Adderall XR Dosing for ADHD
For adults with ADHD, Adderall XR should be started at 10 mg once daily in the morning, with titration by 5 mg weekly increments based on response and tolerability, up to a maximum recommended daily dose of 40-50 mg. 1, 2
Initial Dosing
- For adults, start with 10 mg of Adderall XR once daily in the morning 3, 1
- For children 6 years and older, start with 5-10 mg of Adderall XR once daily in the morning 1
- For children 3-5 years of age, start with 2.5 mg daily 1
- Morning administration is crucial to minimize sleep disturbances 1, 4
Titration Schedule
- Increase dose in weekly increments of 5 mg if symptom control is not achieved 5, 1
- Allow at least one week between dose increases to properly evaluate response 1, 4
- During initial titration, weekly contact can be maintained by telephone, with in-person visits at least monthly until symptoms are stabilized 5, 1
- Clinical response should be assessed using standardized ADHD rating scales to guide dose adjustments 3
Maximum Dosing
- The maximum total daily dose is 40 mg according to the Physician's Desk Reference 5, 1
- More recent guidelines suggest a maximum daily dose of 50 mg for adults 3, 1
- For children weighing less than 25 kg, single doses should not exceed 10 mg 5, 1
- If the maximum recommended dose does not help, more is not necessarily better - consider alternative medications or interventions 5, 1
Monitoring Parameters
- Baseline assessment should include blood pressure, pulse, height, and weight 5, 1
- Follow-up assessment should include evaluation of target ADHD symptoms and side effects (insomnia, anorexia, headaches, social withdrawal, tics, weight loss) 5, 1
- Weigh patients at each visit to monitor for appetite suppression 5, 1
- Side effects should be systematically assessed by asking specific questions about known side effects 5
Duration of Action
- Adderall XR provides approximately 12 hours of symptom control with a single morning dose 6, 7
- This extended duration eliminates the need for in-school administration and reduces dose diversion concerns 6
- Long-term studies have shown that Adderall XR maintains its effectiveness for up to 24 months with stable dosing 8, 9
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
- Long-term studies have demonstrated sustained efficacy and acceptable tolerability in both children and adults 8, 9
Common Pitfalls to Avoid
- Starting at too high a dose, which can lead to unnecessary side effects and decreased medication adherence 3, 1
- Failing to systematically assess both benefits and side effects during titration 1
- Not allowing sufficient time between dose increases to evaluate response 1, 4
- Overlooking the importance of morning administration to minimize sleep disturbances 1, 4
- Continuing to increase the dose beyond maximum recommendations when not effective 5, 1
When Maximum Dose Is Ineffective
- If the maximum dose does not provide adequate symptom control, consider alternative treatments rather than exceeding recommended maximums 5, 1
- Reevaluate the diagnosis and consider comorbid conditions that might be affecting treatment response 3, 1
- Consider switching to a different stimulant formulation or adding a non-stimulant medication 3