Does Vyvanse Cause Tinnitus?

Tinnitus is not one of the common side effects listed for Vyvanse (lisdexamfetamine), but some people do notice ringing, buzzing or hissing after they start it or after a dose change. A stimulant can affect several things that are tied to tinnitus, such as heart rate, blood pressure, sleep, anxiety and jaw clenching, so a link is possible for some people even though it has not been well studied. If you notice new ringing, do not stop the medicine on your own; tell your prescriber what you are hearing and when it started.

What Vyvanse is and how it works

Vyvanse is the brand name for lisdexamfetamine. It is a prescription stimulant used for attention-deficit/hyperactivity disorder (ADHD) and, in adults, for moderate to severe binge eating disorder. It is usually taken once a day in the morning.

Lisdexamfetamine is a "prodrug." It does very little on its own. After you swallow it, your body slowly converts it into dextroamphetamine, the active stimulant. That slow release is why it tends to last through the day and why the effects come on more gradually than some other stimulants.

Like other amphetamine-type medicines, it raises the activity of brain chemicals such as dopamine and norepinephrine. Those same chemicals also affect alertness, heart rate, blood pressure and how strongly you react to things around you, including sound. Your doctor is supposed to check your heart and blood pressure before and during treatment for that reason.

Why a stimulant might make ringing more noticeable

There is no single proven way that Vyvanse causes tinnitus. Instead, there are several common stimulant effects that are known to make tinnitus louder or harder to ignore. Often it is a mix of a few.

Heart rate and blood pressure

Stimulants can raise your pulse and blood pressure a little. For some people that shows up as a faint whooshing or a beat in the ear, especially at night when the room is quiet. A rhythmic sound that keeps time with your heartbeat is called pulsatile tinnitus, and it always deserves a medical check, whatever the cause.

Sleep loss

Trouble falling asleep is one of the best-known stimulant side effects, especially if a dose is taken late in the day. Poor sleep does not create tinnitus out of nothing, but many people find their ringing feels louder and more irritating after a short night.

Anxiety and a "high alert" brain

Some people feel jittery, restless or anxious on stimulants. When your nervous system is on high alert, your brain is more likely to tune in to small internal sounds. A soft hum you never noticed before can suddenly seem impossible to ignore.

Jaw clenching and teeth grinding

Clenching or grinding the teeth (bruxism) has been reported with stimulant medicines. The jaw joint and its muscles sit right next to the ear. Tight jaw and neck muscles can change the pitch or loudness of tinnitus in some people. This is called somatic tinnitus.

Stacking with caffeine and dehydration

Coffee, energy drinks and pre-workout powders add more stimulation on top of the medicine. Stimulants can also dull appetite and thirst, so some people drink and eat less than usual. Neither is proven to cause tinnitus, but both are worth noticing.

What the research says

Here is an honest summary of what is and is not known:

• Tinnitus is not a common side effect in the official drug information. Consumer drug information for lisdexamfetamine lists effects like dry mouth, trouble sleeping, decreased appetite, nervousness and fast heartbeat, not ringing in the ears.
• Individual reports exist. People do describe ringing after starting stimulants in online forums and reports to drug safety systems. Those reports cannot show that the medicine caused the ringing, because tinnitus is very common in the general population and many things can trigger it.
• There are no good studies looking directly at Vyvanse and tinnitus. We do not know how often it happens, who is most at risk, or whether it fades with time.
• The connections above are plausible, not proven. Stress, sleep loss, blood pressure and jaw tension are all known to influence tinnitus in general. Whether they explain ringing in a given person on Vyvanse is something you and your clinician figure out together.

In short, a link is possible for some people, but the evidence is thin. That is also why your own notes about timing are so useful.

Is it the medicine or something else?

Tinnitus has many causes, and starting a new medicine can be a coincidence. The pattern of the ringing can give you and your prescriber useful clues.

None of these clues is proof. They simply help your care team decide what to look at first.

Talking to your prescriber

Bring up the ringing at your next visit, or call sooner if it is bothering you. Never stop a stimulant, skip doses or change the timing without talking to the person who prescribes it. They may have several options to consider with you, and the right one depends on your health, your symptoms and how well the medicine is working.

Questions you can ask:

• Could my tinnitus be related to this medicine, or is something else more likely?
• Should we recheck my blood pressure and heart rate?
• Would taking my dose earlier in the morning help with sleep? (Ask before changing anything.)
• Are any of my other medicines or supplements known to affect the ears?
• Should I see an audiologist or an ear, nose and throat (ENT) doctor for a hearing test?

Your pharmacist is also a good resource. They can review your full medicine list, including over-the-counter products, for anything that might add to the problem.

Everyday steps that may make ringing easier while you sort it out

These habits are low-risk and can help whether or not the medicine turns out to be involved.

1. Watch the caffeine. Try keeping coffee, tea, soda and energy drinks steady for two weeks, and note whether the ringing changes. Do not swap caffeine in or out suddenly if you are used to a lot; headaches can follow.
2. Protect your sleep. Keep the same bedtime, dim screens an hour before bed, and use a fan or soft sound machine so the room is not silent.
3. Relax your jaw. Several times a day, check whether your teeth are touching. Let your lips close, teeth apart, tongue resting behind your upper front teeth. If you grind at night, ask a dentist about it.
4. Eat and drink on a schedule. If your appetite is low, set reminders for water and small meals or snacks.
5. Use low-level background sound. A quiet radio, music or nature sounds can make ringing less noticeable during focused work.
6. Lower the alarm. Slow breathing, a short walk, or a few minutes of stretching can calm a nervous system that is running hot.

Your next steps

1. Keep a two-week log. Write down your dose time, caffeine, hours of sleep, stress level and how loud the ringing is on a 0 to 10 scale, morning and evening.
2. Check your blood pressure at home or at a pharmacy a few times during that period and bring the numbers to your visit.
3. Book a hearing test with an audiologist if the ringing lasts more than a couple of weeks, or sooner if your hearing seems different.
4. Share your log with your prescriber and ask the questions above. Keep taking the medicine as prescribed unless they tell you otherwise.
5. Protect your ears from loud noise with earplugs at concerts, while mowing or using power tools, so you are not adding another source of ringing.