A Single-Dose, Open-Label Study of the Pharmacokinetics, Safety, and Tolerability of Lisdexamfetamine Dimesylate in Individuals With Normal and Impaired Renal Function

BACKGROUND: Lisdexamfetamine (LDX) and d-amphetamine pharmacokinetics were assessed in individuals with normal and impaired renal function after a single LDX dose; LDX and d-amphetamine dialyzability was also examined. METHODS: Adults (N = 40; 8/group) were enrolled in 1 of 5 renal function groups [normal function, mild impairment, moderate impairment, severe impairment/end-stage renal disease (ESRD) not requiring hemodialysis, and ESRD requiring hemodialysis] as estimated by glomerular filtration rate (GFR). Participants with normal and mild to severe renal impairment received 30 mg LDX; blood samples were collected predose and serially for 96 hours. Participants with ESRD requiring hemodialysis received 30 mg LDX predialysis and postdialysis separated by a washout period of 7–14 days. Predialysis blood samples were collected predose, serially for 72 hours, and from the dialyzer during hemodialysis; postdialysis blood samples were collected predose and serially for 48 hours. Pharmacokinetic end points included maximum plasma concentration (C(max)) and area under the plasma concentration versus time curve from time 0 to infinity (AUC(0–∞)) or to last assessment (AUC(last)). RESULTS: Mean LDX C(max), AUC(last), and AUC(0–∞) in participants with mild to severe renal impairment did not differ from those with normal renal function; participants with ESRD had higher mean C(max) and AUC(last) than those with normal renal function. d-amphetamine exposure (AUC(last) and AUC(0–∞)) increased and C(max) decreased as renal impairment increased. Almost no LDX and little d-amphetamine were recovered in the dialyzate. CONCLUSIONS: There seems to be prolonged d-amphetamine exposure after 30 mg LDX as renal impairment increases. In individuals with severe renal impairment (GFR: 15 ≤ 30 mL·min(−1)·1.73 m(−2)), the maximum LDX dose is 50 mg/d; in patients with ESRD (GFR: <15 mL·min(−1)·1.73 m(−2)), the maximum LDX dose is 30 mg/d. Neither LDX nor d-amphetamine is dialyzable.