From the Guidelines
It is not recommended to give an adult Adderall IR 30 mg BID without a thorough medical evaluation and consideration of potential risks and benefits, as this dosage may increase the risk of adverse effects such as elevated blood pressure, according to the 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults 1.
The use of Adderall IR, containing amphetamine salts, is a controlled substance prescribed for conditions like ADHD and narcolepsy. The typical adult dosage range is 5-40 mg per day, often starting at lower doses and gradually increasing. A 30 mg twice daily regimen (60 mg total daily) is at the higher end of the dosing spectrum and may be appropriate for some adults but could pose risks for others.
Some key factors to consider when evaluating the safety of this dosage include:
- Medical history, particularly cardiovascular health
- Potential drug interactions
- Prior response to stimulants
- Risk of substance abuse
- Common side effects such as increased blood pressure, heart rate, insomnia, decreased appetite, and anxiety
As stated in the practice parameter for the use of stimulant medications in the treatment of children, adolescents, and adults, the maximum total daily dose is calculated by adding together all doses taken during a given day, and the consensus from practice is that doses may go higher than the PDR-recommended upper limits on rare occasions 1.
Therefore, only a qualified healthcare provider who has evaluated the specific patient should determine if this dosage is appropriate and safe, taking into account the individual's unique needs and health status, and regularly monitoring the patient for potential adverse effects 1.
From the FDA Drug Label
Adults Sudden deaths, stroke, and myocardial infarction have been reported in adults taking stimulant drugs at usual doses for ADHD Although the role of stimulants in these adult cases is also unknown, adults have a greater likelihood than children of having serious structural cardiac abnormalities, cardiomyopathy, serious heart rhythm abnormalities, coronary artery disease, or other serious cardiac problems. Adults with such abnormalities should also generally not be treated with stimulant drugs
Hypertension and Other Cardiovascular Conditions Stimulant medications cause a modest increase in average blood pressure (about 2 to 4 mmHg) and average heart rate (about 3 to 6 bpm), and individuals may have larger increases.
The use of Adderall IR 30 mg BID in adults may be associated with an increased risk of sudden death, stroke, and myocardial infarction, particularly in those with pre-existing cardiovascular conditions.
- Key considerations:
- Cardiovascular status: Adults should be carefully evaluated for the presence of cardiac disease before initiating treatment with stimulant medications.
- Dose and administration: The dosage should be individually adjusted, and late evening doses should be avoided due to the risk of insomnia. Given the potential risks, it is recommended to exercise caution when prescribing Adderall IR 30 mg BID to adults, especially those with pre-existing cardiovascular conditions or hypertension 2.
From the Research
Safety of Adderall IR 30 mg BID in Adults
- The safety of Adderall IR 30 mg BID in adults is a concern due to its potential for abuse and adverse effects, including elevated blood pressure and heart rate, insomnia, and decreased appetite 3.
- A study on the effects of Adderall on healthy college students without ADHD found that it had minimal effects on cognitive processes, but substantial effects on autonomic responses and subjective drug experiences 4.
- However, the study had a small sample size and should be interpreted cautiously.
- Another study discussed the importance of stimulant optimization as an effective strategy to increase response, and considered factors such as poor adherence, time action properties of stimulants, and poor tolerability before using alternative pharmacological strategies for ADHD 5.
Adverse Effects and Risks
- Adderall IR 30 mg BID can have adverse effects, including anxiety, confusion, insomnia, mood disturbances, cognitive impairments, paranoia, hallucinations, and delusion, especially with prolonged use 6.
- The risk of abuse and dependence is also a concern, especially in individuals with a history of substance use disorders.
- A study on the treatment of amphetamine-type stimulants (ATS)-use disorders found that cognitive-behavioural treatment (CBT) may be effective, but the evidence is limited and more research is needed 6.
Treatment Strategies and Guidelines
- Treatment strategies for ADHD, including pharmacological and non-pharmacological interventions, should be individualized and based on evidence-based guidelines 7, 5.
- The choice of medication for ADHD is still largely based on a trial-and-error process, but advances in precision psychiatry may guide prescribers to tailor medication choice to the specific characteristics of the patient 5.
- A practical, evidence-informed approach to managing stimulant-refractory ADHD includes optimizing stimulant treatment, considering alternative pharmacological strategies, and addressing comorbid non-ADHD symptoms 5.