Can two different dosages of Adderall (amphetamine and dextroamphetamine) be prescribed and picked up at the same time?

Prescribing Multiple Dosages of Adderall Simultaneously

Yes, two different dosages of Adderall (amphetamine and dextroamphetamine) can be prescribed and picked up at the same time, particularly when using different formulations to optimize treatment coverage throughout the day. 1

Clinical Rationale for Multiple Adderall Dosages

• The American Academy of Child and Adolescent Psychiatry explicitly supports using two stimulant formulations (short and long-acting) to "sculpt" dosing for extended coverage throughout the day 1
• This approach allows clinicians to tailor treatment to individual patient needs while maintaining appropriate symptom control

Common Clinical Scenarios for Multiple Dosages

1. Morning/Afternoon Coverage

   • Long-acting formulation (Adderall XR) in the morning
   • Short-acting formulation (immediate-release) for afternoon coverage when the extended-release wears off

2. Dose Optimization

   • Different strengths may be needed to achieve optimal symptom control at different times of day
   • This approach helps minimize side effects while maximizing therapeutic benefit

Pharmacological Considerations

• Adderall is a 3:1 mixture of d- and l-enantiomers of amphetamine salts 2
• Different formulations have distinct pharmacokinetic profiles:
  • Immediate-release Adderall: 4-6 hour duration
  • Adderall XR: 12-hour duration through two-stage delivery system 3

Important Prescribing Safeguards

• The prescriber must have a clear rationale for using medication combinations 1

• Documentation should include:

  • Treatment rationale
  • Monitoring plan
  • Patient/family education
  • Informed consent

• The FDA advises that "the least amount feasible should be prescribed or dispensed at one time in order to minimize the possibility of overdosage" 4

Potential Drug Interactions

When prescribing multiple Adderall dosages, be aware of:

• Risk of serotonin syndrome when combined with other serotonergic medications 1
• Interactions with:
  • MAOIs (contraindicated)
  • Acidifying/alkalinizing agents (affect absorption)
  • Tricyclic antidepressants (potentiate effects)
  • Adrenergic blockers (inhibited by amphetamines) 4

Clinical Monitoring

When prescribing multiple Adderall dosages:

• Monitor vital signs regularly
• Assess weight at each visit to evaluate potential appetite suppression
• Systematically evaluate for side effects (insomnia, anorexia, headache, mood changes) 5
• Watch for signs of tolerance or dependence

Common Pitfalls to Avoid

1. Overlapping peak effects: Ensure dosing schedule prevents excessive concentration of amphetamines, which could increase side effects

2. Inadequate documentation: Clearly document medical necessity for multiple dosages to avoid regulatory scrutiny

3. Pharmacy confusion: Some pharmacies may question multiple prescriptions for the same medication; providing clear instructions can prevent delays

4. Insurance barriers: Some insurance plans may require prior authorization for multiple formulations of the same medication

Conclusion

Multiple dosages of Adderall can be prescribed and dispensed simultaneously when clinically indicated, particularly when using different formulations to optimize symptom control throughout the day. This approach is supported by clinical guidelines and allows for personalized treatment while maintaining appropriate coverage for ADHD symptoms.