Lisdexamfetamine: uses, appearance and warnings

Lisdexamfetamine dimesylate capsules are indicated for the treatment of: Attention Deficit Hyperactivity Disorder (ADHD) in adults and pediatric patients 6 years and older [see Clinical Studies (14.1) ]. Moderate to severe binge eating disorder (BED) in adults [see Clinical Studies (14.2) ] . Limitations of Use: The use of lisdexamfetamine dimesylate capsules is not recommended in pediatric patients younger than 6 years of age because they had higher plasma exposure and a higher incidence of adverse reactions (e.g., weight loss) than patients 6 years and older at the same dosage [see Warnings and Precautions (5.5) , Use in Specific Populations (8.4) ] . Lisdexamfetamine dimesylate capsules are not indicated or recommended for weight loss. Use of other sympathomimetic drugs for weight loss has been associated with serious cardiovascular adverse events. The safety and effectiveness of lisdexamfetamine dimesylate capsules for the treatment of obesity have not been established [see Warnings and Precautions (5.2) ] . Lisdexamfetamine dimesylate are a central nervous system (CNS) stimulant indicated for the treatment of (1) : Attention Deficit Hyperactivity Disorder (ADHD) in adults and pediatric patients 6 years and older. Moderate to severe binge eating disorder (BED) in adults. Limitations of Use: The use of lisdexamfetamine dimesylate capsules is not recommended in pediatric patients younger than 6 years of age because they had higher plasma exposure and a higher incidence of adverse reactions (e.g., weight loss) than patients 6 years and older at the same dosage. (5.5 , 8.4) Lisdexamfetamine dimesylate capsules are not indicated for weight loss. Use of other sympathomimetic drugs for weight loss has been associated with serious cardiovascular adverse events. The safety and effectiveness of lisdexamfetamine dimesylate capsules for the treatment of obesity have not been established. (5.2)

Lisdexamfetamine dimesylate capsules: Lisdexamfetamine dimesylate capsules 20 mg: beige body/beige cap (imprinted with AN 23) Lisdexamfetamine dimesylate capsules 30 mg: white body/orange cap (imprinted with AN 24) Lisdexamfetamine dimesylate capsules 40 mg: white body/sea green cap (imprinted with AN 25) Lisdexamfetamine dimesylate capsules 50 mg: white body/dark blue cap (imprinted with AN 26) Lisdexamfetamine dimesylate capsules 60 mg: light blue body/light blue cap (imprinted with AN 27) Lisdexamfetamine dimesylate capsules 70 mg: blue body/orange cap (imprinted with AN 28) Capsules: 20 mg, 30 mg, 40 mg, 50 mg, 60 mg, 70 mg. (3)

16.1 How Supplied Lisdexamfetamine dimesylate capsules, 20 mg are supplied as beige body/beige cap, imprinted with AN 23. They are available as follows: Bottles of 90: NDC 65162-023-09 Lisdexamfetamine dimesylate capsules, 30 mg are supplied as white body/orange cap, imprinted with AN 24. They are available as follows: Bottles of 90: NDC 65162-024-09 Lisdexamfetamine dimesylate capsules, 40 mg are supplied as white body/sea green cap, imprinted with AN 25. They are available as follows: Bottles of 90: NDC 65162-025-09 Lisdexamfetamine dimesylate capsules, 50 mg are supplied as white body/dark blue cap, imprinted with AN 26. They are available as follows: Bottles of 90: NDC 65162-026-09 Lisdexamfetamine dimesylate capsules, 60 mg are supplied as light blue body/light blue cap, imprinted with AN 27. They are available as follows: Bottles of 90: NDC 65162-027-09 Lisdexamfetamine dimesylate capsules, 70 mg are supplied as blue body/orange cap, imprinted with AN 28. They are available as follows: Bottles of 90: NDC 65162-028-09 16.2 Storage and Handling Dispense in a tight, light-resistant container as defined in the USP. Store at room temperature, 20° to 25°C (68° to 77°F); excursions permitted between 15° and 30°C (59° to 86 ° F) [see USP Controlled Room Temperature].

Lisdexamfetamine dimesylate is contraindicated in patients with: Known hypersensitivity to amphetamine products or other ingredients of Lisdexamfetamine dimesylate capsules. Anaphylactic reactions, Stevens-Johnson Syndrome, angioedema, and urticaria have been observed in post-marketing reports [see Adverse Reactions (6.2) ] . Patients taking monoamine oxidase inhibitors (MAOIs), or within 14 days of stopping MAOIs (including MAOIs such as linezolid or intravenous methylene blue), because of an increased risk of hypertensive crisis [see Warnings and Precautions (5.7) and Drug Interactions (7.1) ] . Known hypersensitivity to amphetamine products or other ingredients in lisdexamfetamine dimesylate capsules. (4 ) Use with monoamine oxidase (MAO) inhibitor, or within 14 days of the last MAO inhibitor dose. ( 4, 7.1 )

Risks to Patients with Serious Cardiac Disease: Avoid use in patients with known structural cardiac abnormalities, cardiomyopathy, serious cardiac arrhythmia, coronary artery disease, or other serious cardiac disease. (5.2) Increased Blood Pressure and Heart Rate: Monitor blood pressure and pulse. (5.3) Psychiatric Adverse Reactions: Prior to initiating lisdexamfetamine dimesylate capsules, screen patients for risk factors for developing a manic episode. If new psychotic or manic symptoms occur, consider discontinuing lisdexamfetamine dimesylate capsules. ( 5.4 ) Long-Term Suppression of Growth in Pediatric Patients: Closely monitor growth (height and weight) in pediatric patients. Pediatric patients not growing or gaining height or weight as expected may need to have their treatment interrupted. ( 5.5 ) Peripheral Vasculopathy, including Raynaud’s phenomenon: Careful observation for digital changes is necessary during lisdexamfetamine dimesylate capsules treatment. Further clinical evaluation (e.g., rheumatology referral) may be appropriate for patients who develop signs or symptoms of peripheral vasculopathy. ( 5.6 ) Serotonin Syndrome: Increased risk when co-administered with serotonergic agents (e.g., SSRIs, SNRIs, triptans), but also during overdosage situations. If it occurs, discontinue lisdexamfetamine dimesylate capsules and initiate supportive treatment. ( 4 , 5.7 , 10 ) Motor and Verbal Tics, and Worsening of To urette’s Syndrome: Before initiating lisdexamfetamine dimesylate capsules, assess the family history and clinically evaluate patients for tics or Tourette’s syndrome. Regularly monitor patients for the emergence or worsening of tics or Tourette’s syndrome. Discontinue treatment if clinically appropriate. ( 5.8 ) 5.1 Abuse, Misuse, and Addiction Lisdexamfetamine dimesylate has a high potential for abuse and misuse. The use of Lisdexamfetamine dimesylate exposes individuals to the risks of abuse and misuse, which can lead to the development of a substance use disorder, including addiction. Lisdexamfetamine dimesylate can be diverted for non-medical use into illicit channels or distribution [see Drug Abuse and Dependence (9.2) ] . Misuse and abuse of CNS stimulants, including lisdexamfetamine dimesylate, can result in overdose and death [see Overdosage (10) ] , and this risk is increased with higher doses or unapproved methods of administration, such as snorting or injection. Before prescribing lisdexamfetamine dimesylate, assess each patient’s risk for abuse, misuse, and addiction. Educate patients and their families about these risks and proper disposal of any unused drug. Advise patients to store lisdexamfetamine dimesylate in a safe place, preferably locked, and instruct patients to not give lisdexamfetamine dimesylate to anyone else. Throughout lisdexamfetamine dimesylate treatment, reassess each patient’s risk of abuse, misuse, and addiction and frequently monitor for signs and symptoms of abuse, misuse, and addiction. 5.2 Risks to Patients with Serious Cardiac Disease Sudden death has been reported in patients with structural cardiac abnormalities or other serious cardiac disease who were treated with CNS stimulants at the recommended ADHD dosage. Avoid lisdexamfetamine dimesylate use in patients with known structural cardiac abnormalities, cardiomyopathy, serious cardiac arrhythmia, coronary artery disease, or other serious cardiac disease. 5.3 Increased Blood Pressure and Heart Rate CNS stimulants cause an increase in blood pressure (mean increase about 2 to 4 mm Hg) and heart rate (mean increase about 3 to 6 bpm). Some patients may have larger increases. Monitor all lisdexamfetamine dimesylate-treated patients for potential tachycardia and hypertension. 5.4 Psychiatric Adverse Reactions Exacerbation of Pre-existing Psychosis CNS stimulants may exacerbate symptoms of behavior disturbance and thought disorder in patients with a pre-existing psychotic disorder. Induction of a Manic Episode in Patients with Bipolar Disorder CNS stimulants may induce a manic or mixed episode. Prior to initiating lisdexamfetamine dimesylate treatment, screen patients for risk factors for developing a manic episode (e.g., comorbid or history of depressive symptoms or a family history of suicide, bipolar disorder, and depression). New Psychotic or Manic Symptoms CNS stimulants, at the recommended dosage, may cause psychotic or manic symptoms (e.g., hallucinations, delusional thinking, or mania) in patients without a prior history of psychotic illness or mania. In a pooled analysis of multiple short-term, placebo-controlled studies of CNS stimulants, psychotic or manic symptoms occurred in approximately 0.1% of CNS stimulant-treated patients compared to 0% of placebo-treated patients. If such symptoms occur, consider discontinuing lisdexamfetamine dimesylate. 5.5 Long-Term Suppression of Growth in Pediatric Patients Lisdexamfetamine dimesylate is not approved for use and is not recommended in pediatric patients below 6 years of age [see Use in Specific Populations (8.4) ] . CNS stimulants have been associated with weight loss and slowing of growth rate in pediatric patients. In a 4-week, placebo-controlled trial of lisdexamfetamine dimesylate in pediatric patients ages 6 to 12 years old with ADHD, there was a dose-related decrease in weight in the lisdexamfetamine dimesylate groups compared to weight gain in the placebo group. Additionally, in studies of another stimulant, there was slowing of the increase in height [see Adverse Reactions (6.1) ] . Closely monitor growth (weight and height) in lisdexamfetamine dimesylate-treated pediatric patients. Patients who are not growing or gaining height or weight as expected may need to have their treatment interrupted. 5.6 Peripheral Vasculopathy, including Raynaud’s Phenomenon CNS stimulants, including lisdexamfetamine dimesylate, used to treat ADHD are associated with peripheral vasculopathy, including Raynaud’s phenomenon. …

The following adverse reactions are discussed in greater detail in other sections of the labeling: Known hypersensitivity to amphetamine products or other ingredients of lisdexamfetamine dimesylate capsules [see Contraindications (4) ] Hypertensive Crisis When Used Concomitantly with Monoamine Oxidase Inhibitors [see Contraindications (4) and Drug Interactions (7.1) ] Abuse, Misuse, and Addiction [see Boxed Warning , Warnings and Precautions (5.1) , and Drug Abuse and Dependence (9.2 , 9.3) ] Risks to Patients with Serious Cardiac Disease [see Warnings and Precautions (5.2) ] Increased Blood Pressure and Heart Rate [see Warnings and Precautions (5.3) ] Psychiatric Adverse Reactions [see Warnings and Precautions (5.4) ] Long-Term Suppression of Growth in Pediatric Patients [see Warnings and Precautions (5.5) ] Peripheral Vasculopathy, including Raynaud’s phenomenon [see Warnings and Preca …

Acidifying and Alkalinizing Agents: Agents that alter urinary pH can alter blood levels of amphetamine. Acidifying agents decrease amphetamine blood levels, while alkalinizing agents increase amphetamine blood levels. Adjust lisdexamfetamine dimesylate dosage accordingly. ( 2.6 , 7 .1 ) 7.1 Drugs Having Clinically Important Interactions with Amphetamines Table 5: Drugs having clinically important interactions with amphetamines. MAO Inhibitors (MAOI) Clinical Impact MAOI antidepressants slow amphetamine metabolism, increasing amphetamines effect on the release of norepinephrine and other monoamines from adrenergic nerve endings causing headaches and other signs of hypertensive crisis. Toxic neurological effects and malignant hyperpyrexia can occur, sometimes with fatal results. …