Adderall Dosing Guidelines
The recommended starting dose of Adderall is 5-10 mg daily, with a maximum daily dose of up to 50 mg daily, as recommended by the American Academy of Child and Adolescent Psychiatry. 1
Dosage Forms and Administration
Adderall (amphetamine and dextroamphetamine) is available in both immediate-release and extended-release formulations:
- Immediate-release tablets: Typically dosed twice daily
- Extended-release capsules (Adderall XR): Once-daily dosing
Dosing Guidelines by Age Group
Children and Adolescents
- Starting dose: 5-10 mg daily
- Titration: Increase gradually based on response and tolerability
- Maximum daily dose: Up to 50 mg daily
- Administration: Usually divided into 1-2 doses per day
Adults
- Starting dose: 5-10 mg daily
- Titration: Can be increased to effective dose
- Maximum daily dose: Up to 50 mg daily
- Average effective dose: 54 mg daily (administered in 2 daily doses) has been shown to be effective in clinical studies 2
Pharmacokinetics
- Immediate-release tablets: Peak plasma concentrations achieved at approximately 3 hours
- Extended-release capsules: Peak plasma concentrations achieved at approximately 8 hours
- Half-life: Approximately 12 hours for both formulations 3
- Bioavailability: Similar between immediate-release and sustained-release formulations 3
- Food effect: Rate and extent of absorption are similar in fed and fasted states 3
Breakthrough Dosing
For patients requiring additional coverage during the day, a breakthrough dose may be considered. This is typically equivalent to 10% of the total daily dose 4.
Clinical Considerations
- Individualized dosing: Titrate to the lowest effective dose that provides symptom control
- Monitoring: Regular follow-up visits (every 3-4 weeks during initial treatment, then every 3-6 months) are necessary to assess efficacy and side effects 1
- Duration of effect: Adderall has been shown to have a longer duration of effect compared to some other stimulants, which may minimize the loss of efficacy throughout the day 5
- Combination therapy: Limited support for combining medications from the same class; optimize single-agent therapy first 1
Safety Considerations
- Overdose risk: Toxic symptoms can occur at doses as low as 2 mg but are rare with doses less than 15 mg; severe reactions may occur at 30 mg, though doses of 400-500 mg are not necessarily fatal 3
- Side effects: Monitor for cardiovascular effects, appetite suppression, sleep disturbances, and anxiety 1
- Pre-existing anxiety: May increase the likelihood of experiencing anxiety with immediate-release Adderall 1
Alternative Treatments
If Adderall is not effective or poorly tolerated, consider:
- Switching to another stimulant medication
- Non-stimulant medications such as atomoxetine, extended-release guanfacine, or extended-release clonidine 1
Remember that medication should be combined with behavioral interventions for optimal ADHD treatment outcomes, as medication alone is not considered optimal treatment 1.