What is the starting dose of Dexedrin (dextroamphetamine) for Attention Deficit Hyperactivity Disorder (ADHD) and narcolepsy?

Dexedrine (Dextroamphetamine) Starting Dose

For ADHD in children aged 3-5 years, start with 2.5 mg daily; for children 6 years and older, start with 5 mg once or twice daily; and for adults/adolescents 12 years and older, start with 10 mg daily. 1

ADHD Dosing by Age Group

Children Ages 3-5 Years

• Initial dose: 2.5 mg daily given upon awakening 2, 1
• Increase by 2.5 mg increments at weekly intervals until optimal response is achieved 1
• Additional doses (1-2) may be given at 4-6 hour intervals as needed 1

Children Ages 6 Years and Older

• Initial dose: 5 mg once or twice daily (morning after breakfast and around noon after lunch) 2, 1
• Increase by 5 mg increments at weekly intervals until symptoms are controlled 2, 1
• Maximum total daily dose rarely exceeds 40 mg 1
• For children weighing less than 25 kg, single doses should generally not exceed 10 mg of dextroamphetamine 2

Adults and Adolescents 12 Years and Older

• Initial dose: 10 mg daily given in the morning 3, 1
• Increase by 5-10 mg increments weekly based on response 2
• Maximum total daily dose is typically 40 mg, though some patients may require up to 0.9 mg/kg or 40 mg total daily 2
• Adults often need multiple daily doses to cover a longer day 2

Narcolepsy Dosing

Children Ages 6-12 Years

• Initial dose: 5 mg daily 1
• Increase by 5 mg increments at weekly intervals until optimal response 1

Patients 12 Years and Older

• Initial dose: 10 mg daily 1
• Increase by 10 mg increments at weekly intervals 1
• Usual dose range: 5-60 mg per day in divided doses 1

Titration Strategy

Two approaches are recommended by the American Academy of Child and Adolescent Psychiatry: 2

Standard Titration

• Start at the recommended initial dose based on age 2
• Increase weekly by 2.5-5 mg increments depending on age group 2
• Stop titration when symptoms resolve and impairment diminishes in clinical judgment 2

Forced Titration Trial

• Patient takes all dose levels (2.5,7.5,10 mg for children) with each dose lasting 1 week 2
• Rating scales collected at each dose level 2
• At follow-up, select the dose producing most benefit with fewest side effects 2

Critical Monitoring Requirements

Before Starting Treatment

• Obtain baseline blood pressure, pulse, height, and weight in context of physical examination 2
• Assess for cardiac disease through careful history, family history of sudden death or ventricular arrhythmia, and physical exam 1
• Evaluate family history and clinically assess for motor/verbal tics or Tourette's syndrome 1

During Titration

• Use standardized ADHD rating scales from parents and teachers before each dose increase 2
• Assess blood pressure, pulse, height, and weight at each visit 2
• Rating scales can be obtained through phone contact between visits 2

Important Clinical Considerations

Timing of Administration

• Give first dose upon awakening to provide coverage throughout the day 1
• Additional doses given at 4-6 hour intervals 1
• Avoid late evening doses due to resulting insomnia 1

Common Pitfalls to Avoid

• Dextroamphetamine and mixed amphetamine salts produce greater effects on appetite and sleep compared to methylphenidate due to longer excretion half-lives 2
• If bothersome adverse reactions appear (insomnia or anorexia), reduce dosage 1
• If top recommended dose doesn't help, more is not necessarily better—consider changing drugs or adding environmental/psychosocial interventions 2
• Approximately 70% of children respond to either dextroamphetamine or methylphenidate alone, and nearly 90% respond if both are tried 2

Documentation Requirements

• When using higher total daily doses, clearly document that symptoms could not be controlled at lower doses and higher doses are not producing side effects (weight loss, blood pressure increase, or agitation) 2
• Monitor for signs of tolerance in patients on higher doses 2