Raynaud's phenomenon during treatment with lisdexamfetamine: risk of cerebral vasospasm?

Lisdexamfetamine, a prodrug used to treat Attention Deficit/Hyperactivity Disorder in children, adolescents, and adults, is an inactive substance that is converted into its active form (dextroamphetamine) after being metabolized. This conversion primarily occurs in the bloodstream through enzymatic cleavage following active absorption from the gastrointestinal lumen. The active metabolite then stimulates the central nervous system by increasing the levels of dopamine and norepinephrine in the brain. It was discovered in 1996 by New River Pharmaceuticals and approved by the FDA in 2007 for the treatment of Attention Deficit/Hyperactivity Disorder in children. In this article, two cases of secondary Raynaud's phenomenon due to the use of lisdexamfetamine are described. Raynaud's disease is the primary form, occurring in the absence of an underlying cause, and differs from secondary Raynaud's phenomenon, which is associated with various medical conditions and pharmacological agents. In the cases reported in this study, the phenomenon occurred during treatment with lisdexamfetamine, where it is listed as an uncommon adverse effect in the prescribing information. In both patients presented in this report, discontinuation of the medication led to resolution of the phenomenon within a few days. This report highlights the fact that one of the patients reported episodes of dizziness during Raynaud's phenomenon, drawing attention to the potential associated complications.