What is the typical dosing for Adderall (amphetamine and dextroamphetamine) IR in adults and children with Attention Deficit Hyperactivity Disorder (ADHD)?

Adderall IR Dosing for ADHD in Adults and Children

For adults with ADHD, Adderall IR should be started at 5 mg twice daily, with gradual titration by 5-10 mg weekly increments based on clinical response and tolerability, up to a maximum daily dose of 40 mg. 1, 2

Initial Dosing

Children:

• For children 3-5 years: Start with 2.5 mg daily, increasing in 2.5 mg increments at weekly intervals 2
• For children 6 years and older: Start with 5 mg once or twice daily, increasing in 5 mg increments at weekly intervals 2, 3
• Children treated with amphetamine may require only once-a-day dosing, while methylphenidate typically requires twice daily dosing 3

Adults:

• Start with 5 mg twice daily (typically after breakfast and lunch) 1, 2
• Titrate upward in 5-10 mg increments each week until symptoms are controlled 3, 1
• Allow at least one week between dose increases to properly evaluate response 1

Titration Schedule

• Week 1: 5 mg twice daily (total 10 mg/day) for adults; 2.5 mg daily for young children; 5 mg once or twice daily for older children 3, 1
• Week 2: If needed, increase to 10 mg twice daily (total 20 mg/day) for adults; increase by 2.5-5 mg for children 3
• Week 3-4: Continue increasing by 5-10 mg weekly increments if needed and tolerated 3, 1
• During titration, assess both symptom improvement and side effects systematically 3, 1

Maximum Dosing

• Maximum daily dose for adults and older adolescents: 40 mg 4, 1, 2
• For children, only in rare cases will it be necessary to exceed 40 mg per day 2
• For children weighing less than 45 lb (20 kg), the 15 mg and 20 mg doses should be omitted during titration 3
• Higher doses do not necessarily provide additional therapeutic benefit but increase risk of adverse effects 4, 1

Administration Timing

• Give first dose on awakening; additional doses at intervals of 4-6 hours 2
• Avoid late evening doses because of resulting insomnia 2
• For adults, typically dosed twice daily (morning and early afternoon) to cover the workday 3, 1
• For children, typically dosed after breakfast and lunch, with a possible third dose after school to help with homework and social activities 3

Monitoring Requirements

• Baseline assessment: blood pressure, pulse, height, and weight 3, 1
• Follow-up assessment: evaluation of target ADHD symptoms and side effects (insomnia, anorexia, headaches, social withdrawal) 3, 1
• Systematically collect symptom and side-effect ratings before each dose increase 3
• Monitor for signs of tolerance at higher doses 3

Common Pitfalls and Considerations

• Starting at too high a dose can lead to unnecessary side effects and decreased medication adherence 1
• Not allowing sufficient time between dose increases to evaluate response 1
• Continuing to increase the dose beyond maximum recommendations when not effective - consider alternative medications instead 4, 1
• Higher doses increase risk of cardiovascular effects (hypertension, tachycardia) and potential for tolerance and dependence 4
• Amphetamines have shown efficacy in reducing ADHD symptoms in adults, but with increased risk of gastrointestinal and metabolic-related adverse events 5, 6

Alternative Approaches

• If one stimulant is ineffective or causes side effects, switching to an alternative stimulant may be beneficial (approximately 90% respond if both methylphenidate and amphetamine are tried) 3
• Consider extended-release formulations for patients who have difficulty with multiple daily dosing 3, 7
• Drug administration should be interrupted occasionally to determine if there is a recurrence of behavioral symptoms sufficient to require continued therapy 2