What is the maximum daily dose of methamphetamine (Attention Deficit Hyperactivity Disorder) medication for adults with ADHD?

Maximum Daily Dose of Methamphetamine for Adult ADHD

For adults with ADHD, the maximum daily dose of methamphetamine (mixed amphetamine salts) is 50 mg per day, with titration starting at 10 mg once daily and increasing by 5 mg weekly increments. 1

Dosing Guidelines for Amphetamine-Based Medications

Initial Dosing and Titration

• Starting dose: 10 mg once daily in the morning 1
• Titration schedule: Increase by 5 mg weekly 1
• Maximum recommended dose: 50 mg daily 1

For immediate-release dextroamphetamine (a component of methamphetamine):

• Starting dose: 5 mg twice daily
• Titration: Increase by 5 mg weekly
• Maximum daily dose: 50 mg 1

Weight-Based Considerations

Some clinicians use weight-based dosing approaches:

• Up to 1.0 mg/kg for methylphenidate
• Up to 0.9 mg/kg for dextroamphetamine/amphetamine 1

Monitoring and Safety Considerations

Required Monitoring

• Blood pressure and pulse at each dose increase
• Weight and height periodically
• Side effects assessment at each visit 1

Common Side Effects to Monitor

• Insomnia
• Decreased appetite
• Irritability
• Headaches
• Cardiovascular effects (increased heart rate, blood pressure) 1

Special Considerations

Documentation Requirements

When prescribing doses at the higher end of the range:

• Document clearly that symptoms could not be controlled at lower doses
• Confirm higher doses are not producing significant side effects (weight loss, blood pressure increase, agitation)
• Monitor for signs of tolerance 1

Risk of Misuse

• Methamphetamine has significant abuse potential
• Consider lisdexamfetamine (Vyvanse) as an alternative in patients with history of substance use disorders, as it has lower abuse potential due to its prodrug formulation 2
• Maximum dose for lisdexamfetamine is 70 mg daily 1

Practical Application

For optimal symptom control:

1. Begin with 10 mg once daily in the morning
2. Assess response after 1 week
3. If inadequate response and no significant side effects, increase by 5 mg
4. Continue weekly assessments and increases until:
   • Symptoms are adequately controlled
   • Maximum dose of 50 mg is reached
   • Side effects become problematic

Important Cautions

• Higher doses may be associated with more growth attenuation in children, but this is less concerning in adults 3
• Cardiovascular monitoring is essential, particularly at higher doses
• If maximum doses do not provide adequate symptom control, consider alternative medications or combination therapy

Remember that medication effectiveness should be assessed based on functional improvement in daily activities, work performance, and quality of life, not just symptom reduction.