So, Vyvanse was approved for Binge Eating Disorder

[wolfvgang22]

So the FDA approved Vyvanse for Binge Eating Disorder.
Is anybody else worried that this will just be a way for people without actual Binge Eating Disorder to use Vyvanse as a weight loss drug, in sort of the same way students without ADHD sometimes seek Adderall?
I'm pretty sure I'll have patients asking me about Vyvanse in clinic on Monday now.

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[F0nzie]

Just read that. Weeeee!

 

[F0nzie]

Maybe have a BMI cutoff?

 

[Ceke2002]

On the more legitimate eating disorder support forums, so far the only concern/discussion point that has come up is whether or not the prescribing of Vyvanse will be undertaken correctly, preferably by specialists with expertise in the area of eating disorders, and used as an adjunct to continuing therapy treatments, not as a replacement - or whether or not it will become something that Family Doctors just start chucking down people's throats as an easy fix.

On the not so legitimate forums, discussions have only just started but already they're shaping up to be more along the lines of 'Help, I'm severely underweight, how do I convince my Doctor to give me Vyvanse' followed by the usual suggestions like sewing weights into clothing to trick the scale. Now how anyone who weighs, let's say a 100 pounds or less expects to be able to sew, carry or otherwise hide enough weights on their person to trick a Doctor into believing they are legitimately in need of being prescribed Vyvanase is beyond me, but if a patient staggers into your office and promptly tips over under the weight of their own clothing, I'd be suspicious.

 

[nitemagi]

I plan to start this immediately myself for my cookie-eating problem.

 

[OldPsychDoc]

V is for Vyvance, that's good enough for me...

 

[shan564]

Is anybody else worried that this will just be a way for people without actual Binge Eating Disorder to use Vyvanse as a weight loss drug, in sort of the same way students without ADHD sometimes seek Adderall?

Yes, absolutely.

Clearly the people who make Vyvanse are brilliant at marketing. Interesting that only the expensive version is approved, and old-school Adderall isn't. Kinda like Cymbalta and Effexor for neuropathic pain and fibromyalgia and IBS - it's hard to argue against the fact that stimulants will make you eat less, but this sounds like a thing that might become more about patient satisfaction scores than actual clinical benefit, just like ADHD.

With abusable drugs, I always worry about replacing the patient's presenting illness with an addiction - especially with benzos. It's hard to disagree with the notion that we overprescribe Adderall when it might not be indicated, and that we're increasing the risk of abuse by doing that, but I think most of us would agree that the benefits outweigh the risks if the patient has real ADHD - the improvement in impulsiveness actually reduces the risk of substance abuse long-term, so I'm more than happy to treat aggressively if it's real ADHD. But for binge eating disorder, I'd worry more about creating a substance habit.

 

[whopper]

If a person used cocaine for depression it would improve their depression. Doesn't mean it should get an FDA approval.

I'm wondering how 2-dimensional vs 3-dimensional the FDA was with this Vyvanse approval. I also sometimes wonder WTF is going on with them with the high amounts of money that's required for FDA approvals and some of the meds that are approved in Europe but aren't approved in the FDA such as rimanobant, a diet med that is not a stimulant that was refused for approval by the FDA.

And then there's the Citalopram 40 mg max dose despite that they didn't announce why they did this for some time (or they at least didn't make the information readily accessible). I had plenty of patients asking me why their pharmacist didn't want to provide their 60 mg dosage despite that they were safely on that for years and they told me it did work better for them at 60 mg vs 40 mg/day, and I had to give them the answer, "cause the FDA told us the new max dose if 40 mg a day and they're not telling me why, nor can I find the answer online." Yes I know they pointed to the QT-prolongation (that now is highly suspect anyway) but they didn't show the source of the information for months as far as I could tell, and I spent hours looking for it.

Why Vyvanse but not rimanobant? Because rimanobant can make the patient suicidal? So too do a lot of meds that are approved. Why refuse rimanobant when virtually any psychotropic med can make one suicidal? I'm not saying there isn't a good reason, just that I don't know what that reason is.

It remains nebulous at least for me cause I don't know how many people were suicidal in terms of %. I see reports saying a few became suicidal in a study but out of how many? Keppra makes about 5% of patients psychotic, it got an approval.

 

[wolfvgang22]

I like your comment, whopper. However, acomplia was withdrawn from the European market due to psychiatric side effects.

 

[Mad Jack]

Is there anything Vyvanse doesn't do (to extend its patent privileges)?

 

[whopper]

However, acomplia was withdrawn from the European market due to psychiatric side effects.

I'm aware of that. My point is not that the med can make one suicidal. I know that. But why refuse Accomplia when other meds are approved that also make one possibly suicidal such as an SSRI? That's what I don't know.

We are physicians, not monkeys putting a ball through a circular hole or a cube though a square hole. IF they approve or not allow a med, they ought to give us the reasoning why in scientific terms.

As I mentioned when the max dose of Citalopram went from 60 to 40 mg, they mentioned only because of the QT problem but they did not, as far as I could tell, give the specifics or the study showing this until months later. E.g. what published study? How many people had the QT problem?

It defeats the purpose as to why we have journal clubs to not expect us to be able to digest this information.

 

[Salpingo]

Yes, absolutely.

Clearly the people who make Vyvanse are brilliant at marketing. Interesting that only the expensive version is approved, and old-school Adderall isn't. Kinda like Cymbalta and Effexor for neuropathic pain and fibromyalgia and IBS - it's hard to argue against the fact that stimulants will make you eat less, but this sounds like a thing that might become more about patient satisfaction scores than actual clinical benefit, just like ADHD.

Shire has gotten really good at finding celebrity endorsements. The real genius is you'd never guess they were shilling for a specific drug, so the celebrity gets to maintain their integrity and Shire gets to extend their patent.

 

[spemat31]

Vyvanse is climbing up there in the snake oil sweepstakes with Provigil, Neurontin and Wellbutrin... three more useless chemicals.