Adderall XR Dosing Recommendations for ADHD
For adults and children with ADHD, Adderall XR should be started at 10 mg once daily in the morning for adults and children 6 years and older, with gradual titration by 5 mg weekly increments based on response and tolerability, up to a maximum daily dose of 40-50 mg for adults. 1, 2
Initial Dosing
Children
- For children 3-5 years: Start with 2.5 mg daily 3
- For children 6 years and older: Start with 5 mg once or twice daily for immediate-release (IR) or 10 mg once daily in the morning for extended-release (XR) 1, 3
- Morning administration is recommended to minimize sleep disturbances 1, 2
Adults
- Start with 10 mg of Adderall XR once daily in the morning 1, 2
- For immediate-release formulation, start with 5 mg twice daily, typically given after breakfast and lunch 1
- Adderall XR provides a 12-hour duration of action, allowing for once-daily dosing 4
Titration Schedule
- Increase dose in 5 mg weekly increments based on clinical response and tolerability 1, 2
- Allow at least one week between dose increases to properly evaluate response 1, 2
- During initial titration, weekly contact can be maintained by telephone, with in-person visits at least monthly until symptoms are stabilized 1
- For older adults, consider a more conservative titration schedule (increasing by 5 mg every 2 weeks instead of weekly) 1, 5
Maximum Dosing
- For children: The maximum total daily dose is 40 mg, with only rare cases requiring higher doses 1, 3
- For children weighing less than 25 kg, single doses should not exceed 10 mg 1
- For adults: The maximum recommended daily dose is 40-50 mg according to recent guidelines 1, 2
- Some guidelines suggest a maximum of 60 mg for adults, with some patients treated with up to 40 mg for dextroamphetamine/amphetamine 5
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
- When prescribing higher doses (above 40 mg), clinicians should clearly document that symptoms could not be controlled at lower doses 5
Special Populations
- Older adults may be more sensitive to both therapeutic and adverse effects due to age-related changes in pharmacokinetics 1, 2, 5
- For older adults, use a more conservative titration schedule (increasing by 5 mg every 2 weeks instead of weekly) 1, 2
Common Pitfalls to Avoid
- Starting at too high a dose, which can lead to unnecessary side effects and decreased medication adherence 1, 2
- Failing to systematically assess both benefits and side effects during titration 1, 2
- Not allowing sufficient time between dose increases to evaluate response 1, 2
- Overlooking the importance of morning administration to minimize sleep disturbances 1, 2
- Continuing to increase the dose beyond maximum recommendations when not effective - consider alternative medications instead 1
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 1, 2
- Consider switching to a different stimulant formulation or adding a non-stimulant medication 2
Efficacy and Tolerability
- Long-term studies show that once-daily Adderall XR (10-30 mg) maintains significant behavioral improvements during 24 months of treatment in children with ADHD 6
- The most frequently reported drug-related adverse events include anorexia, insomnia, and headache, with the incidence increasing with higher doses 6
- Once-daily medications are currently underutilized in adults with ADHD compared to the pediatric population despite strong evidence supporting their efficacy 7