What is the recommended taper schedule for individuals taking Adderall (amphetamine and dextroamphetamine) for less than a year?

Adderall Tapering Schedule for Individuals Taking It Less Than One Year

For individuals taking Adderall for less than one year, a taper schedule of approximately 10% of the original dose per week is recommended to minimize withdrawal symptoms and ensure patient safety. 1

Recommended Tapering Approach

Initial Assessment

• Calculate the patient's total daily Adderall intake
• Maintain the same dosing frequency during the taper
• Assess for any comorbid conditions that may complicate tapering (anxiety, depression)

Tapering Schedule

1. First Phase (Weeks 1-4)

   • Decrease dose by 10% of the original dose per week
   • Example: For a patient taking 20mg daily
     • Week 1: 18mg daily
     • Week 2: 16mg daily
     • Week 3: 14mg daily
     • Week 4: 12mg daily

2. Middle Phase (Weeks 5-8)

   • Continue 10% reductions of original dose
   • Slow to 5% reductions if withdrawal symptoms become problematic
   • Monitor closely for withdrawal symptoms

3. Final Phase (Weeks 9+)

   • When reaching the smallest available dose unit, extend the interval between doses
   • Example: From daily dosing to every other day, then every third day
   • Discontinue when medication is taken less frequently than once daily 1

Monitoring and Follow-up

• Follow up at least weekly during active tapering 1
• Assess for withdrawal symptoms at each visit:
  • Fatigue, increased appetite, sleep disturbances
  • Irritability, anxiety, depression
  • Difficulty concentrating

Management of Withdrawal Symptoms

• Non-pharmacological approaches:

  • Cognitive behavioral therapy
  • Regular exercise
  • Sleep hygiene practices
  • Stress management techniques 1

• Pharmacological management for specific symptoms:

  Symptom	Management
  Sympathetic hyperactivity	Clonidine 0.1-0.2mg orally every 6 hours 2
  Insomnia	Trazodone or hydroxyzine as needed
  Anxiety	Hydroxyzine or short-term use of non-benzodiazepine anxiolytics
  Pain	NSAIDs or acetaminophen

Common Pitfalls to Avoid

• Tapering too rapidly: This increases withdrawal symptoms and reduces success rates 1
• Mistaking withdrawal for ADHD symptom return: Withdrawal symptoms can mimic ADHD symptoms
• Abrupt discontinuation: Significantly increases risk of severe withdrawal symptoms 2
• Inadequate monitoring: Follow-up less than weekly during active tapering can lead to poor outcomes 1

Special Considerations

• If withdrawal symptoms become severe, pause the taper temporarily and resume at a slower rate 2
• For patients with significant anxiety about the taper, consider starting with smaller reductions (5% instead of 10%)
• Avoid tapering during high-stress periods (major life events, exams)
• Consider consulting with an addiction specialist if withdrawal symptoms are difficult to manage 2

The CDC and Mayo Clinic guidelines emphasize that shorter-term users (<1 year) can typically tolerate a faster taper than long-term users, who may require tapers extending over months 2, 1. However, even for shorter-term users, individualization of the taper rate based on withdrawal symptoms is essential for success.