What is the maximum dose of Adderall (amphetamine and dextroamphetamine) in children?

Maximum Dose of Adderall in Children

The maximum recommended total daily dose of Adderall (amphetamine and dextroamphetamine) in children is 40 mg per day. 1

Dosing Guidelines

Initial Dosing and Titration

• Start with low doses: 5 mg of immediate-release Adderall or 10 mg of Adderall XR once daily 2, 1
• Increase dose gradually by 5-10 mg increments at weekly intervals based on clinical response and side effects 1
• For immediate-release formulations, typically given twice daily (morning and midday) 2
• For extended-release formulations (Adderall XR), once-daily dosing is usually sufficient 2, 3

Age-Specific Considerations

• For children weighing less than 20 kg (45 lb), use extra caution during titration and consider omitting the 15-20 mg dosage steps 2
• For children 6-12 years old, the typical effective dose range is 5-30 mg/day 4
• For adolescents (>13 years), doses may be similar to those for school-age children, but some may require up to 40 mg daily 2

Maximum Dose Limits

• The American Academy of Child and Adolescent Psychiatry recommends a maximum total daily dose of 40 mg for amphetamines 1
• Clinical practice consensus consistently limits the upper range to 40 mg total daily dose 1
• For children weighing less than 25 kg, maximum doses should be approached with extra caution 2
• Exceeding the recommended maximum dose does not necessarily provide additional therapeutic benefit 1

Monitoring Requirements

• Blood pressure and pulse should be checked regularly, especially at higher doses 1
• Weight should be monitored at each visit to assess for appetite suppression 1
• Systematic assessment of side effects including insomnia, anorexia, headaches, and mood changes 1, 5
• At higher doses, carefully document that symptoms could not be controlled at lower doses and that higher doses are not producing significant side effects 2

Side Effects and Risks of Higher Doses

• Higher doses increase risk of cardiovascular effects (hypertension, tachycardia) 1
• Common side effects include anorexia, insomnia, and headache 4, 5
• The incidence of drug-related adverse events increases with increasing dose, suggesting a dose-response relationship 4
• Higher doses increase potential for tolerance and dependence 1

Alternative Approaches When Maximum Dose Is Reached

• If symptoms are not adequately controlled at maximum dose, consider switching to an alternative stimulant medication 2, 1
• Nearly 90% of children will respond if both methylphenidate and amphetamine stimulants are tried 2
• Consider non-stimulant medication options if maximum doses of stimulants are ineffective 1

Clinical Pearls

• The lower dose of Adderall (7.5 mg) has been shown to produce effects comparable to higher doses of methylphenidate (17.5 mg) in some studies 6
• Single-dose treatments of Adderall may be as effective as twice-daily doses of methylphenidate, potentially eliminating the need for school administration of medication 7
• Extended-release formulations (Adderall XR) show longer time to maximum concentration compared to immediate-release formulations, making them suitable for once-daily dosing 3
• Weight-adjusted dosing (mg/kg) is problematic in office practice and not uniformly supported by research; fixed-dose titration is more common in clinical practice 2