ADHDnotepad
Medication guide

Elvanse (lisdexamfetamine)

Elvanse is a once-daily lisdexamfetamine stimulant for ADHD in children and adults. Benefit lasted up to 14 hours in adult studies, but individual duration varies. This guide covers doses, daily use, side effects and when to get help.

StimulantOnce dailySchedule 2 CD

Written and clinically reviewed by ADHD Advanced Practitioner and Clinical Prescribing Pharmacist

Reading time: about 8 minutesLast reviewed: Next review: Download the one-page summary (PDF)

Elvanse: key facts

What it is
A once-daily stimulant used to treat ADHD, lasting roughly 12–14 hours.
How to take it
One capsule in the morning (ideally before 9am), with or without food.
When it kicks in
Gradually over 1–2 hours. No sharp 'switch on' feeling.
Most common early effects
Reduced appetite, difficulty falling asleep, mild headache and dry mouth. Most settle within 1–2 weeks, and taking your dose early helps sleep.
When to seek urgent help
Call 999 for severe or spreading chest pain, severe shortness of breath, a severe allergic reaction, signs of a stroke or a seizure. Contact your prescriber or 111 today for mild chest pain, hallucinations or thoughts of self-harm (call 999 if you might act on them). See the red-flag list in section 6.
Section 1

What is Elvanse?

Elvanse is a stimulant that your body converts into dexamfetamine. It is taken once each morning, comes in six strengths from 20 mg to 70 mg, and is a Schedule 2 controlled drug.

Elvanse at a glance

Elvanse: key facts at a glance, each with its source
FactDetail
Active ingredientLisdexamfetamine dimesylate: a prodrug that your body converts into dexamfetamineSource: Elvanse SmPC (eMC)
Medicine typeStimulant. Once daily. Schedule 2 controlled drugSource: BNF: lisdexamfetamine mesilate
Strengths20, 30, 40, 50, 60 and 70 mg capsulesSource: Elvanse SmPC (eMC)
Usual starting dose (adults)20 or 30 mg once each morning, increased by 10–20 mg no faster than weeklySource: Elvanse SmPC (eMC)
Maximum licensed dose70 mg a daySource: Elvanse SmPC (eMC)
How long it lastsUp to 12–14 hours from one morning doseSource: Elvanse SmPC (eMC)
FoodWith or without food. Breakfast first is recommendedSource: Elvanse SmPC (eMC)
How to take itSwallow whole, or open the capsule into water, orange juice or yoghurt and take straight awaySource: Elvanse SmPC (eMC)
LicenceLicensed for ADHD in adults and in children aged 6 and overSource: Elvanse SmPC (eMC)

When it's prescribed

First-line for adults with ADHD in the UK. You do not need to have tried methylphenidate first; this requirement only applies to children. Also licensed for children aged 6 and over and adolescents.

Pros of Elvanse

  • Once-daily dosing: no midday top-up required
  • Smooth onset and offset, fewer peaks and troughs
  • Lower misuse potential than immediate-release stimulants
  • Capsule can be opened and mixed with water, orange juice, or yogurt: all work identically
  • Adults do not need to fail on methylphenidate first

Cons of Elvanse

  • Appetite suppression, particularly in the afternoon: eat breakfast before it takes effect
  • Cardiovascular monitoring required before and during treatment
  • Controlled drug (Schedule 2): stricter prescription rules; keep it secure and never share it
  • Cannot be taken within 14 days of stopping an MAOI antidepressant
  • Not suitable with certain heart conditions, hyperthyroidism, or active psychosis
Section 2

How does Elvanse work?

Elvanse is inactive when you swallow it. Your red blood cells slowly convert it into dexamfetamine, so the effect builds over 1–2 hours and fades gently later in the day.

Lisdexamfetamine, also commonly known as the brand Elvanse, is a prodrug; it arrives in your stomach inactive. Your body then slowly converts it into the active ingredient (dexamfetamine) inside your red blood cells. Because this happens gradually, the effect builds up over an hour or two and wears off gently later in the day, without the sharp peaks and troughs of some other stimulants.

Once absorbed, dexamfetamine boosts two brain chemicals in the areas most affected by ADHD. Dopamine is your brain's "is this worth doing?" signal: low dopamine is why starting tasks feels genuinely hard. Noradrenaline is your brain's signal-to-noise filter; it helps the planning part of your brain focus on what matters and filter out distractions. Unlike some medications that only block reabsorption of these chemicals, dexamfetamine actively pushes more of them into the synapse: which is why the effect is noticeable and why the dose is carefully titrated.

This is helpful for ADHD symptoms such as impulsivity, emotional reactivity, poor task initiation and reward-driven behaviours, such as binge eating, impulse spending or constantly seeking stimulation.

However, because dexamfetamine can have a stronger releasing effect on dopamine and noradrenaline, some people may experience more side effects, such as poor sleep, vivid dreams, feeling overstimulated, or circulation-related symptoms such as cold fingers, colour changes or Raynaud’s-type symptoms. If this happens, and it is clinically appropriate, a trial of methylphenidate may be considered, as it can still improve ADHD symptoms but may be better tolerated for some people.

How Elvanse works: visual guide

Follow Elvanse from capsule to effect. Use ADHDnotepad's animated visual medication journey to see how lisdexamfetamine is taken as an inactive prodrug, converted into active dexamfetamine primarily in red blood cells, and then produces its effects on dopamine and noradrenaline signalling in the brain.

ClinicalDeeper clinical detail

Lisdexamfetamine dimesylate is a lysine-conjugated prodrug of d-amphetamine. After oral administration, enzymatic hydrolysis: primarily by red blood cell peptidases: cleaves the lysine moiety, releasing active d-amphetamine. The rate-limited conversion provides a slower, more controlled rise in plasma amphetamine levels compared to immediate-release dexamfetamine formulations.

d-Amphetamine acts as a releasing agent and reuptake inhibitor of dopamine and noradrenaline in presynaptic neurons, and to a lesser extent serotonin. It also inhibits monoamine oxidase. The net effect is substantially increased monoaminergic neurotransmission in prefrontal cortical circuits involved in executive function, attention, and impulse regulation.

The prodrug mechanism confers reduced misuse liability: non-oral administration (e.g. intranasal) attenuates enzymatic conversion and blunts the euphoric response. Clinically relevant where misuse risk is a consideration.

Section 3

How do I take Elvanse?

Take one capsule each morning, ideally between 7am and 9am, with or after breakfast. Swallow it whole, or open it and stir the contents into water, orange juice or yoghurt.

Interactive Elvanse duration & effect chart

See how Elvanse may work across the day. Use ADHDnotepad's interactive Elvanse effect chart to adjust dose time and strength and explore how the medication's effects may change throughout the day, including when effects may start, reach their main effect, begin wearing off and return towards baseline. The chart is illustrative, as actual onset and duration vary between people.

When to take it

Once each morning, ideally between 7am and 9am, at a consistent time. Taking it after 10–11am often makes sleep harder that night.

With or without food

Usually recommend with or after a decent breakfast for two reasons. Firstly, some people find it feels smoother and is better tolerated when taken after food. Food does not reduce how much medication is absorbed, but it can slightly delay the peak effect, so it may feel less abrupt for some people. Secondly, Elvanse commonly reduces appetite, so having breakfast first means you have already had a proper meal before the appetite suppression starts. Bonus tip: a higher-protein breakfast can be helpful for ADHD. Protein provides amino acids, which your body uses to help make neurotransmitters such as dopamine and noradrenaline. This can help support steadier energy, concentration and appetite control through the day.

Swallowing the capsule

Swallow whole with water, or open the capsule and stir the contents into a glass of water, orange juice, or yogurt. Drink or eat straight away. Don't crush or chew. All three mixing options are clinically identical in effect.

Missed dose

Before noon → take it when you remember. After noon → skip that day and take your normal dose tomorrow. Never double up.

Titration period

Almost always started at 20 or 30 mg and increased every 2–4 weeks. This isn't a sign it 'isn't working': it's your prescriber finding the lowest dose that gives you the best benefit with the fewest side effects. Most people reach their target dose within 6–12 weeks.

Don't combine with

MAOIs (a type of antidepressant): absolute no: cannot be taken within 14 days of stopping one. SSRIs and SNRIs: usually fine, but do carry the risk of Seretonin Syndrome, so speak to your prescriber. Large amounts of vitamin C (orange juice is fine) around the time of your dose: can reduce absorption. Antacids or sodium bicarbonate (e.g Gaviscon, Remmies etc.): can increase absorption. Always tell your prescriber and pharmacist about everything you take.

Drug testing

Elvanse converts to dexamfetamine in the body, so it will produce a positive result for amphetamines on any standard drug test: urine, saliva, or blood. This applies to workplace, legal, sporting, and roadside testing. Carry your prescription or a letter from your prescriber. The law provides a statutory medical defence for roadside tests if you are taking a prescribed dose and are not impaired.

ClinicalPrescribing and clinical detail

Licensed doses in the UK: 20, 30, 40, 50, 60, 70 mg. Titration typically begins at 20–30 mg daily, with increments of 10–20 mg at intervals of no less than one week, guided by response and tolerability. Maximum licensed dose: 70 mg daily.

Measure blood pressure and heart rate at baseline and after each dose increase, then at least every six months once stable. Monitor weight and height in children. Ask about personal or family history of cardiac conditions, arrhythmias, or sudden cardiac death before initiation. A resting ECG is not routinely required but should be considered where there is clinical concern.

Schedule 2 Controlled Drug under the Misuse of Drugs Regulations 2001. Prescriptions must comply with controlled-drug requirements (quantity in words and figures, no repeats). Cannot be prescribed on FP10MDA (instalment) forms for ADHD.

Section 4

What should I expect from Elvanse week by week?

Many people notice something in the first 1–3 days, and some feel nothing at the starting dose: both are normal. Your prescriber usually starts you on 20 or 30 mg and increases it every 2–4 weeks.

Days 1–3

First impressions

Many people notice something different quickly: improved focus, less mental noise, a sense of calm. Some feel nothing obvious at the starting dose: that's also normal. Appetite often drops straight away.

Week 1

Settling in

Effects become more predictable. You'll start to notice when it kicks in and when it wears off. Mild headaches and reduced appetite are common: both usually ease. Sleep may be disrupted if you dose too late.

Weeks 2–3

Finding your rhythm

Most people find a pattern that works for them. The initial side effects (headache, nausea, dry mouth) often settle by now. You may notice a 'rebound': feeling quieter or more emotionally sensitive as the dose wears off. Worth mentioning at your next review.

At target dose

Established effect

Consistent, manageable focus through the day. It shouldn't feel like a different you: more like things that were always hard becoming slightly more accessible.

Section 5

What are the side effects of Elvanse?

The most common early side effects of Elvanse are reduced appetite, difficulty falling asleep, mild headache and dry mouth. Most settle within 1–2 weeks, and taking your dose early helps sleep.

All expanded by default: tap a category to collapse it. Most of these ease in the first 1–2 weeks.

Reduced appetite during the day

Very common

What helps

  • Eat breakfast before or with your dose, before your appetite drops.
  • Appetite usually returns in the evening: plan your main meal for then.
  • If you can, prepare it earlier in the day, while the medicine is working.
  • Balanced ready-to-heat meals (freshly made, not processed microwave meals) save the planning that stops many people eating.
  • Tell your prescriberIf weight is dropping, or you cannot eat enough, speak to your prescriber within a few days.

Nausea, particularly in the first week

Common

Most common in the first weeks of treatment.

Usually settles within 7–10 days.

What helps

  • Taking Elvanse with or just after food may help.
  • Drinking enough water and eating regular, smaller meals may help.

Difficulty falling asleep

Very common

What helps

  • Take your dose as early in the morning as you can: Elvanse can last up to 14 hours, so a later dose is more likely to keep you awake.
  • Try the interactive Elvanse duration & effect chart to see how a change of timing may affect when it wears off.
  • Cut down on caffeine, especially after midday: it often makes stimulant side effects worse.
  • Tell your prescriberIf sleep is still hard, ask your prescriber about the timing or dose.

Feeling tired when medication wears off

Common

A predictable evening dip is normal as medication clears.

What helps

  • Planning low-demand activities in the late afternoon can help.

Emotional sensitivity or irritability as dose wears off

Common

What helps

  • Note when it happens: as Elvanse is kicking in, while it is working, or as it wears off (sometimes called a rebound effect).
  • If it is as Elvanse kicks in, take your dose with or just after food: food slows how quickly the medicine is absorbed, so it reaches your bloodstream more gradually, without reducing the total amount absorbed.
  • Tell your prescriberMention the pattern to your prescriber: dose or timing adjustments sometimes help.

Feeling unusually flat or emotionally blunted

Frequency not known

A dose reduction often resolves this.

  • Tell your prescriberIf emotions feel too muted or you feel unlike yourself, discuss at your next review.

Suicidal thoughts

Frequency not known
  • Get help todayContact your prescriber or crisis support immediately. Do not wait for a routine appointment.
  • Call 999If you feel you might act on these thoughts, or you have harmed yourself, call 999 or go to A&E.

Headaches, particularly in the first 1–2 weeks

Very common

Most common in the first 1–2 weeks and often eases.

What helps

  • Drinking enough water and eating regular meals may help.
  • Paracetamol can usually be taken alongside Elvanse.
  • Check with a pharmacist first if you have other health conditions or take other medicines.

Dry mouth

Very common in adults; common in children and teenagers

What helps

  • Sip water regularly.
  • Sugar-free gum or mints can help.
  • Keep brushing twice a day and keep up dental check-ups.
  • Tell your prescriberMention it at your review if it bothers you or is severe.

Constipation or stomach discomfort

Common (stomach pain is very common in children)

What helps

  • Drink enough fluids and eat fibre: fruit, vegetables and wholegrains.
  • Regular, moderate exercise such as a daily walk, cycling, swimming or gardening helps keep your gut moving.
  • Tell your prescriberIf persistent, mention at your next review.

Mildly increased heart rate or blood pressure

Common

A small rise in pulse and blood pressure is an expected effect of Elvanse.

That is why your prescriber checks them before you start, after each dose change and at least every 6 months.

What helps

  • Cut down on caffeine and avoid cold and flu remedies that contain a decongestant.
  • Keep salt and alcohol down, and keep up regular moderate exercise.
  • Tell your prescriberTell your prescriber within a few days if your resting pulse stays above 100. The same if your blood pressure stays at 140/90 or higher (135/85 at home).
  • Get help todayA reading of 180/120 or higher after 5 minutes' rest, or a resting pulse above 120: contact your prescriber or 111 today.

Tics (repeated movements or sounds): new or worsening

Common in children; uncommon in teenagers and adults
  • Tell your prescriberTell your prescriber before starting Elvanse if you have a personal or family history of tics or Tourette's; this is caution requiring assessment, not an automatic exclusion.
  • Tell your prescriberIf tics appear or worsen on treatment, contact your prescriber for review.

Raynaud's phenomenon (fingers or toes going pale or cold)

Uncommon in children; frequency not known in teenagers and adults
  • Tell your prescriberContact your prescriber.

Priapism (painful erection lasting more than 2 hours)

Frequency not known: medical emergency
  • Call 999Attend A&E immediately.

This is the full list for this guide, including uncommon and rare effects. For step-by-step tips on managing the common ones, and when to speak to your prescriber, see Elvanse side effects: what helps.

Section 6

When should I get help while taking Elvanse?

Call 999 for severe or spreading chest pain, severe breathlessness, signs of a stroke, a seizure or a suspected overdose. Call 999 too for a severe allergic reaction: sudden swelling of the lips, mouth or throat, or difficulty breathing. Contact your prescriber or 111 today for mild chest pain, a racing or irregular heartbeat at rest, hallucinations or thoughts of self-harm (call 999 if you might act on them). Most early effects need no action.

Emergency: call 999 or go to A&E

  • Severe chest pain, or chest pain spreading to your arm, jaw or back
  • Severe shortness of breath or struggling to breathe
  • Suspected stroke (FAST: face drooping, arm weakness, speech difficulty, time to call 999)
  • A seizure: any first seizure, or a seizure with loss of consciousness
  • Suspected overdose
  • Priapism (a painful erection lasting more than 2 hours): go to A&E straight away
  • Thoughts of harming yourself or someone else that you feel you might act on, or you have harmed yourself
  • Severe allergic reaction (anaphylaxis): sudden swelling of the lips, mouth, throat or tongue, or difficulty breathing or swallowing. Call 999.
No action

Expected adjustment effects

Common in the first few weeks: no action usually needed

  • Reduced appetite during the day
  • Mild headaches, particularly in week one
  • Dry mouth
  • Feeling more talkative or slightly energised
  • Nausea in the first week
  • Mild difficulty falling asleep if still adjusting timing
  • Emotional dip as medication wears off in the evening
Contact prescriber

Contact your prescriber within a few days

Not urgent: but worth discussing if ongoing

  • Persistent sleep problems (more than 2–3 weeks)
  • Significant weight loss or inability to eat
  • Feeling emotionally blunted or unlike yourself
  • Noticeable low mood, anxiety, or tearfulness not settling
  • Irritability or agitation affecting relationships
  • Tics (repetitive movements or sounds): new or worsening
  • Persistent headaches beyond the first two weeks
  • Raynaud's symptoms; blurred vision
Urgent

Contact prescriber or 111 today

Do not wait for a routine appointment

  • Mild chest pain or tightness, or an irregular heartbeat at rest
  • Resting HR consistently above 120 bpm; BP significantly raised; fainting
  • Signs of very high blood pressure (severe headache, vision changes, confusion)
  • Hallucinations or loss of touch with reality
  • Thoughts of self-harm or suicide
  • A new rash, without swelling or breathing problems
  • New mania

What you can safely try while waiting for a review

  • Drink enough water through the day: it may help with headaches and a dry mouth
  • Eat breakfast before the medication kicks in
  • Move your dose 30 minutes earlier if sleep is affected
  • Keep a brief daily note of symptoms, timing, and mood: invaluable at reviews
  • Reduce caffeine, particularly after midday
  • Plan lower-demand activities for the late afternoon when energy dips
  • Paracetamol can usually be taken for headaches: check with a pharmacist if you have other health conditions or take other medicines
Section 7

Frequently asked questions about Elvanse

Can I drink alcohol while taking Elvanse?

Best advice: avoid it entirely.

Elvanse and alcohol push your heart harder together than either does alone. You may notice a faster heart rate, palpitations, and higher blood pressure.

Alcohol also hides the stimulant effect. That means you can drink far more than you planned without feeling it.

There is little research on Elvanse and alcohol together, and alcohol can also make some side effects worse. If you do drink, keep it to an absolute minimum and tell your prescriber.

What happens when I stop Elvanse?

Plan stopping with your prescriber. The right approach depends on your dose, how long you have taken it and why you are stopping. ADHD symptoms may return, and some people experience fatigue, low mood or appetite changes. These are sometimes called withdrawal symptoms: feeling very tired or flat, low mood, and sleeping or eating more than usual. They are more likely after a long time on a higher dose. Your prescriber will want to know if they happen, so seek advice if they are severe or persistent. Do not use repeated stopping and restarting to manage side effects yourself.

I have a history of tics: can I still take Elvanse?

Possibly yes: tell your prescriber before starting. A history of tics or Tourette's is not an automatic exclusion. Your prescriber will assess the situation and monitor you. If tics develop or worsen after starting Elvanse, contact your prescriber for review: a dose adjustment or medication change may be needed.

What about Elvanse during pregnancy?

Talk to your prescriber before becoming pregnant if possible, or as soon as you know you are pregnant. Do not stop suddenly without medical advice.

Current evidence (BUMPS/UKTIS) doesn't suggest Elvanse causes birth defects. But taking it later in pregnancy may affect the baby's growth. If you continue into the third trimester, your baby may experience temporary withdrawal symptoms after birth. A planned approach with your prescriber is safer than an abrupt stop.

Can I breastfeed while taking Elvanse?

Elvanse passes into breast milk and has not been studied as extensively as methylphenidate during breastfeeding. If possible, your prescriber may suggest switching to methylphenidate: particularly if your baby is under 8 weeks old or exclusively breastfed, as methylphenidate is better studied and considered the stimulant of choice during breastfeeding (Breastfeeding Network).

Don't stop breastfeeding automatically: discuss the options with your prescriber and make the decision together. If you do breastfeed, monitor your baby for unusual irritability, difficulty feeding, or reduced sleep.

Do I need to try methylphenidate before Elvanse?

Not as an adult. The requirement to try methylphenidate first applies to children only. For adults, Elvanse is a first-line option and your prescriber can choose it directly based on your clinical picture.

Will I need to take Elvanse indefinitely?

Not necessarily. ADHD is a lifelong neurological condition for most people, but that doesn't automatically mean lifelong medication. Some people use Elvanse during high-demand periods and take breaks at other times. Others find the consistent benefit means they choose to continue long-term. This is a decision to revisit with your prescriber regularly.

What if Elvanse stops working?

A change in benefit needs a review. It does not establish the cause. Your prescriber can check your dose, timing, sleep, side effects, other medicines and whether treatment still suits your needs. Record what has changed. Do not increase the dose or arrange treatment breaks yourself.

Can I take a break at weekends?

Yes: some people do this by choice, particularly if weekends involve fewer demands on focus and they experience significant appetite suppression during the week. However, discuss with your prescriber first. There is no medical requirement to take breaks, and some people find their ADHD symptoms are equally disruptive without medication even on quieter days.

Will Elvanse change my personality?

No: and if it feels like it is, that's worth reporting to your prescriber. A well-matched dose should make focus and impulse control more accessible, not change who you are. Feeling flat, emotionally blunted, or unlike yourself is a sign the dose may need adjusting.

What do I do if I run out of my prescription?

Elvanse is a Schedule 2 Controlled Drug: prescriptions cannot be repeated or called in easily. Plan ahead: request your next prescription 7–10 days before you run out. If you do run out unexpectedly, contact your GP practice (not the pharmacy) as a priority. Missing a few days is not medically dangerous, but your ADHD symptoms may return temporarily.

Does Elvanse interact with antidepressants?

It depends on the type. SSRIs and SNRIs are generally fine alongside Elvanse, but your prescriber should be aware because both affect serotonin: monitor for signs of serotonin syndrome. MAOIs are an absolute contraindication: do not take Elvanse within 14 days of stopping an MAOI. Always tell your prescriber and pharmacist about all medications you take.

Section 8

What should I ask my prescriber about Elvanse?

Questions worth raising at your next review. You don't need to cover all of them: pick the ones that feel most relevant.

  • Are there any monitoring checks I'm due: blood pressure, pulse, weight?
  • Do I need to have tried methylphenidate first, or can we go straight to Elvanse?
  • Am I on the right type of stimulant: could a different formulation suit me better?
  • Are any of my other medicines interacting with Elvanse?
  • I have a history of tics: is Elvanse still an option?
  • What should I do if my prescription runs out before my next appointment?
  • Is there anything I should avoid eating, drinking, or taking at the same time?
  • If I want to take a break from the medication, how should I do this safely?
  • What would be the signs that Elvanse isn't the right medication for me?
  • Are you pregnant, planning a pregnancy, or has anything changed with contraception?
Section 9

Elvanse: notes for GPs and clinicians

For GPs and clinicians

Clinical notes by , ADHD Advanced Practitioner and Clinical Prescribing Pharmacist.

ClinicalShared care considerations

Elvanse is frequently initiated by a specialist and transferred to GP shared care once the dose is stable. Before accepting shared care, confirm the patient has been established on a stable dose with no recent safety concerns. Blood pressure, pulse, weight, and height (in children) should be monitored at each review: every 3–6 months in adults once stable.

ClinicalAdult first-line status

Elvanse is licensed as first-line for adults in the UK. The NICE NG87 requirement to try methylphenidate first applies to children only. Adult patients do not need to have failed on methylphenidate before Elvanse can be prescribed.

ClinicalCardiovascular monitoring

Obtain pre-treatment blood pressure and heart rate. A resting ECG is not required routinely but should be considered where there is a personal or family history of cardiac abnormalities, or where the patient reports palpitations on treatment. Elvanse should be used with caution in hypertension; it is contraindicated in significant structural heart disease or uncontrolled hypertension.

ClinicalTics and Tourette's

Pre-existing tics or Tourette's syndrome are not an absolute contraindication. Assess individually, counsel appropriately, and monitor. If tics emerge or worsen during treatment, review and consider dose adjustment or medication change.

ClinicalProdrug pharmacology and misuse liability

The rate-limited enzymatic conversion of lisdexamfetamine to d-amphetamine results in a flatter plasma concentration curve and a lower abuse signal compared with immediate-release amphetamine salts. This makes Elvanse pharmacologically preferable where misuse risk is a clinical consideration, though it remains a Schedule 2 Controlled Drug.

ClinicalTitration guidance

Start at 20–30 mg daily. Increase by 10–20 mg at intervals of no less than one week, guided by tolerability and clinical response. Maximum licensed dose: 70 mg daily. Most adults respond optimally at 50–70 mg.

ClinicalDrug interactions

Avoid concomitant use with MAOIs or within 14 days of stopping an MAOI: risk of hypertensive crisis. Alkalinising agents (including high-dose sodium bicarbonate or some antacids) may increase amphetamine absorption. Use with serotonergic agents warrants caution due to serotonin syndrome risk.

ClinicalStopping Elvanse

Review the indication for discontinuation, dose, duration of exposure and current mental state. Counsel about recurrence of ADHD symptoms and possible fatigue, low mood or appetite changes. Individualise the stopping and monitoring plan. Avoid categorical statements that dependence, tolerance or withdrawal effects cannot occur. The Elvanse SmPC records withdrawal symptoms such as fatigue and depression (4.4) and, unlike the Amfexa SmPC (4.2), does not require a gradual dose reduction; in the paediatric trial, symptom scores after discontinuation did not exceed baseline (5.1). Patients are told what withdrawal symptoms can look like (fatigue, low mood, more sleep or appetite) and that they are more likely after prolonged higher-dose use.

ClinicalPregnancy

Pregnancy (BUMPS/UKTIS): Do not advise abrupt discontinuation. Individual risk-benefit assessment. Third-trimester use may affect fetal growth; neonatal withdrawal symptoms possible.

ClinicalBreastfeeding

Breastfeeding (BfN April 2025): Elvanse passes into breast milk. Less well-studied than methylphenidate during breastfeeding. Methylphenidate preferred where possible: particularly for babies under 8 weeks or exclusively breastfed. If continuing Elvanse, monitor infant for CNS stimulation. Do not advise automatic cessation of breastfeeding: individual decision with specialist input.

Patient page: How shared care works, and what to do if your GP declines or stops it

This guide is written for educational purposes and does not constitute medical advice. Always follow the guidance of your prescriber or pharmacist. If you have concerns about your medication, contact your clinical team.

Sources

About this guide

Written and clinically reviewed by
ADHD Advanced Practitioner and Clinical Prescribing Pharmacist
First published
Last updated
Last reviewed
Next review
What changed
October 2026: clearer advice on when to call 999 (severe or spreading chest pain, severe breathlessness, or thoughts of self-harm you might act on) and when to get help the same day. Side effect frequencies now use the categories in the product information (SmPC). The headache advice now says drinking enough water may help. Paracetamol can usually be taken, but check with a pharmacist if you have other health conditions or take other medicines. 21 October 2026: the stopping answer and the clinician note no longer say there is no physical dependence or withdrawal, and a change in benefit is now something for your prescriber to review rather than ruled out as tolerance.

“Last updated” is when the content last changed. “Last reviewed” is when it was last checked against current sources.

How this content is written, sourced and checked: editorial policy

Spotted an error? Report it by email. This is for website feedback only. It can’t give advice about your own treatment.