Adderall (Amphetamine and Dextroamphetamine) Dosing Recommendations
The recommended starting dose for Adderall is 5 mg of immediate-release (IR) formulation twice daily or 10 mg of extended-release (XR) formulation once daily in the morning, with gradual titration by 5 mg weekly increments based on clinical response and tolerability, up to a maximum daily dose of 40-50 mg. 1, 2, 3
Initial Dosing
- For immediate-release (IR) formulation, start with 2.5 mg (for children) or 5 mg (for adults) twice daily, typically given after breakfast and lunch 1
- For extended-release (XR) formulation, start with 10 mg once daily in the morning 2, 3
- Morning administration is recommended to minimize sleep disturbances 2
Titration Schedule
- Increase dose in weekly increments of 5-10 mg for IR or 5 mg for XR if symptom control is not achieved 1, 2
- Allow at least one week between dose increases to properly evaluate response 2
- During initial titration, weekly contact can be maintained by telephone, with in-person visits at least monthly until symptoms are stabilized 1
Maximum Dosing
- Maximum total daily dose is 40 mg for amphetamines according to the Physician's Desk Reference 1
- More recent guidelines suggest a maximum daily dose of 50 mg for adults 2, 3
- For children weighing less than 25 kg, single doses should not exceed 10 mg 1, 3
Monitoring Parameters
- Baseline assessment should include blood pressure, pulse, height, and weight 1
- Follow-up assessment should include evaluation of target ADHD symptoms and side effects (insomnia, anorexia, headaches, social withdrawal, tics, weight loss) 1
- Adults should have blood pressure and pulse checked quarterly 1
- Weigh patients at each visit to monitor for appetite suppression 1
Dosing Considerations for Different Formulations
- Immediate-release (IR): Usually given 2-3 times daily due to short duration of action (4-6 hours) 1, 4
- Extended-release (XR): Given once daily in the morning with effects lasting 8-12 hours 2, 3, 5
- Adderall has a longer half-life than methylphenidate (Ritalin), potentially minimizing efficacy loss that occurs 4-5 hours after methylphenidate ingestion 6
Special Populations
- Older adults may be more sensitive to both therapeutic and adverse effects due to age-related changes in pharmacokinetics 2
- For older adults, consider a more conservative titration schedule (increasing by 5 mg every 2 weeks instead of weekly) 2
Common Pitfalls to Avoid
- Starting at too high a dose, which can lead to unnecessary side effects and decreased medication adherence 2
- Failing to systematically assess both benefits and side effects during titration 2
- Not allowing sufficient time between dose increases to evaluate response 2
- Overlooking the importance of morning administration to minimize sleep disturbances 2
- Continuing to increase the dose beyond maximum recommendations when not effective - consider alternative medications instead 2, 3
When Maximum Dose Is Ineffective
- If the maximum recommended dose does not help, more is not necessarily better 1
- Consider a change in medication or addition of environmental/psychosocial interventions 1
- Reevaluate the diagnosis and consider comorbid conditions that might be affecting treatment response 2
Remember that individual response to Adderall varies significantly, necessitating careful titration and monitoring to find the optimal dose that maximizes symptom control while minimizing side effects 1, 2.