Is it safe to take 90 mg of Adderall (amphetamine and dextroamphetamine)?

90 mg of Adderall Is Not Safe and Exceeds Maximum Recommended Dosage

Taking 90 mg of Adderall is unsafe as it significantly exceeds the maximum recommended daily dose of 40-60 mg and increases the risk of serious adverse effects including cardiovascular events, psychosis, and death. 1, 2

Maximum Recommended Dosage

• The Physician's Desk Reference states that the maximum total daily dose is 60 mg for methylphenidate and 40 mg for amphetamines (including Adderall) 1
• Clinical practice consensus indicates that doses may occasionally go higher than PDR-recommended limits, but experts typically limit the upper range to a total daily dose of 40 mg of amphetamine 1
• If the top recommended dose does not help, more is not necessarily better - a change in medication or alternative intervention may be required 1

Risks of Exceeding Maximum Dosage

• Exceeding recommended doses significantly increases the risk of serious adverse effects 1, 3
• High doses of amphetamines are associated with:
  • Cardiovascular complications including tachycardia, hypertension, and arrhythmias 4
  • Severe psychiatric symptoms including persistent psychosis 3
  • Hyperthermia and metabolic disturbances 4
  • Seizures and other neurological complications 4

Proper Dosing Guidelines

• For adults with ADHD, the appropriate starting dose is much lower:
  • Immediate-release: Start with 5 mg given 2-3 times daily 1
  • Extended-release (Adderall XR): Start with 10 mg once daily in the morning 2, 5
• Dose titration should be gradual:
  • Increase by 5-10 mg increments for immediate-release or 5 mg for extended-release 1
  • Allow at least one week between dose increases to properly evaluate response 2
  • Titration should be based on clinical response and tolerability 2, 6

Monitoring Requirements

• Blood pressure and pulse should be checked quarterly in adults taking stimulants 1
• Weight should be monitored at each visit to assess for appetite suppression 1
• Assessment for side effects including insomnia, anorexia, headaches, and social withdrawal should be conducted regularly 1

Clinical Evidence on Efficacy

• Research shows that therapeutic benefits are typically achieved at much lower doses:
  • In clinical trials, the average effective dose of mixed amphetamine salts was 54 mg administered in 2 daily doses 7
  • A systematic review found that amphetamines were effective for ADHD at standard doses, with higher doses not providing additional benefit but increasing side effects 8
  • A 4-week study in adolescents found significant improvement with doses ranging from 10-40 mg/day compared to placebo 6

Pitfalls to Avoid

• Continuing to increase the dose beyond maximum recommendations when not effective - consider alternative medications instead 1, 2
• Starting at too high a dose, which leads to unnecessary side effects and decreased medication adherence 2
• Not allowing sufficient time between dose increases to evaluate response 1, 2

Alternative Approaches When Maximum Dose Is Ineffective

• If maximum recommended doses are ineffective, consider:
  • Switching to a different stimulant medication 1
  • Trying non-stimulant medications like atomoxetine (maximum dose 100 mg/day) or bupropion (maximum dose 450 mg/day) 1
  • Implementing behavioral and psychosocial interventions 1

In conclusion, 90 mg of Adderall significantly exceeds the maximum recommended daily dose and poses substantial health risks. If current treatment is inadequate, consult with a healthcare provider about alternative medications or approaches rather than exceeding the recommended maximum dose.