Can you provide a prescription write‑up for Adderall (mixed amphetamine salts) 5 mg taken once daily?

Prescription Write-Up for Adderall 5 mg Once Daily

For ADHD treatment, Adderall 5 mg once daily is an appropriate starting dose, particularly for children or adults beginning stimulant therapy, though the standard evidence-based approach typically involves twice-daily dosing initially. 1

Prescription Format

Adderall (Mixed Amphetamine Salts) 5 mg

• Quantity: 30 tablets
• Directions: Take 1 tablet by mouth once daily in the early morning
• Refills: As appropriate (Schedule II controlled substance - no refills in most jurisdictions; new prescription required monthly)
• DEA number required
• Dispense with Medication Guide

Clinical Context and Dosing Rationale

Starting Dose Justification

The 5 mg once-daily regimen aligns with guideline recommendations for initiating amphetamine therapy. Guidelines recommend starting patients on 2.5 mg of mixed amphetamine salts (AMP/DEX), though 5 mg is commonly used as the practical starting dose. 1 The evidence indicates that:

• Children may be started with AMP/DEX once daily in the early morning, with a noon dose added only if symptom control doesn't last through the school day 1
• Adults and older adolescents may be started on 5 mg of AMP, with titration upward in 5-10 mg intervals each week until symptoms are controlled 1
• Evidence suggests that increasing the morning dose of amphetamine may extend its duration of action, potentially eliminating the need for multiple daily doses 1

Expected Titration Path

Once-daily dosing at 5 mg represents Week 1 of the standard titration schedule. If inadequate response occurs:

• Week 2: Increase to 10 mg once daily (or split to 5 mg twice daily)
• Week 3: Consider 15 mg total daily dose
• Week 4: Consider 20 mg total daily dose
• Maximum doses: Up to 40 mg total daily for DEX/AMP in adults; 0.9 mg/kg/day 1

Monitoring Requirements

Before initiating treatment, obtain:

• Baseline ADHD rating scales (from parents/teachers for children; from patient/significant other for adults)
• Blood pressure and pulse
• Height and weight
• Assessment for substance abuse risk (particularly in adolescents) 2

During treatment:

• Weekly contact (visit or phone) during titration to assess symptom response and side effects 1
• Serial ADHD rating scales to guide dose adjustments
• Monitor for appetite suppression, insomnia, stomachaches (common with amphetamines) 3
• Avoid prescribing to patients with comorbid anxiety disorders without careful consideration, as acute anxiety symptoms occurred in 57% of patients with anxiety diagnoses in one study 4

Critical Prescribing Considerations

Schedule II Controlled Substance Requirements

• No refills permitted - new prescription required for each fill
• Must include DEA number
• Pharmacist must dispense Medication Guide 5
• Monitor for diversion risk, especially in adolescents 2

Common Pitfalls to Avoid

1. Don't rely solely on once-daily dosing long-term - many patients require twice or thrice daily dosing for adequate symptom coverage throughout the day
2. Don't increase doses too rapidly in small children - metabolize stimulants more slowly 2
3. Don't continue ineffective treatment - if no response after appropriate titration, switch to alternative stimulant (methylphenidate); approximately 90% respond to either amphetamine or methylphenidate when both are tried 1
4. Don't prescribe without objective monitoring - use validated ADHD rating scales, not just subjective reports 1

Response Expectations

Research demonstrates response rates of 59-89% with Adderall, depending on whether parent or teacher criteria are used 3. The mean effective dose for adult responders was approximately 10.77 mg/day (0.14 mg/kg/day) in one study, suggesting many patients respond to relatively low doses 4.