What is the recommended dosing for Adderall (amphetamine/dextroamphetamine) in a 16-year-old patient who is 5'1" and weighs 105 pounds?

Adderall Dosing for a 16-Year-Old Patient (105 lbs, 5'1")

For a 16-year-old patient weighing 105 pounds (47.6 kg) and 5'1" tall, the recommended starting dose of Adderall is 5 mg once or twice daily, with a maximum total daily dose not exceeding 40 mg. 1, 2

Initial Dosing Protocol

• Start with 5 mg of Adderall (amphetamine/dextroamphetamine) once or twice daily, given in the morning after breakfast and at noon after lunch 2
• For extended-release formulations (Adderall XR), start with 10 mg once daily in the morning 3
• Avoid late evening doses to prevent insomnia 1
• The minimum starting dose should be used to initiate therapy in adolescents 2

Titration Schedule

• If symptom control is not achieved, increase the dose in weekly increments of 2.5-5 mg for immediate-release formulations 2
• For extended-release formulations, increase by 5-10 mg increments at weekly intervals 3
• During initial titration, maintain weekly contact by phone or office visits to assess response and side effects 2
• Titration typically requires 2-4 weeks to determine optimal dosing 2

Maximum Dosing Considerations

• The FDA-approved maximum total daily dose for amphetamines is 40 mg 2, 1
• For this patient's weight (105 lbs/47.6 kg), exceeding this maximum is not recommended 2, 3
• If the top recommended dose does not provide adequate symptom control, more medication is not necessarily better - consider alternative approaches instead 2

Monitoring Requirements

• Check blood pressure and pulse at each visit during titration and quarterly thereafter 2
• Monitor weight at each visit to assess for appetite suppression 2
• Systematically assess for side effects by asking specific questions about:
  • Insomnia and sleep disturbances 2, 4
  • Anorexia/decreased appetite 4
  • Headaches 4
  • Social withdrawal 2
  • Mood changes 3

Common Pitfalls and Caveats

• Exceeding the maximum recommended dose increases risk of adverse cardiovascular effects (hypertension, tachycardia) without providing additional therapeutic benefit 3, 5
• Higher doses increase the potential for tolerance and dependence 3
• Amphetamines have a greater impact on appetite and sleep than methylphenidate alternatives 2, 4
• For adolescents, self-ratings of effectiveness and side effects are important to obtain 2
• If the patient shows no improvement at maximum doses, consider switching to an alternative stimulant medication or adding behavioral interventions 2, 3

Alternative Approaches if Maximum Dose is Ineffective

• Consider switching to methylphenidate if Adderall is ineffective at maximum doses 2
• Nearly 90% of patients will respond to either amphetamines or methylphenidate if both are tried sequentially 2
• Consider non-stimulant medication options if stimulants are ineffective or poorly tolerated 3
• Implement environmental or psychosocial interventions to augment medication effects 2, 3

Remember that individual response to stimulant medications varies considerably, so careful monitoring during the titration phase is essential to determine the optimal dose for this specific patient 2.