Adderall (Amphetamine and Dextroamphetamine) Dosing Guidelines
The recommended starting dose for Adderall is 5-10 mg daily, with gradual titration based on response and tolerability to a maximum daily dose of up to 50 mg. 1
Dosing Protocol for Adderall
Initial Dosing
- Start with 5-10 mg once daily in the morning 1
- For immediate-release formulations: Consider divided doses (morning and early afternoon)
- For extended-release formulations: Single morning dose is typically sufficient
Titration Schedule
- Increase by increments of 5-10 mg at weekly intervals
- Assess response and tolerability before each dose increase
- Target the lowest effective dose that provides symptom control
Maximum Dosing
- Maximum daily dose: 50 mg 1
- Doses should generally not exceed 40 mg/day for adults in clinical practice
- Higher doses increase risk of side effects without necessarily improving efficacy
Formulation Considerations
Immediate-Release Adderall
- Duration of action: 4-6 hours per dose
- May require multiple daily doses (typically 2-3 times daily)
- Morning and early afternoon dosing (avoid late afternoon/evening dosing to prevent insomnia)
Extended-Release Adderall XR
- Duration of action: 8-12 hours
- Single morning dose is usually sufficient
- Provides coverage throughout the school/work day
Special Dosing Considerations
Children (6-12 years)
- Starting dose: 5 mg once or twice daily
- Increase weekly by 5 mg increments
- Maximum daily dose: 30 mg (rarely exceeding 40 mg)
Adolescents (13-17 years)
- Starting dose: 10 mg once daily
- Increase weekly as needed
- Maximum daily dose: 40 mg
Adults
- Starting dose: 10 mg once daily or 5 mg twice daily
- Increase weekly as needed
- Maximum daily dose: 50 mg
Pharmacokinetic Considerations
- A single morning dose of Adderall has been shown to provide behavioral effects throughout an entire school day, equivalent to twice-daily methylphenidate dosing 2
- Adderall contains a 3:1 mixture of d- and l-enantiomers of amphetamine salts 3
- Peak concentrations occur 1-3 hours after administration
- The d-enantiomer is present in higher concentrations initially, with the proportion of l-enantiomer increasing over time 3
Monitoring and Adjustments
- Assess effectiveness using standardized rating scales
- Monitor for side effects at each visit, particularly:
- Cardiovascular effects (heart rate, blood pressure)
- Appetite suppression and weight changes
- Sleep disturbances
- Mood changes
- Follow-up visits:
- Every 3-4 weeks during initial treatment
- Every 3-6 months once stabilized 1
Important Considerations
- Adderall is a DEA Schedule II controlled substance with high potential for abuse 4
- Avoid late afternoon dosing to prevent insomnia
- Drug holidays (weekends, school breaks) may be considered to assess continued need and minimize tolerance
- Regular reassessment of the need for continued medication is necessary 1
While these guidelines provide a framework for Adderall dosing, clinical response should guide individual treatment decisions, with the goal of achieving optimal symptom control while minimizing adverse effects.