What is the best starting dose of Adderall (amphetamine and dextroamphetamine)?

From the Guidelines

The best starting dose of Adderall for adults is typically 5 mg to 10 mg once or twice daily, while children usually start at 5 mg once daily. This recommendation is based on the practice parameter for the use of stimulant medications in the treatment of children, adolescents, and adults, as outlined in the Journal of the American Academy of Child and Adolescent Psychiatry 1. The starting dose is intentionally low to minimize side effects like increased heart rate, blood pressure, anxiety, and insomnia while allowing your body to adjust to the medication.

Key Considerations

• The medication should be taken in the morning and early afternoon to avoid sleep disturbances, with doses spaced at least 4-6 hours apart.
• The medication should be taken with or without food consistently.
• Your doctor will likely schedule follow-up appointments to assess effectiveness and side effects, gradually adjusting the dose as needed.
• Never adjust your Adderall dose without consulting your healthcare provider, as this medication requires careful monitoring and individualized dosing.

Titration Schedule

• Using a consistent titration schedule, if symptom control is not achieved, the dose generally should be increased in weekly increments of 5 to 10 mg per dose for MPH or 2.5 to 5 mg for DEX/AMP 1.
• Alternatively, the physician may elect to use a fixed-dose titration trial, similar to that found in the MTA study, in which a full set of different doses is switched on a weekly basis 1.

Monitoring and Assessment

• Follow-up assessment should include evaluation of target symptoms of ADHD, asked regularly of the parent and of a teacher 1.
• These clinical assessments may be supplemented by the use of parent and teacher rating scales.
• It is essential to obtain self-ratings from adolescents and from adults.
• Side effects should be systematically assessed by asking specific questions of patients and of parents about known side effects, such as insomnia, anorexia, headaches, social withdrawal, tics, and weight loss 1.

From the Research

Starting Dose of Adderall

The starting dose of Adderall (amphetamine and dextroamphetamine) can vary depending on the individual and the specific condition being treated.

• According to a study published in 2000 2, the starting dose for adults with attention-deficit/hyperactivity disorder (ADHD) was 5 mg p.o. b.i.d. (twice a day), with titration according to clinical response.
• A 2018 review of amphetamines for ADHD in adults found that the dose range for mixed amphetamine salts (MAS) was 12.5 mg/d to 80 mg/d 3.
• For children, a 1999 study compared morning-only and morning/late afternoon Adderall to morning-only, twice-daily, and three times-daily methylphenidate, and found that a single morning dose of Adderall produced equivalent behavioral effects to those of methylphenidate received twice-daily 4.
• A 2005 study on the long-term tolerability and effectiveness of once-daily mixed amphetamine salts (Adderall XR) in children with ADHD started treatment with 10 mg once daily, with 10-mg weekly dose increases to optimal effectiveness (maximum dose, 30 mg/d) 5.
• Another study published in 2001 discussed the efficacy of SLI381 (Adderall-XR), a longer-acting form of Adderall, and its therapeutic effects on the core symptoms of ADHD 6.

Key Findings

• The starting dose of Adderall can vary depending on the individual and the specific condition being treated.
• The dose range for mixed amphetamine salts (MAS) in adults with ADHD is 12.5 mg/d to 80 mg/d.
• A single morning dose of Adderall can produce equivalent behavioral effects to those of methylphenidate received twice-daily in children.
• Once-daily mixed amphetamine salts (Adderall XR) can be effective and well-tolerated in children with ADHD for up to 24 months.