Vyvanse and Autoimmune Disease: What Clinicians and Patients Need to Know

Does the Vyvanse label address autoimmune disease?

The label lists two contraindications: known hypersensitivity to amphetamine products or other ingredients of Vyvanse, and use with a monoamine oxidase inhibitor, including linezolid or intravenous methylene blue, or within 14 days of stopping one [1].

Its warnings and precautions cover serious cardiac disease, increases in blood pressure and heart rate, psychiatric reactions, growth suppression in children, peripheral vasculopathy, serotonin syndrome and tics. Autoimmune disease is not named among them [1].

Peripheral vasculopathy and Raynaud's phenomenon

This is the label warning closest to rheumatology care. CNS stimulants, including Vyvanse, are associated with peripheral vasculopathy, including Raynaud's phenomenon [1]. The label calls the signs and symptoms usually intermittent and mild, but notes that consequences have included digital ulceration and soft tissue breakdown, reported at therapeutic doses in all age groups, and that they generally improved after dose reduction or discontinuation [1]. It states that careful observation for digital changes is necessary and that further clinical evaluation, such as a rheumatology referral, may be appropriate if they develop [1].

Hypersensitivity and medicines the label flags

The label reports that anaphylactic reactions, Stevens-Johnson syndrome, angioedema and urticaria have been observed in postmarketing reports. Known hypersensitivity to amphetamine products is a contraindication [1].

The label's table of clinically important interactions covers MAO inhibitors, serotonergic drugs, CYP2D6 inhibitors, urinary alkalinizing and acidifying agents, and tricyclic antidepressants [1]. No immunosuppressant appears in that table. SSRIs and SNRIs are among the serotonergic drugs that raise serotonin syndrome risk; the label says to start at lower doses and monitor, particularly at initiation and after a dose increase [1]. Before treatment, the label also calls for a cardiac history, a family history of sudden death or ventricular arrhythmia, and a physical exam [1].