Can Adderall (amphetamine and dextroamphetamine) ER 15mg be taken twice a day?

Adderall ER Should Not Be Taken Twice Daily

Adderall ER (extended-release) 15mg should not be taken twice daily as it is designed for once-daily dosing and taking it twice daily could increase the risk of side effects and adverse reactions.

FDA Dosing Guidelines

The FDA label for amphetamine products clearly states that Adderall should be administered at the lowest effective dosage and dosage should be individually adjusted 1. The extended-release formulation (Adderall XR) is specifically designed for once-daily administration, eliminating the need for multiple daily doses that are typically required with immediate-release formulations.

Taking Adderall ER twice daily would:

1. Exceed the intended duration of action
2. Potentially increase the risk of insomnia (especially with late evening doses)
3. Increase the likelihood of adverse effects including cardiovascular effects
4. Potentially lead to tolerance development more quickly

Pharmacological Considerations

Adderall ER is formulated to provide a sustained therapeutic effect throughout the day with a single dose. The American Academy of Child and Adolescent Psychiatry guidelines note that if ADHD symptoms return in the afternoon with immediate-release formulations, a second daily dose may be given 2. However, this recommendation applies to immediate-release formulations, not extended-release versions like Adderall ER.

Safety Concerns

Taking Adderall ER twice daily raises several safety concerns:

• Cardiovascular risks: Increased exposure could exacerbate effects on heart rate and blood pressure
• Sleep disruption: Late doses significantly increase the risk of insomnia
• Potential for toxicity: Higher daily exposure increases the risk of adverse effects including anxiety, irritability, and other stimulant-related side effects 3
• Drug interactions: Adderall is contraindicated with MAO inhibitors and requires careful monitoring with certain other medications 4

Alternative Approaches

If a single daily dose of Adderall ER 15mg is not providing adequate symptom control throughout the day, consider these options:

1. Dose adjustment: Work with your healthcare provider to adjust the single daily dose (up to FDA-approved maximum)
2. Medication switch: Consider trying a different extended-release stimulant with potentially longer duration
3. Augmentation strategy: Adding a small dose of immediate-release Adderall in the afternoon (rather than a second full ER dose) if breakthrough symptoms occur

Evidence for Once-Daily Dosing

Research supports the efficacy of once-daily dosing with extended-release stimulant formulations:

• Studies have demonstrated that once-daily Adderall XR provides effective symptom control throughout the school/work day 5
• Medication compliance is significantly better with once-daily dosing compared to multiple daily doses, with compliance rates of 79% for once-daily versus 65% for three-times-daily regimens 6

Clinical Recommendation

If the current 15mg ER dose is not providing adequate duration of effect, the most appropriate approach would be to:

1. Evaluate whether the dose needs to be increased (within FDA guidelines)
2. Consider switching to a different extended-release stimulant with potentially longer duration
3. Discuss with your healthcare provider about possibly adding a small dose of immediate-release Adderall in the afternoon if breakthrough symptoms occur

Remember that late evening doses of any stimulant medication should be avoided due to the high risk of insomnia 1.