Recommended Starting Dose for Adderall Extended Release
The recommended starting dose for Adderall extended release (XR) in adults is 10 mg once daily in the morning, with dose titration occurring in 5 mg weekly increments based on response and tolerability, up to a maximum of 50 mg daily. 1, 2
Initial Dosing Considerations
- Adderall XR should be administered at the lowest effective dosage, with the initial dose of 10 mg taken once daily in the morning to minimize sleep disturbances 3, 1
- Morning administration is critical as late evening doses can cause insomnia 2
- The extended-release formulation is designed to produce therapeutic effects throughout the day with a single morning dose, eliminating the need for multiple daily dosing 4, 5
- Pharmacokinetic studies show that Adderall XR has an extended time to maximum concentration (Tmax) compared to immediate-release formulations, making it suitable for once-daily dosing 6
Titration Protocol
- Dose increases should occur in 5 mg increments at weekly intervals until optimal response is achieved 3, 1
- Allow at least one week between dose increases to properly evaluate response and side effects 1
- During initial titration, weekly contact can be maintained by telephone, with in-person visits at least monthly until symptoms are stabilized 1
- Clinical response should be assessed using standardized ADHD rating scales to guide dose adjustments 3
Maximum Dosing
- The maximum recommended daily dose for adults is 50 mg 7, 1
- If the maximum dose is reached without adequate symptom control, consider alternative treatments rather than exceeding the recommended maximum dose 1
Monitoring During Treatment
- Baseline assessment should include blood pressure and pulse 3, 1
- Follow-up assessment should include evaluation of target ADHD symptoms and side effects (insomnia, anorexia, headaches) 1
- Monitor vital signs with each dose increase and then quarterly once stabilized 3, 1
- Weight should be monitored at each visit to assess for appetite suppression 1
Common Pitfalls to Avoid
- Starting at too high a dose, which can lead to unnecessary side effects and decreased medication adherence 3, 1
- Not allowing sufficient time between dose increases to evaluate response (at least one week) 3, 1
- Overlooking the importance of morning administration to minimize sleep disturbances 3, 2
- Continuing to increase the dose beyond maximum recommendations when not effective - consider alternative medications instead 1
- Failing to systematically assess both benefits and side effects during titration 3
Special Populations
- Older adults may be more sensitive to both therapeutic and adverse effects due to age-related changes in pharmacokinetics 3
- For older adults, consider a more conservative titration schedule (increasing by 5 mg every 2 weeks instead of weekly) 3
- Efficacy and safety of Adderall XR have been demonstrated in controlled clinical trials, with dose-dependent improvements in attention and behavior 4, 5, 8