Vyvanse Cardiovascular Impact Long-Term: What the Evidence Actually Shows

How much does Vyvanse raise heart rate and blood pressure?

The Vyvanse label's warning section gives figures for CNS stimulants: a mean blood pressure increase of about 2 to 4 mm Hg and a mean heart rate increase of about 3 to 6 bpm, with some patients having larger increases [1].

In the 4-week adult ADHD trial (358 people on Vyvanse, 62 on placebo), the label reports increased blood pressure in 3% versus 0%, increased heart rate in 2% versus 0%, and palpitations in 2% versus 0% [1]. In the two 12-week binge eating disorder trials (373 versus 372), increased heart rate was reported in 7% versus 1% and feeling jittery in 6% versus 1% [1].

In the published binge eating disorder program, mean pulse rose 4.41 to 6.31 bpm across the two trials at week 12 or early termination, systolic pressure rose 0.2 to 1.45 mm Hg and diastolic pressure 1.06 to 1.83 mm Hg [5]. The two trials enrolled 383 and 390 adults [5].

What the long-term data actually cover

The controlled lisdexamfetamine trials cited here are short: 4 weeks in children aged 6 to 12 (290 randomized to 30, 50 or 70 mg or placebo) [6], 4 weeks in 420 adults with ADHD [7], and 12 weeks in the two binge eating disorder trials [5].

A randomized-withdrawal study followed selected adults with binge eating disorder for longer: 418 adults entered 12 weeks of open-label Vyvanse, 275 responders were randomized to continue it or switch to placebo for up to 26 weeks, and relapse occurred in 3.7% of those who continued versus 32.1% of those switched to placebo [8]. That outcome was binge-eating relapse, not cardiovascular events, so the study does not establish long-term cardiovascular safety.

A 2025 meta-analysis pooled 93 randomized trials of methylphenidate, lisdexamfetamine and other amphetamines, with treatment up to 52 weeks, and found a higher risk of any adverse event than placebo (risk ratio 1.34, 90% CI 1.27 to 1.41; heterogeneity I2 67%), a finding that held for lisdexamfetamine on its own [4]. That outcome is any adverse event, not a cardiac endpoint.

Who the label says should avoid Vyvanse

The label's cardiac warning states that sudden death has been reported in patients with structural cardiac abnormalities or other serious cardiac disease treated with CNS stimulants at recommended ADHD doses, and directs that Vyvanse be avoided in known structural cardiac abnormalities, cardiomyopathy, serious cardiac arrhythmia, coronary artery disease or other serious cardiac disease [1]. Before treatment, the dosing section calls for a careful history, a family history of sudden death or ventricular arrhythmia, and a physical exam [1].

The contraindications section lists two things: known hypersensitivity to amphetamine products or other ingredients in Vyvanse, and use of a monoamine oxidase inhibitor, or within 14 days of stopping one [1]. Hypertension is not among them [1].

Two other label points belong here. Vyvanse is not indicated for weight loss, and the label notes that use of other sympathomimetic drugs for weight loss has been associated with serious cardiovascular adverse events [1]. And the single boxed warning on this label is abuse, misuse and addiction, not a cardiac warning [1].

Heart attacks and strokes: what the population studies found

The largest dataset is a retrospective cohort using records from four health plans: 1,200,438 children and young adults aged 2 to 24, with 2,579,104 person-years of follow-up including 373,667 person-years of current ADHD drug use [2]. There were 81 serious cardiovascular events (sudden cardiac death, acute myocardial infarction or stroke), a rate of 3.1 per 100,000 person-years. Current use of an ADHD drug was not associated with increased risk (adjusted hazard ratio 0.75, 95% CI 0.31 to 1.85) [2]. The authors noted that the upper limit of that interval could not rule out a doubling of risk, but that the absolute size of such an increase would be low [2].

In adults, 150,359 people aged 25 to 64 with prescriptions for methylphenidate, amphetamine or atomoxetine were each matched to two nonusers, for 443,198 people in total [3]. Over 806,182 person-years there were 1,357 myocardial infarctions, 296 sudden cardiac deaths and 575 strokes. The adjusted rate ratio for serious cardiovascular events with current use versus nonuse was 0.83 (95% CI 0.72 to 0.96) [3]. When current users were compared with remote users, a comparison used to account for healthy-user bias, the adjusted rate ratio was 1.03 (95% CI 0.86 to 1.24) [3].

People with high blood pressure

High blood pressure is common with age. In 2017-2018, 54.5% of US adults aged 40 to 59 and 74.5% of those 60 and older met the 130/80 mm Hg definition of hypertension or were taking medication for it [9]. The 4-week adult ADHD trial enrolled people aged 18 to 55 [7].

The label says all Vyvanse-treated patients should be monitored for tachycardia and hypertension [1].

Interactions the label flags

Monoamine oxidase inhibitors are contraindicated during Vyvanse treatment and for 14 days after stopping one; the label says MAOIs slow amphetamine metabolism, increasing its effect on the release of norepinephrine and other monoamines, which can cause hypertensive crisis, toxic neurological effects and malignant hyperpyrexia [1].

With tricyclic antidepressants, the label says Vyvanse may enhance the activity of tricyclic or sympathomimetic agents, causing striking and sustained increases in brain d-amphetamine, and cardiovascular effects can be potentiated; it calls for frequent monitoring [1].

Urinary pH matters too. The label says alkalinizing agents such as sodium bicarbonate raise amphetamine blood levels and potentiate its effects, so coadministration should be avoided; acidifying agents such as ascorbic acid lower levels and efficacy, and the dose is increased based on clinical response [1].