Adderall Dosing Guidelines
For ADHD treatment, Adderall should be started at 5 mg once or twice daily for adults and 2.5-5 mg once or twice daily for children, with gradual weekly titration based on symptom response and side effects, up to a maximum of 40 mg daily for children and 50 mg daily for adults. 1, 2
Initial Dosing Recommendations
Children with ADHD:
- Ages 3-5 years: Start with 2.5 mg daily 1, 2
- Ages 6-12 years: Start with 5 mg once or twice daily 1, 2
- Titration schedule:
- Week 1: Starting dose
- Week 2: Increase by 5 mg increments
- Week 3: Increase by 5 mg increments (omit for children <45 lb/20 kg)
- Week 4: Increase to 10 mg once or twice daily 1
- Maximum dose: Up to 40 mg daily 1, 2
Adults with ADHD:
- Starting dose: 5 mg once or twice daily 1, 2
- Titration schedule:
- Week 1: 5 mg once or twice daily
- Week 2: 10 mg once or twice daily
- Subsequent weeks: Increase by 5-10 mg increments weekly until optimal response 1
- Maximum dose: Up to 50 mg daily (some may require up to 0.9 mg/kg) 1
Administration Timing
- First dose: Give upon awakening 2
- Additional doses: At intervals of 4-6 hours 2
- Avoid late evening doses to prevent insomnia 2
- Dosing frequency:
Special Considerations
Narcolepsy Dosing:
- Children ≥12 years and adults: Start with 10 mg daily; increase in 10 mg increments weekly 2
- Children 6-12 years: Start with 5 mg daily; increase in 5 mg increments weekly 2
- Usual dose range: 5-60 mg per day in divided doses 2
Monitoring Parameters:
- During titration: Monitor every 3-4 weeks 1
- Once stabilized: Monitor every 3-6 months 1
- Key parameters to monitor:
- Vital signs (especially blood pressure)
- Weight
- Sleep quality
- Appetite
- Mood changes
- Growth parameters in children 1
Clinical Pearls
- Adderall has been shown to produce longer-lasting effects than methylphenidate, often allowing for once-daily dosing in some patients 3
- The functional potency of Adderall appears to be higher than equivalent mg doses of methylphenidate 4
- For optimal effectiveness, consider administering with food to minimize gastrointestinal side effects, but avoid acidic foods/beverages which may reduce absorption
- Periodically interrupt medication to assess continued need, especially during school breaks for children 2
- Consider drug holidays to evaluate continued need and minimize tolerance development
Remember that while these are general dosing guidelines, the principle of "start low, go slow" applies to minimize side effects while finding the optimal therapeutic dose for each individual.