Adderall XR Dosing for ADHD
For patients with ADHD, Adderall XR should be initiated at 5-10 mg once daily in the morning, with dose adjustments in 5-10 mg increments at weekly intervals until optimal response is achieved, not exceeding 40 mg daily for children and 50 mg daily for adults. 1, 2
Age-Specific Dosing Recommendations
Children (3-5 years)
- Starting dose: 2.5 mg once daily in the morning
- Titration: Increase by 2.5 mg at weekly intervals
- Maximum dose: Rarely necessary to exceed 40 mg per day 2
Children (6-12 years) and Adolescents
- Starting dose: 5-10 mg once daily in the morning
- Titration: Increase by 5-10 mg at weekly intervals
- Maximum dose: 40 mg per day 2, 3
Adults
- Starting dose: 10 mg once daily in the morning
- Titration: Increase by 10 mg at weekly intervals
- Maximum dose: Up to 50 mg daily 1, 4
Administration Guidelines
- Administer in the morning as a single daily dose 5, 6
- Avoid late evening doses to prevent insomnia 2
- Adderall XR provides 12-hour duration of action, eliminating the need for in-school administration 6
- Drug administration should be interrupted occasionally to determine if continued therapy is necessary 2
Monitoring and Follow-up
- Schedule follow-up visits every 3-4 weeks during initial treatment, then every 3-6 months 1
- Assess both ADHD symptoms and potential side effects using standardized rating scales 1
- Monitor for common adverse effects:
- Anorexia/decreased appetite (35.6%)
- Headache (16.3%)
- Insomnia (12.0%)
- Abdominal pain (10.7%)
- Weight loss (9.4%) 3
Special Considerations
- Anxiety disorders: Pre-existing anxiety disorders increase the likelihood of experiencing anxiety with Adderall; consider lower doses in these patients 1
- Pregnancy: Individualized treatment plans should be developed for the perinatal period, considering lowest effective dose or intermittent use 1
- Breastfeeding: Amphetamine derivatives require discussion of safety and consideration of timing feeding to achieve lowest concentration in milk 1
Clinical Pearls
- Efficacy has been demonstrated across all age groups with significant improvements in ADHD symptoms compared to placebo 6, 3, 4
- Lower doses (average 10.77 mg/day) may be effective in some adults, potentially reducing side effects 7
- Adderall XR has shown superior efficacy to non-stimulant atomoxetine in comparative trials 5
- Consider behavioral interventions and structured physical activity as adjunctive treatments alongside medication 1
Common Pitfalls to Avoid
- Initiating with too high a dose, which may increase side effects
- Failing to periodically assess the continued need for medication
- Not accounting for comorbid anxiety disorders, which may be exacerbated by stimulants
- Administering late in the day, which can significantly worsen insomnia