your doctor’s help.

Speak to your doctor if you decide you want to stop your medicine. Your doctor will also assess if the medication is still helping you at each treatment review and talk to you about trying a treatment break if appropriate.

If you are on a low dose, you will be able to stop it suddenly. If you are on a higher dose, it will be better to gradually reduce the dose before stopping it.

It is safe to stop this medication suddenly, but stopping it abruptly or reducing the dose too much at once may cause uncomfortable withdrawal symptoms. These may include feeling tired, low mood or irritability, increased appetite, aches and pains.

Not everyone experiences these, but it is important to be aware of them so you know what to look out for. They are caused by the brain adjusting to not having the medicine, and some may be due to a return of ADHD symptoms.

If you do experience any withdrawal symptoms, they should stop after a few days. If they do not, or they are stopping you getting on with your life, discuss this with your doctor.

Warnings and safety

If you have taken more than the dose prescribed by your doctor, contact NHS 111 immediately to ask for advice, or ask a family member or friend to do this for you. This is important even if you don’t feel any different.

NHS 111 can give you advice and direct you to the best place to get more help if you need it.

If you have taken too much medication on purpose, or if after taking this you quickly feel unwell, call 999 or get someone to take you to A&E straight away. This includes any of the following signs:

feeling very excited
having a seizure (fit), which can lead to a coma
hallucinating (seeing, feeling or hearing things that are not real)
changes in your heartbeat (slow, fast or uneven)
your breathing getting slower

If you need to go to A&E, do not travel alone or drive yourself there. Get your parent, family member or friend to go with you to support you and keep you safe on the way. If someone is not able to drive you there, call for an ambulance. Take your medication with you and tell doctors how much you have taken.

Serious side effects

Lisdexamfetamine can cause serious side effects, including allergic reactions.

Stop taking lisdexamfetamine and go to a hospital straight away if you get any of the following symptoms:

difficulty breathing or talking, wheezing and tightness in the chest or throat
an allergic reaction or allergy (including symptoms such as high body temperature, swelling of your face, eyelids, lips, tongue or throat so that you cannot swallow or breathe, really bad itching of the skin with raised lumps
a rash or hives where the skin is itchy, red, swollen, blistered or peeling (the rash may be circular in appearance which is darker in the middle and lighter around the outside)
fast, uneven heartbeat and fainting (this could mean a life-threatening condition called Torsades de Pointes)
having seizures or fits
trouble breathing or talking, wheezing and tightness in the chest or throat

Get your parent, family member or friend to take you or go with you to support you and keep you safe on the way. If someone is not able to drive you there, call for an ambulance. Take your medication with you.

Contact your doctor immediately but don't stop taking lisdexamfetamine, if you get any of the following symptoms:

concerns about weight loss, weight gain, or slower growth
any changes or worsening of your mood or behaviour
feeling or hearing things that are not real or believing things that are not true
your behaviour changes because you feel very happy or over-excited
uncontrolled speech or body movements
uneven or racing heartbeats that feel like thumping inside your chest

If you are unable to contact your doctor, call NHS 111 for urgent advice.

Side effects and your health

Side effects are more common when you first start taking a new medicine. Many go away as you continue your medicine. If they don’t get better, or if you are worried by them and they are causing you distress, speak to your doctor, specialist team or pharmacist about them.

Very common side effects of taking lisdexamfetamine (affecting more than one in ten people) include:

disturbed sleep
decreased appetite leading to lack of normal weight gain and, possibly, weight loss
dry mouth
headache

Common side effects of taking lisdexamfetamine (affecting up to one in ten people) include:

feeling sick or being sick
diarrhoea or constipation
cramps or pain in your stomach
feeling unusually happy
feeling irritable or aggressive
feeling confused or having a low mood (depression)
cramps or pain in your gut
heart and blood pressure changes, including fast heart rate
rashes or itching skin
uncontrolled twitching, jerking, shaking, trembling or being unusually active

There are other side effects that you can get when taking this medicine. We have only included the most common ones here.

This list of side effects can look scary. You may not experience any of them, but it’s important to be aware of them so you know what to do if they do happen.

Unless your side effects are very severe or distressing, try to continue taking your medication until you can talk to your doctor. Your doctor can make changes to your medication to help if needed.

Additional monitoring is recommended with this medicine to check for any unwanted changes the medicine might cause and make sure your doctor can review them quickly.

Before you start taking lisdexamfetamine, if you change your dose, and at least every six months after you start, the doctor will do some tests to check that lisdexamfetamine is still right for you.

They will ask about your appetite, as lisdexamfetamine can make you want to eat less.

They will check your weight and height, as lisdexamfetamine can slow down your growth.

They will check your heart rate and blood pressure, as lisdexamfetamine can sometimes increase these.

They will ask you about your mood and how you are feeling to check that the medicine is working, but also whether you are having any side effects.

They will ask you about any feelings of aggression or dislike towards others, which can be a side effect of the medicine.

Before starting lisdexamfetamine, your doctor may also check your heart using an electrocardiogram (ECG).