Adderall IR Prescription Writing Protocol
When prescribing Adderall IR (immediate-release), start with a low dose of 5-10 mg once or twice daily and titrate weekly based on symptom response, with a maximum daily dose of 60 mg for most adults. 1
Initial Dosing and Titration
Starting Dose
- For adults and adolescents: 10 mg once daily in the morning
- For children (6+ years): 5 mg once or twice daily (morning and midday)
- For small children (<45 lbs/20 kg): Use extra caution with lower starting doses 2
Titration Schedule
- Week 1: Starting dose (5-10 mg daily)
- Week 2: Increase by 5 mg increments if needed
- Week 3-4: Continue increasing by 5 mg weekly until optimal symptom control or maximum dose reached 2, 1
Dosing Frequency
- Immediate-release formulation typically requires twice daily dosing
- Standard administration: Morning dose after breakfast, second dose at midday/lunch
- Consider adding a third afternoon dose to help with homework and evening activities 2
Prescription Writing Elements
Required Information
- Patient's full name, address, and date of birth
- Drug name: "Adderall" or "Mixed Amphetamine Salts"
- Strength: Specify tablet strength (5 mg, 10 mg, 15 mg, 20 mg, or 30 mg)
- Quantity: Calculate based on days of treatment (e.g., 60 tablets for 30 days at BID dosing)
- Directions: "Take ___ mg by mouth ___ times daily" (specify exact timing if needed)
- DEA number: Required as Adderall is a Schedule II controlled substance
Sample Prescription Format
Rx: Adderall (Mixed Amphetamine Salts) 10 mg tablets
Disp: #60 tablets
Sig: Take 1 tablet by mouth twice daily, morning and noon
No refills (Schedule II medication)Monitoring and Follow-up
Initial Follow-up
- Schedule follow-up within 1-2 weeks of starting medication
- Assess vital signs (blood pressure, pulse) at each dose increase 2, 1
- Document symptom response using standardized rating scales when possible
Ongoing Monitoring
- Blood pressure and pulse at each visit
- Height and weight periodically (especially in children)
- Side effects assessment (appetite, sleep, irritability)
- Efficacy assessment using standardized tools when available 1
Important Considerations
Maximum Dosing
- Maximum daily dose: 60 mg for adults and children >6 years 2, 1
- Some clinicians use weight-based dosing: up to 0.9 mg/kg for dextroamphetamine/amphetamine 1
- When using higher doses, document clearly that symptoms could not be controlled at lower doses 2
Contraindications
- Advanced arteriosclerosis
- Symptomatic cardiovascular disease
- Moderate to severe hypertension
- Hyperthyroidism
- Known hypersensitivity to amphetamine products
- Glaucoma
- Agitated states
- History of drug abuse
- During or within 14 days of MAO inhibitor use 2
Common Side Effects to Monitor
- Decreased appetite
- Insomnia
- Headache
- Stomach pain
- Irritability
- Increased heart rate and blood pressure 1, 3
Clinical Pearls
- Adderall IR has been shown to be more potent on a milligram basis than methylphenidate IR, with 7.5 mg of Adderall producing effects comparable to 17.5 mg of methylphenidate 4
- Consider timing the last daily dose to minimize sleep disruption
- Document clearly if exceeding standard dosing ranges
- For patients with anxiety disorders, be cautious as Adderall may precipitate anxiety symptoms 5
- If a patient fails to respond to Adderall, consider switching to methylphenidate, as approximately 90% of patients will respond to either stimulant when both are tried 2