Is a temporary increase to 35mg of Adderall (amphetamine and dextroamphetamine) considered during premenstrual syndrome (PMS)?

Temporary Adderall Dose Increase During PMS

Temporarily increasing Adderall dosage to 35mg during premenstrual syndrome (PMS) is a reasonable approach for women experiencing worsening ADHD symptoms during this phase of their menstrual cycle. 1

Evidence for Premenstrual Dose Adjustment

• Preliminary research demonstrates benefits of increasing premenstrual psychostimulant dosage in women with ADHD who experience premenstrual worsening of ADHD and mood symptoms 1
• Women with ADHD may experience diminished response to amphetamines in the late luteal phase, suggesting a need for dosage adjustment 1
• In a community case study, women who received increased psychostimulant dosage during the premenstrual period experienced improved ADHD symptoms, mood, and minimal adverse events 1

Dosing Considerations

• The FDA-approved maximum daily dose for Adderall (amphetamine and dextroamphetamine) is 40mg per day, with some guidelines suggesting up to 50mg for adults 2, 3
• Standard dosing recommendations include titrating by 5mg weekly increments based on clinical response and tolerability 2
• Amphetamines should be administered at the lowest effective dosage with individual adjustment 3

Implementation Approach

• Increase the dose only during the premenstrual week when symptoms worsen 1
• Monitor for improvement in premenstrual inattention, irritability, and energy levels 1
• Return to regular dosage after the premenstrual period ends 1
• Document response to the temporary dose increase and any side effects 2

Safety Monitoring

• Monitor blood pressure and pulse, as amphetamines can cause increased blood pressure 4
• Watch for common side effects including decreased appetite, sleep disturbances, and headaches 5
• Ensure the total daily dose remains within safe limits (generally not exceeding 40-50mg) 2, 3

Alternative Approaches

• If increasing stimulant medication is not effective or causes side effects, consider:
  • Adding non-pharmacological treatments like Dialectical Behavior Therapy (DBT) which has modules addressing poor concentration, disorganization, and emotion regulation 4
  • Calcium supplementation, which has demonstrated effectiveness in reducing emotional, behavioral, and physical premenstrual symptoms 6
  • Selective serotonin reuptake inhibitors (SSRIs), which are established as first-line treatment for premenstrual dysphoric disorder 7

Important Considerations

• The temporary increase should be planned and discussed with your healthcare provider, not implemented independently 2
• This approach should be individually explored and monitored for effectiveness and side effects 1
• The consensus among experts is that intermittent use of stimulants on an as-needed basis is a possible solution to maximize functioning while reducing overall exposure 4

Cautions

• Avoid exceeding the maximum recommended daily dose of 40-50mg 2, 3
• Be aware that amphetamines have a high potential for abuse and misuse 5
• Monitor for rebound of symptoms when medication effect wears off 5