Vyvanse withdrawal vs. crash: Symptoms, timeline, treatment

Learn the difference between a Vyvanse withdrawal vs. a crash and what to do when symptoms arise

By Daniel Cardin, Pharm.D. | Feb. 19, 2022

Vyvanse is a brand-name drug approved by the FDA for the treatment of attention deficit hyperactivity disorder (ADHD) in adults and children, and binge-eating disorder (BED) in adults. Vyvanse is an amphetamine and central nervous system stimulant. It is designed to be long-acting due to its chemical properties and provides a sustained effect when taken as a capsule or chewable tablet. Since ADHD medications are relatively common, you may have heard about a “Vyvanse crash.” This article will explain all you need to know about common difficulties that patients might experience when taking Vyvanse and describe how to avoid some unnecessary side effects.

What is a Vyvanse crash?

A Vyvanse crash describes multiple symptoms that can occur when Vyvanse effects start to wear off. Also known as Vyvanse “comedown,” this crash includes feelings of anxiety, irritability, tiredness, mood swings, and a return of ADHD symptoms (such as trouble concentrating). The active component of Vyvanse remains in your system for about two to three days after a dose. However, more than half the dose will be out of your system after about 11 hours. A crash or rebound effect usually occurs in the afternoon or evening when drug levels are dwindling. It may also happen when patients forget to take a dose. Crashes like this are not unique to Vyvanse—they occur with many prescription stimulant drugs such as Adderall, Ritalin, Focalin, etc. Crashes can occur in patients taking short-acting or long-acting stimulants for ADHD.

Vyvanse crash vs. Vyvanse withdrawal

A Vyvanse crash is not the same as a Vyvanse withdrawal. While both are caused by low levels or absence of Vyvanse, they differ in their timing and symptoms. Withdrawal occurs when a patient stops taking Vyvanse, with symptoms developing around 36 hours after the last dose. A crash entails milder symptoms and is far more common. Crashes can occur despite consistent and proper use of Vyvanse. Crash symptoms are typically easier to manage than symptoms of withdrawal.

How to avoid a Vyvanse crash

People just starting out on Vyvanse may be more susceptible to a Vyvanse crash. A healthcare provider may need to adjust a patient’s medications before their ADHD medication is working optimally. Here are a few tips that can help patients avoid crashes in the meantime:

Take Vyvanse exactly as prescribed. Clarify any directions that are not clear with your doctor.
Take Vyvanse at the same time every morning. This will help ensure consistent levels of Vyvanse in your body while helping you remember to take your dose every morning.
Inform your doctor if you are experiencing crash symptoms. Your healthcare provider may decide to adjust your dosage or prescribe a different medication for ADHD.
Tell your healthcare provider about all of your prescription medications. Certain medications may contribute to a Vyvanse crash, such as depressants. Examples include alcohol, muscle relaxants, marijuana, and sedatives. Additionally, medications that make urine more acidic have been shown to reduce the effectiveness of Vyvanse. Your provider may adjust the scheduling of your doses or change medications as appropriate to minimize drug interactions.
Avoid certain foods such as grapefruit juice, citrus fruits, and caffeinated drinks. Foods that make urine more acidic can reduce the effectiveness of Vyvanse. Caffeine can contribute to a Vyvanse crash by causing similar rebound symptoms such as fatigue or irritability and can contribute to sleeping difficulties. Caffeine can also worsen anxiety or shakiness caused by a Vyvanse crash.
Eat well and stay hydrated. It is easy for patients on Vyvanse to become so focused on tasks that they forget to eat and drink regularly. Eating three healthy meals and drinking water throughout the day can minimize crash symptoms such as low energy, shakiness, irritability, or brain fog.

What happens if you stop taking Vyvanse?

Vyvanse withdrawal symptoms can occur in patients stopping Vyvanse abruptly. However, symptoms are usually not serious and can be further minimized by gradually decreasing the stimulant dose before stopping therapy altogether. Patients on higher doses of Vyvanse (e.g., 70 mg) with a long duration of therapy are more likely to experience withdrawal symptoms.

Patients may desire to stop taking Vyvanse for various reasons. They might find side effects such as weight loss, dry mouth, or nausea intolerable or may simply desire to be independent of ADHD medications. However, it may be necessary to gradually decrease a patient’s dose before they can stop taking Vyvanse.

Central nervous system stimulants like Vyvanse cause physiological changes with continued use. Over time, the brain adjusts to the regular effects of Vyvanse, such as the feelings of reward, reinforcement, and motivation caused by increased dopamine. The body counteracts these effects by decreasing its sensitivity to norepinephrine and dopamine in certain regions of the brain. This is one reason patients experience drug tolerance or the need for higher and higher doses to sustain the same drug efficacy. Patients can experience withdrawal when the body suddenly stops receiving the stimuli that it has become dependent upon. By slowly weaning off Vyvanse, the body has time to make small adjustments and regain its sensitivity to dopamine and norepinephrine. When normal sensitivity is achieved, natural levels of these neurotransmitters will be enough to cause their intended functions.

Do not make abrupt changes to Vyvanse doses without first consulting a healthcare provider. Vyvanse should be taken consistently without skipping any doses. Regular dosing ensures the greatest benefit and allows doctors to evaluate how well the current dose manages ADHD. In some cases, doctors may allow for a “drug holiday” so a patient can temporarily stop taking Vyvanse.

One reason for a drug holiday would be changes in a patient’s weight; prescribers might allow pediatric patients to come off Vyvanse until they regain weight and then restart therapy. Physicians sometimes grant a parent’s request that a child discontinues ADHD medication during the summer when the child is not in school.

Another reason a healthcare provider might ask a patient to temporarily discontinue Vyvanse would be to evaluate the efficacy and assess the need for continued therapy.

Finally, patients may need to stop Vyvanse immediately to avoid certain drug interactions. For example, opioids, migraine meds, anti-nausea drugs, and antidepressants have the potential to cause serotonin syndrome when taken with Vyvanse. A class of antidepressants called monoamine oxidase inhibitors (MAOIs) can cause dangerously high blood pressure if taken less than 14 days before a dose of Vyvanse. It may be necessary to stop Vyvanse entirely to avoid these drug interactions.

Vyvanse withdrawal symptoms

When a longtime user of Vyvanse suddenly stops taking their medication, they may experience:

Mood swings
Anxiety
Fatigue
Shakiness
Difficulty sleeping
Increased appetite
Excessive sleeping
Cravings for Vyvanse
Headaches
Anhedonia (decreased ability to feel pleasure)
Inability to focus and concentrate.

Further information on Vyvanse withdrawal symptoms can be found at withdrawal.net, a resource provided by the American Addiction Centers.

Vyvanse withdrawal timeline

Symptoms of withdrawal usually begin within 36 hours of the last dose, shortly after the active component is fully eliminated. Withdrawal can last for several days or weeks, especially in patients who have been on a high dose of Vyvanse for a long time.

Patients typically experience a noticeable drop in energy and mood as their first symptoms, which may be like symptoms of a Vyvanse crash. They may also experience a desire to eat more.

This stage is followed by physical symptoms such as joint aches and muscle pain, with continued mental health effects like irritation or depression. During this time, many patients have trouble sleeping. While this is a common pattern, the withdrawal timeline may be different for any given patient.

How to safely stop taking Vyvanse

Stopping Vyvanse should only be done under the direction of a medical professional. A healthcare provider will decide whether it is okay to stop Vyvanse immediately. If not, they will determine the most appropriate tapering schedule. Patients on higher doses of Vyvanse (e.g., 70 mg) with a long duration of therapy are more likely to experience withdrawal symptoms and therefore might require a gradual dose reduction before stopping therapy. A healthcare provider may schedule regular visits with a patient during the weeks that the Vyvanse dose is being tapered. Patients should inform their healthcare provider of any ADHD or withdrawal symptoms during this time.

Vyvanse misuse

Recreational use of Vyvanse, also called nonmedical use (NMU), is taking Vyvanse in any way other than prescribed. According to studies surveying adults in the U.S., 7% to 8% of respondents were estimated to have lifetime nonmedical use of prescription stimulants such as Vyvanse. It is estimated that up to 17% of college students abuse prescription stimulants. Nonmedical use of stimulants is most common among patients aged 18 to 25 years.

Oral misuse is the most prevalent form of nonmedical use of prescription stimulants, making up 52% to 95% of all cases. This includes possessing or using stimulants without a prescription, selling or giving prescription stimulants to others, using prescription stimulants for a non-therapeutic purpose, or orally ingesting prescription stimulants in ways other than prescribed (i.e., chewing capsules). The most common method of non-oral NMU is snorting (insufflation) followed by injection, which can cause excessive harm.

Vyvanse is different from other prescription stimulants such as Adderall (amphetamine-dextroamphetamine) or Ritalin (methylphenidate) because it is inactive in its original form. Drugs that remain inactive until they are metabolized are called prodrugs, which can have a lower potential for substance abuse disorders. Vyvanse is metabolized into the active drug dextroamphetamine through a chemical process called hydrolysis. This is a rate-limiting step that is responsible for the delayed and sustained effect of Vyvanse. Therefore, crushing, chewing, snorting, or injecting Vyvanse will not result in an immediate effect that produces euphoria or “drug likeability” similar to other commonly abused medications. The prodrug formulation deters patients from seeking immediate stimulation via snorting or injecting the stimulant as the drug’s effects occur over a period of time.

A study comparing intranasal and oral administration of Vyvanse showed similar effects. A study conducted among stimulant abusers showed no significant difference in “drug likability” between injected Vyvanse and placebo. However, this does not mean that alternative administration methods are safe; snorting, injecting, or ingesting Vyvanse other than prescribed opens a greater possibility of an overdose, which can be fatal.

Despite its abuse-deterrent properties, Vyvanse is categorized as a Schedule II controlled substance due to its potential for abuse and physical dependence. People can become addicted to Vyvanse, particularly when it is taken above the recommended dosage. Signs of abuse or a substance use disorder in a loved one taking Vyvanse include dilated pupils, sweating, reduced appetite, insomnia, shaking, hostility, and flushed skin. Signs of an overdose may include nausea and vomiting, diarrhea, stomach pain, muscle pain, tremors, hallucinations, confusion, panic, changes in blood pressure, aggression, rapid breathing, irregular heart rate, and loss of consciousness.

For further information about Vyvanse abuse and Vyvanse addiction treatment options, consult your healthcare provider for medical advice about Vyvanse detox programs and inpatient treatment centers or outpatient treatment programs for substance abuse. You can also visit the American Addiction Centers’ article on the topic.