When You Can't Fill Your Lisdexamfetamine Prescription

The ongoing Lisdexamfetamine shortage has forced many patients to consider alternatives. If you've been searching for your medication without success, knowing your options can help you work with your doctor to find a solution that keeps your treatment on track.

This post covers what Lisdexamfetamine is, how it works, and four real alternatives your doctor might consider if you can't fill your prescription.

Important: Never switch medications on your own. Always talk to your prescriber before making any changes to your ADHD or BED treatment plan.

What Is Lisdexamfetamine?

Lisdexamfetamine (brand name Vyvanse) is a central nervous system stimulant prescribed for ADHD in patients aged 6 and older and for moderate to severe binge eating disorder in adults. It's a Schedule II controlled substance, which means it has recognized medical uses but also a high potential for misuse.

Lisdexamfetamine is a prodrug of dextroamphetamine. This means it's inactive when you swallow it — your body converts it into active dextroamphetamine during digestion. This prodrug design gives Lisdexamfetamine a smoother onset and longer-lasting effect (typically 10 to 14 hours) compared to immediate-release amphetamines.

How Does Lisdexamfetamine Work?

Once converted to dextroamphetamine in your body, Lisdexamfetamine works by:

• Increasing dopamine levels in the brain — dopamine is a chemical messenger involved in attention, motivation, and reward
• Increasing norepinephrine levels — norepinephrine helps with alertness and focus
• Blocking the reuptake of these neurotransmitters, keeping them active in the brain longer

The result is improved focus, reduced impulsivity, and better executive function for people with ADHD. For binge eating disorder, it helps reduce the number of binge eating episodes.

Alternative 1: Adderall XR (Mixed Amphetamine Salts, Extended-Release)

Adderall XR is one of the most commonly prescribed alternatives to Lisdexamfetamine. It contains a mix of four amphetamine salts (75% dextroamphetamine, 25% levoamphetamine) in an extended-release capsule that lasts approximately 10 to 12 hours.

How it compares:

• Same drug class (amphetamine stimulant)
• Similar duration of action
• Available as a generic (mixed amphetamine salts XR), which can cost as little as $30 to $50 per month with a coupon
• Also a Schedule II controlled substance

Key differences: Adderall XR contains both dextroamphetamine and levoamphetamine, while Lisdexamfetamine converts only to dextroamphetamine. Some patients find one works better than the other in terms of side effects and efficacy.

Availability note: Adderall and Adderall XR have also experienced shortages, though availability has improved in recent months. Check Medfinder for current stock.

Alternative 2: Concerta (Methylphenidate, Extended-Release)

Concerta uses a completely different active ingredient — Methylphenidate — which is the other major class of ADHD stimulant medication. It uses a unique osmotic release system (OROS) that provides consistent medication delivery over 10 to 12 hours.

How it compares:

• Different mechanism: blocks dopamine and norepinephrine reuptake but doesn't increase their release like amphetamines do
• May have fewer cardiovascular side effects for some patients
• Available as a generic (Methylphenidate ER)
• Also Schedule II

Key differences: Because Methylphenidate works differently than amphetamines, patients who respond well to Lisdexamfetamine don't always respond the same way to Concerta, and vice versa. However, it's a solid option to try — many patients do well on either class.

Alternative 3: Dexedrine (Dextroamphetamine)

Dexedrine contains dextroamphetamine — the same active compound that Lisdexamfetamine converts into. The key difference is that Dexedrine delivers dextroamphetamine directly, rather than as a prodrug.

How it compares:

• Available in immediate-release tablets (lasting 4 to 6 hours) and extended-release capsules (Dexedrine Spansule, lasting 8 to 10 hours)
• Generics are widely available and affordable
• Pharmacologically very similar to Lisdexamfetamine once converted

Key differences: Because it's not a prodrug, Dexedrine has a faster onset and may have a higher abuse potential. The immediate-release version requires multiple doses per day. If you need all-day coverage, the extended-release Spansule or multiple daily doses would be needed.

Alternative 4: Strattera (Atomoxetine) — A Non-Stimulant Option

Strattera (Atomoxetine) is a non-stimulant ADHD medication that works by selectively inhibiting norepinephrine reuptake. It's not a controlled substance, which means it's easier to prescribe and fill — no DEA quotas, no monthly prescription limits, and no shortage issues related to controlled substance regulations.

How it compares:

• Not a stimulant — no abuse potential
• Can be prescribed with refills (unlike Schedule II medications)
• Takes 4 to 6 weeks to reach full effectiveness
• Available as a generic for approximately $20 to $50 per month

Key differences: Strattera is generally less effective than stimulants for ADHD symptom control, and it takes weeks to work (versus hours for Lisdexamfetamine). However, it may be preferred for patients with a history of substance abuse, anxiety disorders, or those who can't tolerate stimulant side effects.

How to Talk to Your Doctor About Switching

If you're considering an alternative, here's how to approach the conversation with your prescriber:

1. Explain the situation: Let them know you've been unable to find Lisdexamfetamine and for how long
2. Ask about equivalency: Your doctor can help determine the closest equivalent dose of an alternative medication
3. Discuss temporary vs. permanent: You may want to try an alternative temporarily during the shortage and switch back when Lisdexamfetamine becomes available
4. Check availability first: Use Medfinder to verify the alternative is actually in stock before your doctor writes a new prescription

Final Thoughts

No one wants to switch medications that are working well. But during a prolonged shortage, having a backup plan is essential. Adderall XR, Concerta, Dexedrine, and Strattera are all legitimate alternatives to Lisdexamfetamine — each with different strengths and trade-offs.

Before switching, try our tips for finding Lisdexamfetamine in stock first. And if cost is a factor in your decision, check out our guide on how to save money on Lisdexamfetamine.