What are the guidelines for prescribing Adderall (dextroamphetamine-amphetamine) in attention deficit hyperactivity disorder (ADHD)?

From the Guidelines

Adderall (dextroamphetamine-amphetamine) should be prescribed for ADHD after confirming diagnosis through comprehensive evaluation and considering non-pharmacological interventions first, with a recommended starting dose of 2.5 mg for children and adolescents, and 10-20 mg for adults, with gradual titration based on symptom response, as recommended by the most recent guidelines 1. When prescribing Adderall, it is essential to conduct a thorough medical history, physical examination, and cardiovascular assessment, as Adderall is contraindicated in patients with cardiovascular disorders, hyperthyroidism, glaucoma, or history of drug abuse.

Key Considerations

• The primary care clinician should titrate doses of medication for ADHD to achieve maximum benefit with tolerable side effects, as stated in the 2019 clinical practice guideline for the diagnosis, evaluation, and treatment of attention-deficit/hyperactivity disorder in children and adolescents 1.
• Regular monitoring is essential, including vital signs, growth parameters in children, and assessment for side effects like decreased appetite, insomnia, and increased blood pressure.
• Drug holidays (weekends or school breaks) may be considered to evaluate continued need and minimize tolerance.
• Adderall works by increasing dopamine and norepinephrine levels in the brain, improving attention, focus, and impulse control.
• Extended-release formulations (Adderall XR) provide once-daily dosing and may improve adherence and reduce stigma associated with taking medication during school or work hours.

Dosage and Titration

• The starting dose of Adderall is 2.5 mg for children and adolescents, and 10-20 mg for adults, with gradual titration based on symptom response.
• The maximum recommended daily dose is 30 mg for children and 40-60 mg for adults, usually divided into morning and midday doses to minimize sleep disruption.
• The optimal dose of medication is required to reduce core symptoms to, or close to, the levels of children without ADHD, as recommended by the 2019 clinical practice guideline 1.

From the FDA Drug Label

DOSAGE AND ADMINISTRATION Regardless of indication, amphetamines should be administered at the lowest effective dosage, and dosage should be individually adjusted according to the therapeutic needs and response of the patient. Attention Deficit Hyperactivity Disorder Not recommended for children under 3 years of age. In children from 3 to 5 years of age, start with 2.5 mg daily; daily dosage may be raised in increments of 2.5 mg at weekly intervals until optimal response is obtained. In children 6 years of age and older, start with 5 mg once or twice daily; daily dosage may be raised in increments of 5 mg at weekly intervals until optimal response is obtained. Only in rare cases will it be necessary to exceed a total of 40 mg per day Give first dose on awakening; additional doses (1 or 2) at intervals of 4 to 6 hours. Prior to treating patients with dextroamphetamine saccharate, amphetamine aspartate, dextroamphetamine sulfate and amphetamine sulfate tablets assess: for the presence of cardiac disease (i.e., perform a careful history, family history of sudden death or ventricular arrhythmia, and physical exam [see WARNINGS]. the family history and clinically evaluate patients for motor or verbal tics or Tourette’s syndrome before initiating dextroamphetamine saccharate, amphetamine aspartate, dextroamphetamine sulfate and amphetamine sulfate tablets [see WARNINGS]

The guidelines for prescribing Adderall (dextroamphetamine-amphetamine) in Attention Deficit Hyperactivity Disorder (ADHD) are as follows:

• Dosage: Start with 2.5 mg daily for children from 3 to 5 years of age, and 5 mg once or twice daily for children 6 years of age and older.
• Titration: Increase daily dosage in increments of 2.5 mg at weekly intervals for children from 3 to 5 years of age, and in increments of 5 mg at weekly intervals for children 6 years of age and older.
• Maximum dosage: Only exceed a total of 40 mg per day in rare cases.
• Administration: Give the first dose on awakening, with additional doses at intervals of 4 to 6 hours.
• Assessment: Evaluate patients for cardiac disease and motor or verbal tics or Tourette’s syndrome before initiating treatment 2. Key considerations:
• Age restrictions: Not recommended for children under 3 years of age.
• Cardiac evaluation: Perform a careful history, family history of sudden death or ventricular arrhythmia, and physical exam before treating patients with Adderall.
• Tourette’s syndrome evaluation: Clinically evaluate patients for motor or verbal tics or Tourette’s syndrome before initiating treatment.

From the Research

Guidelines for Prescribing Adderall in ADHD

The guidelines for prescribing Adderall (dextroamphetamine-amphetamine) in attention deficit hyperactivity disorder (ADHD) are based on various studies and reviews.

• The American Academy of Pediatrics and other organizations recommend a comprehensive evaluation and diagnosis of ADHD before initiating treatment with Adderall or other medications 3.
• Adderall is approved for the treatment of ADHD in children and adults, and its efficacy has been demonstrated in numerous studies 4, 5.
• The dosage of Adderall should be individualized and titrated to achieve optimal therapeutic effects while minimizing side effects 3, 6.
• Patients with ADHD should be monitored regularly for changes in symptoms, side effects, and potential interactions with other medications 6, 5.

Considerations for Prescribing Adderall

When prescribing Adderall, healthcare providers should consider the following factors:

• Age and weight of the patient: Adderall dosages may vary depending on the patient's age and weight 3, 5.
• Medical history: Patients with certain medical conditions, such as cardiovascular disease or glaucoma, may require special consideration or alternative treatments 6.
• Concomitant medications: Adderall may interact with other medications, including antidepressants, antihistamines, and blood thinners 6.
• Potential for abuse or diversion: Adderall has a high potential for abuse and diversion, and healthcare providers should carefully evaluate patients for these risks 3, 6.

Monitoring and Follow-up

Regular monitoring and follow-up are essential for patients taking Adderall for ADHD.

• Healthcare providers should assess patients' symptoms, side effects, and overall response to treatment at regular intervals 3, 5.
• Patients should be educated about the potential risks and benefits of Adderall, as well as the importance of adhering to the prescribed treatment regimen 3, 6.
• Healthcare providers should also be aware of the potential for long-term effects of Adderall and other ADHD medications, and consider these factors when making treatment decisions 5.