What is the maximum daily dosing of Adderall (amphetamine and dextroamphetamine) ER (extended release)?

Maximum Daily Dosing of Adderall ER (Extended Release)

The maximum daily dose of Adderall ER (extended release) for adults is 60 mg per day.

Dosing Guidelines for Adderall ER

Adderall ER (extended release) is a stimulant medication containing amphetamine and dextroamphetamine used primarily for the treatment of Attention-Deficit/Hyperactivity Disorder (ADHD). The dosing guidelines are as follows:

• Starting dose: 20 mg once daily in the morning 1
• Titration: Dose can be adjusted weekly based on therapeutic response and tolerability
• Maximum daily dose: 60 mg per day 2

Evidence Supporting Maximum Dosage

The maximum daily dose of 60 mg is supported by long-term safety and effectiveness studies. In a 24-month open-label extension study, adults with ADHD were treated with MAS XR (Mixed Amphetamine Salts Extended Release, the generic name for Adderall ER) at doses up to 60 mg/day 2. This study demonstrated:

• Sustained symptomatic improvement for up to 24 months
• Generally good tolerability at doses up to 60 mg/day
• Significant improvement in ADHD symptoms as measured by standardized rating scales

Dose Titration Process

When initiating Adderall ER therapy, a careful titration process is recommended:

1. Begin with 20 mg once daily in the morning
2. Assess response after 1 week
3. If needed, increase by 10-20 mg increments at weekly intervals
4. Titrate to the lowest effective dose that provides optimal symptom control
5. Do not exceed 60 mg per day

Common Side Effects and Monitoring

At higher doses, patients should be monitored for:

• Cardiovascular effects: Increased heart rate, elevated blood pressure 1
• Neuropsychiatric effects: Insomnia, nervousness, anxiety
• Gastrointestinal effects: Dry mouth, decreased appetite, weight loss
• Other: Headache, irritability

Regular monitoring of vital signs, weight, and mental status is essential, particularly when approaching maximum dosages.

Special Considerations

• Renal/hepatic impairment: Lower doses may be required
• Elderly patients: Lower doses are typically recommended due to increased sensitivity
• Drug interactions: Avoid concurrent use with MAOIs and use caution with other serotonergic medications
• Abuse potential: Adderall is a Schedule II controlled substance with high potential for abuse 3

Clinical Pearls

• The therapeutic effect of Adderall ER typically lasts 10-12 hours, allowing for once-daily dosing
• Some patients may achieve optimal symptom control at lower doses (20-40 mg daily)
• If side effects become problematic at higher doses, consider alternative ADHD medications
• Avoid late afternoon or evening dosing to prevent insomnia

Remember that while 60 mg is the maximum recommended daily dose, the goal is to find the lowest effective dose that adequately controls symptoms while minimizing side effects.