Adderall Immediate Release Dosing Guidelines
For Adderall immediate release (amphetamine/dextroamphetamine), the recommended starting dose is 5 mg given 2-3 times daily, with titration in 5 mg weekly increments up to a maximum daily dose of 40-60 mg depending on response and tolerability. 1
Initial Dosing Protocol
- Starting dose: 5 mg of immediate release Adderall given 2-3 times daily (typically morning and noon)
- Timing: Administer after breakfast and lunch to minimize appetite suppression
- Titration schedule: Increase by 5 mg weekly if symptom control is not achieved
- Maximum daily dose: 40 mg for amphetamine mixed salts according to most guidelines, though up to 60 mg may be used in select cases 1
Dosing Considerations by Age
Children and Adolescents
- Starting dose: 5 mg twice daily
- Titration: Increase by 5 mg weekly
- Weight consideration: Children weighing less than 25 kg should not receive single doses greater than 10 mg 1
- Maximum daily dose: 40 mg (though PDR states up to 60 mg for methylphenidate and 40 mg for amphetamines) 1
Adults
- Starting dose: 5-10 mg twice daily
- Titration: Increase by 5-10 mg weekly
- Maximum daily dose: Similar to children (40-60 mg), though some adult patients may be treated with total daily doses up to 0.9 mg/kg 1
Monitoring Protocol
Initial titration phase (first 2-4 weeks):
- Weekly contact (in-person or telephone)
- Assess target symptoms of ADHD
- Monitor side effects (insomnia, anorexia, headaches, social withdrawal)
- Check weight at each visit
Maintenance phase:
- Monthly follow-up until symptoms stabilized
- Monitor blood pressure and pulse regularly
Common Pitfalls and Considerations
- Duration of effect: Immediate release Adderall typically lasts 4-6 hours, necessitating multiple daily doses
- Timing considerations: Last dose should generally be given before 2-3 PM to avoid insomnia
- Side effect management: Most common side effects include appetite suppression and insomnia 2, 3
- Dose ceiling: If maximum recommended dose does not provide symptom control, switching to an alternative stimulant should be considered rather than exceeding recommended doses 1
- Efficacy assessment: If no response is seen at maximum doses, consider alternative medications or diagnoses
Clinical Evidence and Comparative Efficacy
Research indicates that Adderall may have a longer duration of action compared to immediate-release methylphenidate, with some studies showing that a single morning dose of Adderall may produce effects equivalent to twice-daily methylphenidate dosing 4, 5. This may allow for less frequent dosing in some patients, though individual response varies considerably.
For patients requiring longer coverage throughout the day, extended-release formulations should be considered as an alternative to multiple daily immediate-release doses.