What are the adult dosing guidelines for Adderall (amphetamine and dextroamphetamine) for Attention Deficit Hyperactivity Disorder (ADHD)?

Adult Dosing Guidelines for Adderall (Amphetamine and Dextroamphetamine) for ADHD

For adults with ADHD, Adderall should be started at 10 mg once daily in the morning, with titration in 5 mg weekly increments based on response and tolerability, up to a maximum recommended daily dose of 60 mg. 1, 2, 3

Initial Dosing and Titration

• Start with 10 mg once daily in the morning to minimize sleep disturbances 1
• Increase by 5 mg weekly increments based on symptom control and side effects 1, 2
• Administer in the morning to avoid insomnia; additional doses may be added at 4-6 hour intervals if needed 3
• For immediate-release formulations, doses are typically divided throughout the day (morning and early afternoon) 4
• For extended-release formulations (Adderall XR), once-daily morning dosing is usually sufficient 5

Maximum Dosing

• The maximum FDA-approved daily dose is 60 mg 3
• In clinical practice, maximum doses typically range from 40-60 mg per day 2
• Higher total daily doses in adults (compared to children) may be necessary to cover a longer day of activities 2
• When prescribing doses above 40 mg, clinicians must document that symptoms could not be controlled at lower doses 2

Monitoring During Titration

• Assess vital signs (blood pressure and pulse) at baseline and with each dose increase 1
• Use standardized ADHD rating scales to objectively evaluate symptom improvement 1
• Schedule follow-up appointments at least monthly until symptoms are stabilized 4
• Monitor for common side effects: insomnia, anorexia, headaches, social withdrawal, agitation, and weight loss 4
• Weigh the patient at each visit to objectively assess appetite effects 4

Special Considerations

• Older adults may be more sensitive to both therapeutic and adverse effects due to age-related changes in pharmacokinetics 1, 2
• For older adults, consider a more conservative titration schedule (increasing by 5 mg every 2 weeks instead of weekly) 1, 2
• Late evening doses should be avoided because of resulting insomnia 3
• Amphetamines should be administered at the lowest effective dosage with individual adjustment 3

Common Pitfalls to Avoid

• Starting at too high a dose, which can lead to unnecessary side effects and decreased medication adherence 1
• Failing to systematically assess both benefits and side effects during dose titration 1
• Not allowing sufficient time between dose increases (at least one week) to properly evaluate response 1
• Not documenting the clinical necessity for doses exceeding standard recommendations 2
• Overlooking the importance of morning administration to minimize sleep disturbances 1

Efficacy Considerations

• At an average dose of 54 mg daily (administered in 2 doses), Adderall has been shown to significantly reduce ADHD symptoms in adults by approximately 42% 6
• Clinical trials have demonstrated that approximately 70% of adults with ADHD show significant improvement (reduction in ADHD rating scale of ≥30%) with Adderall treatment 6
• Adderall XR provides 12-hour duration of action, which may improve adherence through once-daily dosing 5