What is the typical dose titration for Adderall (amphetamine and dextroamphetamine)?

Adderall Dose Titration Protocol

The recommended starting dose for Adderall is 5 mg daily for adults and 2.5 mg daily for children, with gradual titration upward based on symptom response and side effects. 1, 2

Initial Dosing and Titration Schedule

For Children:

• Week 1: Start with 2.5 mg once or twice daily
• Week 2: Increase to 5 mg once or twice daily
• Week 3: Increase to 7.5 mg once or twice daily (omit this step for children weighing less than 45 lb/20 kg)
• Week 4: Increase to 10 mg once or twice daily

For Adults and Adolescents:

• Week 1: Start with 5 mg once or twice daily
• Week 2: Increase to 10 mg once or twice daily
• Week 3-4: Titrate upward in 5-10 mg increments weekly until optimal symptom control

Maximum Dosing Guidelines

• Children: Up to 40 mg daily for dextroamphetamine/mixed amphetamine salts 2
• Adults: Up to 50 mg daily, though some may require up to 0.9 mg/kg 2, 1

Administration Schedule

• For immediate-release formulations, typically dosed twice daily (morning and midday)
• Children may benefit from a third afternoon dose to help with homework and social activities 2
• Adults may require more frequent dosing to cover a longer day 2

Monitoring During Titration

• Assess response using standardized rating scales from parents/teachers for children or self/significant other reports for adults
• Monitor vital signs, weight, height (in children), and side effects at each dose adjustment
• Schedule follow-up visits every 3-4 weeks during titration 1
• Once stabilized, follow-up every 3-6 months 1

Clinical Considerations

• Low doses can be effective for some adults - studies show positive responses at average doses of 10.77 mg/day (0.14 mg/kg/day) 3
• Higher doses should be justified by documented failure to control symptoms at lower doses 2
• Different target symptoms may require different doses; prioritize which symptoms are most important for titration 2

Important Caveats

• Inadequate dose titration is a common pitfall that can lead to suboptimal outcomes 1
• Patients with comorbid anxiety may experience exacerbation of anxiety symptoms, particularly at higher doses 3
• Monitor for signs of tolerance at higher doses 2
• If no response after reaching maximum doses, consider switching to an alternative stimulant (approximately 90% of patients respond to either methylphenidate or amphetamine when both are tried) 2

Practical Titration Approach

1. Begin with lowest available dose
2. Increase weekly based on symptom control and side effects
3. Continue titration until optimal symptom control or side effects become problematic
4. If side effects occur before adequate symptom control, consider switching to an alternative medication

This structured titration approach allows for individualization while maintaining safety and efficacy in the treatment of ADHD with Adderall.