What is the recommended starting dose of Adderall (amphetamine and dextroamphetamine) for adults and children with Attention Deficit Hyperactivity Disorder (ADHD)?

Adderall Starting Dosage for ADHD

The recommended starting dose of Adderall for adults with ADHD is 5 mg once or twice daily, while children should start with 2.5 mg once or twice daily, with gradual titration upward based on symptom response and side effects. 1

Age-Specific Dosing Guidelines

Children with ADHD

• Initial dose: 2.5 mg once or twice daily during Week 1 1
• Titration schedule:
  • Week 2: Increase to 5 mg once or twice daily
  • Week 3: Increase to 7.5 mg once or twice daily (skip this step for children weighing less than 45 lb/20 kg)
  • Week 4: Increase to 10 mg once or twice daily
• Maximum daily dose: Up to 40 mg daily 1

Adults with ADHD

• Initial dose: 5 mg once or twice daily during Week 1 1
• Titration schedule:
  • Week 2: Increase to 10 mg once or twice daily
  • Subsequent weeks: Titrate upward in 5-10 mg increments weekly until optimal symptom control
• Maximum daily dose: Up to 50 mg daily (some may require up to 0.9 mg/kg) 1

Clinical Considerations for Dosing

Efficacy at Lower Doses

Research shows that many adults respond to relatively low doses of Adderall. In one study, the mean effective dose for adult responders was only 10.77 mg/day (0.14 mg/kg/day) 2. This suggests that clinicians should carefully evaluate response at lower doses before escalating.

Monitoring During Titration

• Regular monitoring every 3-4 weeks during dose titration is essential 1
• Parameters to monitor include:
  • Vital signs (especially heart rate and blood pressure)
  • Weight
  • Sleep quality
  • Appetite
  • Mood changes
  • Symptom control

Common Side Effects to Monitor

The most frequently reported adverse events include:

• Decreased appetite (significantly more common with Adderall than placebo) 3
• Insomnia/trouble sleeping 3
• Abdominal pain 3
• Headaches (more common at higher doses) 4
• Anxiety (particularly in patients with pre-existing anxiety disorders) 2

Special Considerations

Comorbid Conditions

• Anxiety disorders: Exercise caution as Adderall may precipitate anxiety in vulnerable individuals 2. Consider starting at the lowest possible dose.
• Bipolar disorder: Stabilize mood symptoms with mood stabilizers before considering low-dose stimulants 1

Formulation Selection

When choosing between immediate-release and extended-release formulations:

• Consider the patient's daily schedule requirements
• Extended-release formulations may provide more consistent coverage throughout the day
• Immediate-release formulations allow for more flexible dosing

Pitfalls to Avoid

1. Starting with too high a dose: This increases the risk of side effects without necessarily improving efficacy
2. Escalating doses too quickly: Allow sufficient time (typically 1 week) between dose increases to properly assess response and side effects
3. Ignoring comorbid conditions: Pre-existing anxiety may be exacerbated by Adderall 2
4. Inadequate monitoring: Regular follow-up is essential during the titration phase
5. Neglecting non-pharmacological interventions: Medication should be part of a comprehensive treatment plan that includes behavioral interventions 1

Remember that while these guidelines provide a framework for Adderall dosing, clinical response and tolerability should guide individual treatment decisions.