What Medications Cannot Be Taken with Vyvanse? An Essential Guide

October 6, 2025 •

5 min read

The FDA has issued a boxed warning for Vyvanse due to its potential for misuse and dependence, highlighting the drug's potent effects on the central nervous system. Understanding exactly what medications cannot be taken with Vyvanse is critical for patient safety, as many common prescriptions and over-the-counter drugs can lead to dangerous, life-threatening interactions.

Quick Summary

Certain medications and substances should be avoided when taking Vyvanse due to a high risk of severe adverse effects. These include MAOIs, other CNS stimulants, serotonergic drugs, some blood pressure medications, and certain supplements. Always consult your doctor before combining any medications.

Key Points

MAOIs are strictly prohibited: Taking Vyvanse with Monoamine Oxidase Inhibitors (MAOIs) is a severe contraindication that can cause a life-threatening hypertensive crisis.
Serotonergic drugs increase risk: Combining Vyvanse with SSRIs, SNRIs, TCAs, triptans, or opioids can lead to the potentially fatal condition known as serotonin syndrome.
Other stimulants amplify effects: The stimulant effects of Vyvanse can be dangerously amplified when combined with other stimulants, such as caffeine, decongestants, or other ADHD medications.
Blood pressure medication effectiveness is reduced: Vyvanse can raise blood pressure and counteract the effects of blood pressure medications, requiring close monitoring by a healthcare provider.
Certain supplements and foods interfere: Herbal supplements like St. John's Wort and high doses of Vitamin C can interact with Vyvanse, as can substances that alter urinary pH.
Open communication with a doctor is vital: Always inform your healthcare provider of all prescription medications, over-the-counter products, and supplements to avoid dangerous drug interactions with Vyvanse.

Vyvanse, the brand name for lisdexamfetamine dimesylate, is a central nervous system (CNS) stimulant prescribed primarily for the treatment of attention-deficit hyperactivity disorder (ADHD) and binge eating disorder. As with any potent medication, it is metabolized and interacts with the body's systems in complex ways, making it crucial to be aware of potential drug interactions. Combining Vyvanse with certain other substances can lead to a range of complications, from reduced effectiveness to life-threatening medical emergencies like hypertensive crisis and serotonin syndrome.

The Most Critical Contraindications: MAOIs

This is the most severe and dangerous interaction associated with Vyvanse. Monoamine oxidase inhibitors (MAOIs) are a class of older antidepressants used for depression and other conditions like Parkinson's disease. Taking Vyvanse with an MAOI is absolutely contraindicated and can have fatal consequences.

The Risk: Both Vyvanse and MAOIs affect the levels of norepinephrine and serotonin in the brain. When taken together, they can cause a sudden, severe increase in blood pressure, known as a hypertensive crisis. This can lead to stroke, heart attack, or other cardiovascular events.
The Waiting Period: A 14-day washout period is required, meaning you should not take Vyvanse if you have taken an MAOI within the last two weeks.
Examples of MAOIs: Isocarboxazid (Marplan), Phenelzine (Nardil), Tranylcypromine (Parnate), and the antibiotic Linezolid (Zyvox).

High-Risk Interactions: Serotonergic Drugs

Many medications that increase serotonin levels in the brain can lead to serotonin syndrome when combined with Vyvanse. This condition is caused by an excess of serotonin and can range from mild to life-threatening.

Selective Serotonin Reuptake Inhibitors (SSRIs): These are commonly prescribed antidepressants. The combination can lead to serotonin syndrome, with symptoms including agitation, rapid heartbeat, and confusion.
- Examples: Sertraline (Zoloft), Fluoxetine (Prozac), Citalopram (Celexa), and Escitalopram (Lexapro).
Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs): Like SSRIs, SNRIs increase serotonin, but they also affect norepinephrine, which can exacerbate cardiovascular side effects.
- Examples: Venlafaxine (Effexor XR) and Duloxetine (Cymbalta).
Tricyclic Antidepressants (TCAs): Another class of antidepressants that can cause serotonin syndrome.
Triptan Migraine Medications: Used for acute migraines, triptans affect serotonin receptors and can increase the risk of serotonin syndrome.
Opioid Pain Medications: Certain opioids, such as Tramadol (Conzip), are known to increase serotonin levels and interact with Vyvanse.
Other Serotonergic Medications: Buspirone (BuSpar), Lithium, and the herbal supplement St. John's wort also carry a risk of serotonin syndrome.

Interactions Affecting the Cardiovascular System

Vyvanse is a stimulant and naturally increases heart rate and blood pressure. Combining it with other stimulants or with medications used to control blood pressure requires careful management.

Other Stimulant Medications

Taking Vyvanse with other CNS stimulants can amplify the stimulant effects, leading to a dangerously high heart rate and blood pressure, as well as an increased risk of insomnia and anxiety.
This includes other ADHD medications (e.g., Adderall), appetite suppressants (e.g., Phentermine), and certain over-the-counter decongestants (e.g., those containing pseudoephedrine or phenylephrine).

Blood Pressure Medications

Vyvanse can counteract the effects of antihypertensive drugs, making them less effective at controlling blood pressure.
Patients with a history of heart conditions or high blood pressure need to be closely monitored by a physician when taking Vyvanse.

Interactions with Over-the-Counter Drugs and Supplements

It's not just prescription medications that can cause issues. Several over-the-counter products and supplements can also interact with Vyvanse.

Caffeine: As a CNS stimulant, caffeine can have an additive effect with Vyvanse, worsening side effects like jitteriness, anxiety, and insomnia. Energy drinks and large amounts of coffee should be limited or avoided.
St. John's Wort: This herbal supplement, often used for depression, can raise serotonin levels and contribute to the risk of serotonin syndrome.
Antacids and Urinary Agents: Medications that alter the pH of the stomach or urine can affect how Vyvanse is absorbed and eliminated.
- Alkalinizing agents (e.g., baking soda, certain antacids like Tums) can increase Vyvanse absorption and effects.
- Acidifying agents (e.g., high doses of Vitamin C, cranberry juice) can decrease Vyvanse absorption and effectiveness.
Cold and Flu Medicine: Some cold medicines contain stimulants (like decongestants) or serotonergic drugs (like dextromethorphan), which can lead to dangerous interactions.

Vyvanse Interaction Risk Comparison


Medication/Class	Type of Interaction	Risk Level	Reason
MAOIs (e.g., Marplan, Nardil)	Hypertensive Crisis, Serotonin Syndrome	Severe (CONTRAINDICATED)	Profound increase in blood pressure and serotonin levels.
Serotonergic Antidepressants (SSRIs, SNRIs)	Serotonin Syndrome	High	Increases serotonin levels, especially when combined with Vyvanse.
Other CNS Stimulants (e.g., Adderall, decongestants, high caffeine)	Increased Heart Rate/Blood Pressure	High	Additive stimulant effects on the cardiovascular system.
Blood Pressure Medication	Decreased Effectiveness of BP Meds	Moderate	Vyvanse raises blood pressure, counteracting the intended effects of antihypertensives.
St. John's Wort	Serotonin Syndrome	High	Herbal supplement that increases serotonin levels.
Urinary Alkalinizers (e.g., some antacids)	Increased Vyvanse Levels	Moderate	Can alter Vyvanse metabolism and clearance.
Urinary Acidifiers (e.g., high dose Vitamin C)	Decreased Vyvanse Levels	Moderate	Can speed up Vyvanse elimination.

Conclusion: Prioritize Open Communication

Given the potential for serious and even fatal interactions, it is essential to be completely open and transparent with your healthcare provider about all medications, supplements, and over-the-counter products you are taking. Never start or stop a medication without first consulting your doctor or pharmacist. The information presented here is for educational purposes only and is not a substitute for professional medical advice. By understanding the potential risks and working closely with a healthcare professional, you can help ensure your safety while on Vyvanse.

For more detailed information on lisdexamfetamine and its interactions, you can consult a reliable source like Drugs.com.

What are the symptoms of serotonin syndrome?

Serotonin syndrome symptoms can range from mild to severe and include agitation, confusion, hallucinations, rapid heart rate, high body temperature, sweating, dilated pupils, and tremors. Seek immediate medical attention if you experience these symptoms.

What cold medicines are safe to take with Vyvanse?

Over-the-counter cold medicines that contain decongestants (like pseudoephedrine or phenylephrine) or dextromethorphan can interact with Vyvanse. It is best to consult your doctor or pharmacist for a safe alternative, as non-stimulant cold remedies like saline nasal sprays or antihistamines may be more suitable.

Can I drink alcohol while taking Vyvanse?

Combining Vyvanse with alcohol is not recommended. Alcohol is a depressant, while Vyvanse is a stimulant. Mixing them can mask the effects of both substances, potentially leading to increased alcohol consumption and a higher risk of heart problems. It is best to avoid or minimize alcohol intake.

How do antacids affect Vyvanse?

Antacids that contain alkalinizing agents can increase the absorption and effects of Vyvanse. To minimize this, you should avoid taking antacids and Vyvanse at the same time and consult with your doctor or pharmacist.

Is it dangerous to mix Vyvanse and antidepressants?

Mixing Vyvanse with most antidepressants, particularly SSRIs, SNRIs, and TCAs, carries a risk of serotonin syndrome. While some combinations may be carefully managed by a doctor, it is a high-risk interaction that requires careful monitoring and should not be done without medical supervision.

Does Vyvanse interact with caffeine?

Yes, because both Vyvanse and caffeine are CNS stimulants, combining them can intensify side effects like anxiety, jitters, and sleep problems. It is often best to limit or avoid caffeine, especially from high-concentration sources like energy drinks.

What about herbal supplements like St. John's Wort?

St. John's wort can increase serotonin levels, and combining it with Vyvanse significantly increases the risk of serotonin syndrome. You should inform your doctor about all supplements you take before starting Vyvanse.

Frequently Asked Questions

Combining Vyvanse and Adderall is generally not recommended because both are CNS stimulants and can lead to an increased risk of cardiovascular side effects like high blood pressure and rapid heart rate. A doctor may, in some specific cases, carefully manage the combination, but it should never be attempted without strict medical guidance.

Serotonin syndrome is a potentially life-threatening reaction caused by an excess of serotonin. Symptoms can range from mild (tremors, sweating, rapid heart rate) to severe (fever, confusion, seizures). Immediate medical attention is necessary for severe symptoms.

Many over-the-counter cold medicines contain stimulants (decongestants like pseudoephedrine or phenylephrine) or serotonergic drugs (like dextromethorphan), which can interact dangerously with Vyvanse. Consult your doctor or pharmacist for safe alternatives.

Drinking alcohol while on Vyvanse is generally not recommended. Because Vyvanse is a stimulant and alcohol is a depressant, one can mask the effects of the other, increasing the risk of alcohol poisoning and adverse cardiac effects.

Antacids containing alkalinizing agents (like baking soda, calcium carbonate) can increase Vyvanse absorption and raise the risk of side effects. It is advisable to avoid taking antacids at the same time as Vyvanse, and to speak with a healthcare provider.

Since both are stimulants, consuming too much caffeine with Vyvanse can worsen side effects such as jitters, nervousness, and insomnia. Limiting caffeine intake, especially from energy drinks, is often recommended.

St. John's Wort is an herbal supplement that affects serotonin levels, and combining it with Vyvanse increases the risk of developing serotonin syndrome. It is critical to inform your doctor about all supplements you take.