Adderall XR Dosing Recommendations
The recommended starting dose of Adderall XR is 10 mg once daily in the morning, with gradual titration by 5 mg weekly increments based on clinical response and tolerability, up to a maximum daily dose of 40-50 mg for adults. 1, 2, 3
Initial Dosing
- For extended-release (XR) formulation, start with 10 mg once daily in the morning 1, 2, 3
- For immediate-release (IR) formulation, the starting dose is 2.5 mg (for children) or 5 mg (for adults) twice daily, typically given after breakfast and lunch 1, 4
- Morning administration is critical to minimize sleep disturbances 1, 3
- Children weighing less than 25 kg should not receive single doses greater than 10 mg 1, 4
Titration Schedule
- Increase dose in weekly increments of 5 mg if symptom control is not achieved 1, 2, 3
- Allow at least one week between dose increases to properly evaluate response 1, 3
- During initial titration, weekly contact can be maintained by telephone, with in-person visits at least monthly until symptoms are stabilized 1, 4
- The titration phase typically requires 2-4 weeks 4
Maximum Dosing
- The maximum total daily dose is 40 mg for amphetamines according to the Physician's Desk Reference 1, 4
- More recent guidelines suggest a maximum daily dose of 50 mg for adults 1, 2
- If the maximum recommended dose does not provide adequate symptom control, more is not necessarily better - consider alternative medications or interventions instead 1, 4, 3
Monitoring Parameters
- Baseline assessment should include blood pressure, pulse, height, and weight 1, 2
- Follow-up assessment should include evaluation of target ADHD symptoms and side effects (insomnia, anorexia, headaches, social withdrawal, tics, weight loss) 1, 4
- Adults should have blood pressure and pulse checked quarterly 1, 4
- Weigh patients at each visit to monitor for appetite suppression 1, 4
Special Populations
- Older adults may be more sensitive to both therapeutic and adverse effects due to age-related changes in pharmacokinetics 1, 2
- For older adults, consider a more conservative titration schedule (increasing by 5 mg every 2 weeks instead of weekly) 1, 2
Clinical Advantages of XR Formulation
- Once-daily dosing improves medication adherence by eliminating the need for in-school or afternoon doses 3, 5
- Provides consistent symptom control throughout the day with a single morning dose 5, 6
- The extended-release formulation has been shown to provide significant improvement in both morning and afternoon behavior 6
Common Pitfalls to Avoid
- Starting at too high a dose, which can lead to unnecessary side effects and decreased medication adherence 1, 3
- Not allowing sufficient time between dose increases to evaluate response 1, 3
- Continuing to increase the dose beyond maximum recommendations when not effective 1, 3
- Overlooking the importance of morning administration to minimize sleep disturbances 1, 3
- Failing to systematically assess both benefits and side effects during titration 1, 2