Vyvanse Bone Health and Density Impact: What the Evidence Shows

What the Vyvanse label says about growth

Section 5.5 of the Vyvanse label, Long-Term Suppression of Growth in Pediatric Patients, states that CNS stimulants have been associated with weight loss and slowing of growth rate in children [1]. In a 4-week placebo-controlled trial in children aged 6 to 12 with ADHD, there was a dose-related decrease in weight in the Vyvanse groups compared with weight gain on placebo [1].

The same section credits the height finding to a different drug: slowing of the increase in height was seen in studies of another stimulant, not in the Vyvanse trial [1].

The label says to closely monitor growth (weight and height) in Vyvanse-treated children, and states that patients who are not growing or gaining height or weight as expected may need to have their treatment interrupted [1]. Vyvanse is not approved or recommended for children under 6, who had higher plasma exposure and more adverse reactions such as weight loss [1].

How much weight do children lose on Vyvanse?

Mean weight loss from baseline after 4 weeks was 0.9, 1.9 and 2.5 pounds at 30, 50 and 70 mg [1]. Decreased weight was reported in 9% of children aged 6 to 12 on Vyvanse versus 1% on placebo, and in 9% of adolescents aged 13 to 17 versus 0% on placebo [1]. Decreased appetite was reported in 39% versus 4% in the younger group, 34% versus 3% in adolescents, and 27% versus 2% in adults with ADHD [1].

Could amphetamines affect bone through the nervous system?

Lisdexamfetamine is an inactive prodrug converted mainly in the blood to dextroamphetamine, which blocks reuptake of norepinephrine and dopamine and increases release of both [1]. Separately, a 2014 review in Calcified Tissue International describes anatomical, pharmacologic and genetic evidence that sympathetic nervous system signaling through beta-adrenergic receptors regulates skeletal remodeling [2].

Those are two separate bodies of work. Neither shows that Vyvanse changes bone remodeling in people.

What the adult trials reported

In a 4-week trial, 420 adults with ADHD were randomized to 30, 50 or 70 mg/day or placebo; the most common adverse events were dry mouth, decreased appetite and insomnia [3]. In two 12-week binge eating disorder trials (n=383 and n=390), lisdexamfetamine reduced binge eating days per week more than placebo, with treatment differences of -1.35 and -1.66 days per week (both P<0.001); dry mouth, insomnia and headache were the most common adverse events, and mean pulse rose 4.41 to 6.31 beats per minute [4]. In the label's pooled data from those two trials in adults with binge eating disorder, decreased weight appeared in 4% of patients on Vyvanse versus 0% on placebo [1].