From the Research
Adderall dosing should be reduced in patients with chronic kidney disease (CKD). For patients with mild to moderate CKD (eGFR 30-89 mL/min), start with 50% of the normal dose, typically 2.5-5 mg once or twice daily, and titrate slowly based on response and tolerability. For severe CKD (eGFR <30 mL/min) or patients on dialysis, begin with the lowest possible dose (2.5 mg daily) and increase cautiously, with close monitoring for side effects. Maximum daily doses should generally not exceed 20 mg in moderate CKD and 10 mg in severe CKD.
Key Considerations
- Adderall and its metabolites are partially excreted by the kidneys, and reduced renal clearance can lead to drug accumulation, potentially causing increased side effects including cardiovascular complications, hypertension, and CNS stimulation 1.
- CKD patients often have comorbid cardiovascular disease, making them more vulnerable to Adderall's sympathomimetic effects.
- Regular monitoring of blood pressure, heart rate, and mental status is essential, and alternative non-stimulant medications may be preferable in patients with advanced kidney disease or significant cardiovascular comorbidities.
Dosing Recommendations
- Mild to moderate CKD (eGFR 30-89 mL/min): 50% of normal dose, 2.5-5 mg once or twice daily
- Severe CKD (eGFR <30 mL/min) or patients on dialysis: lowest possible dose, 2.5 mg daily, increase cautiously
- Maximum daily doses: 20 mg in moderate CKD, 10 mg in severe CKD