Maximum Daily Dose of Methamphetamine for ADHD
The maximum daily dose of methamphetamine for treating ADHD is 50 mg per day. 1
Dosing Guidelines and Titration
Methamphetamine (mixed amphetamine salts) treatment for ADHD should follow a structured approach:
- Starting dose: 10 mg once daily in the morning 1
- Titration schedule: Increase by 5 mg weekly increments 1
- FDA-approved dosing: For children 6 years or older, the usual effective dose is 20 to 25 mg daily, which may be given in two divided doses 2
- Maximum dose: 50 mg per day for adults 1
Some clinicians use weight-based dosing approaches with a maximum dose of up to 0.9 mg/kg for amphetamine preparations 1.
Medication Administration
- Administer at the lowest effective dosage
- Avoid late evening medication due to resulting insomnia 2
- The total daily dose may be given in two divided doses 2
Monitoring and Assessment
Before initiating treatment:
- Assess for cardiac disease (careful history, family history of sudden death or ventricular arrhythmia, physical exam)
- Evaluate family history of motor or verbal tics or Tourette's syndrome 2
During treatment:
- Monitor blood pressure and pulse at each dose increase
- Assess weight periodically
- Evaluate side effects at each visit 1
High-Dose Considerations
When prescribing doses at the higher end of the range:
- Document clearly that symptoms could not be controlled at lower doses
- Confirm that higher doses are not producing significant side effects
- Monitor for signs of tolerance 1
Alternative Medications
For patients with concerns about methamphetamine's abuse potential, consider:
- Lisdexamfetamine (Vyvanse): Maximum dose 70 mg daily; has reduced abuse liability compared to short-acting amphetamines 1, 3
- Atomoxetine: A non-stimulant option with maximum recommended dosage of 1.4 mg/kg/day or 100 mg/day, whichever is lower 4
Efficacy and Response Rates
Studies indicate that more than 70% of children and adolescents with ADHD respond to methylphenidate when a full range of doses is administered. When both methylphenidate and amphetamine classes are tried, more than 90% of patients show a beneficial response 4.
Cautions and Considerations
- Methamphetamine has abuse potential similar to cocaine 5
- Careful monitoring is essential, especially in patients with history of substance use disorders
- Long-acting formulations may be preferable to reduce abuse potential 3
Remember that individual response to stimulants is variable and unpredictable, requiring careful titration from a low dose to achieve optimal symptom control while minimizing adverse effects 4.