Recommended Dosage of Amphetamine and Dextroamphetamine for ADHD
The recommended dosage of amphetamine and dextroamphetamine for ADHD is 5 mg once or twice daily as a starting dose for adults, and 2.5 mg daily for children ages 3-5 or 5 mg once or twice daily for children 6 years and older, with gradual weekly titration based on symptom response and side effects. 1, 2
Age-Specific Dosing Guidelines
Children (3-5 years)
- Starting dose: 2.5 mg daily
- Titration: Increase by 2.5 mg at weekly intervals
- Maximum dose: Rarely necessary to exceed 40 mg per day 1, 2
Children (6+ years) and Adolescents
- Starting dose: 5 mg once or twice daily
- Titration: Increase by 5 mg at weekly intervals
- Week 1: 5 mg once or twice daily
- Week 2: 10 mg once or twice daily
- Week 3: 7.5 mg once or twice daily (omit for children <45 lb/20 kg)
- Week 4: 10 mg once or twice daily
- Maximum dose: Up to 40 mg daily 1, 2
Adults
- Starting dose: 5 mg once or twice daily
- Titration: Increase by 5-10 mg at weekly intervals
- Week 1: 5 mg once or twice daily
- Week 2: 10 mg once or twice daily
- Continue titrating upward in 5-10 mg increments weekly until optimal symptom control
- Maximum dose: Up to 50 mg daily (some may require up to 0.9 mg/kg) 1
Administration Recommendations
- First dose should be given upon awakening
- Additional doses (1 or 2) at intervals of 4 to 6 hours
- Avoid late evening doses due to potential insomnia 2
- Administer at the lowest effective dosage with individualized adjustment 2
Monitoring and Follow-up
- Monitor every 3-4 weeks during dose titration
- Once stabilized, monitor every 3-6 months
- Parameters to monitor at each visit:
- Vital signs
- Weight
- Sleep quality
- Appetite
- Mood changes
- Growth parameters (in children)
- Symptom control 1
Common Adverse Events to Monitor
The most commonly reported adverse events include:
- Decreased appetite (significantly more common with amphetamines, RR 6.31) 3
- Insomnia/trouble sleeping (significantly more common with amphetamines, RR 3.80) 3
- Abdominal pain (RR 1.44) 3
- Nausea/vomiting
- Headaches
- Anxiety 3
Special Considerations
- Where possible, drug administration should be interrupted occasionally to determine if behavioral symptoms still require continued therapy 2
- For patients with comorbid anxiety, consider that untreated ADHD with comorbid anxiety leads to poorer long-term outcomes 1
- Stimulant selection should be based on individual factors including age, comorbidities, prior medication response, daily schedule requirements, and side effect profile 1
Lifestyle Recommendations During Treatment
- Maintain a healthy diet emphasizing fruits, vegetables, whole grains, and low-fat dairy products
- Limit sodium intake to 6 g/day to minimize cardiovascular side effects
- Limit caffeine intake to less than 300 mg per day
- Avoid tyramine-containing foods
- Limit alcohol consumption
- Maintain a regular sleep schedule
- Engage in structured physical activity (≥150 minutes/week) 1
Amphetamines have been shown to be effective at reducing core ADHD symptoms, but they are associated with a number of adverse events that require careful monitoring 3. The evidence suggests no significant differences between long-acting and short-acting amphetamine preparations in terms of efficacy 3.
AI: I notice I'm being asked to make a firm recommendation on ADHD medication dosing. This is a topic where individualization is critical for safety and efficacy. While I'll provide evidence-based guidelines, please understand that actual prescribing should be done by a qualified healthcare provider who can assess the specific patient's needs, medical history, and response to medication.