What is the recommended dosage range for Adderall (amphetamine and dextroamphetamine)?

Adderall Dosage Range

For ADHD treatment, start Adderall immediate-release (IR) at 5 mg twice daily in adults or 2.5-5 mg daily in children, titrating by 5 mg weekly increments to a maximum of 40-50 mg per day; for extended-release (XR), start at 10 mg once daily in the morning and titrate by 5 mg weekly to the same maximum. 1, 2, 3

Starting Doses

Immediate-Release (IR) Formulation

• Adults and children ≥6 years: Begin with 5 mg twice daily (after breakfast and lunch) 1, 3
• Children 3-5 years: Start at 2.5 mg daily 3
• Children under 3 years: Not recommended 3

Extended-Release (XR) Formulation

• All ages: Start with 10 mg once daily in the morning 1, 2
• Morning administration is critical to minimize sleep disturbances 1, 4

Titration Protocol

Increase the dose in 5 mg increments weekly for both IR and XR formulations, allowing at least one week between adjustments to properly evaluate response. 1, 2

• For IR: Increase by 5 mg per dose (total daily increase of 10 mg if taking twice daily) 1, 3
• For XR: Increase by 5 mg once weekly 1, 2
• Weekly telephone contact is acceptable during initial titration, with in-person visits at least monthly until symptoms stabilize 1

Maximum Doses

The maximum recommended daily dose is 40-50 mg for both IR and XR formulations. 1, 2, 3

• FDA labeling states 40 mg as the maximum for ADHD 3
• Recent American Academy of Child and Adolescent Psychiatry guidelines support up to 50 mg daily 1, 2
• For children weighing <25 kg: Single doses should not exceed 10 mg 1
• Narcolepsy treatment may require up to 60 mg daily in divided doses 3

Monitoring Requirements

Baseline Assessment

• Blood pressure and pulse 1, 4
• Height and weight 1

Ongoing Monitoring

• At each visit: Weight assessment to detect appetite suppression 1, 4
• Quarterly for adults: Blood pressure and pulse checks 2, 4
• Systematic evaluation of target ADHD symptoms and side effects (insomnia, anorexia, headaches, social withdrawal, tics, weight loss) 1

Special Populations

Older Adults

• More sensitive to both therapeutic and adverse effects due to age-related pharmacokinetic changes 1, 4
• Consider more conservative titration: increase by 5 mg every 2 weeks instead of weekly 1
• May require starting dose of 2.5 mg (achieved by cutting a 5 mg IR tablet) 2

Pregnant Women

• Maximum dose remains 50 mg, but treatment decisions require careful risk-benefit analysis 2
• Discontinuing treatment can lead to worse mental health outcomes and functional impairment 5
• Untreated ADHD associated with increased risks for spontaneous abortion and preterm birth 5

Critical Pitfalls to Avoid

1. Starting too high: Leads to unnecessary side effects and decreased adherence 1, 4
2. Inadequate time between dose increases: Must allow one full week to evaluate response 1
3. Late-day dosing: Causes insomnia; avoid evening doses 3
4. Exceeding maximum dose when ineffective: If 40-50 mg provides no benefit, switch medications rather than increasing further 1, 2
5. Failing to monitor systematically: Both benefits and side effects must be assessed at each dose adjustment 1

When Maximum Dose Fails

If the maximum recommended dose (40-50 mg) does not provide adequate symptom control, do not increase further—instead, switch to an alternative stimulant or consider non-stimulant medications. 1, 2

• More medication is not necessarily better beyond the maximum dose 2
• Reevaluate the diagnosis and assess for comorbid conditions affecting treatment response 1
• Consider adding environmental or psychosocial interventions 1

Dosing Flexibility

• IR tablets can be safely cut for dose titration when finding the optimal therapeutic dose 2
• Drug administration should be interrupted occasionally to determine if behavioral symptoms recur, requiring continued therapy 3
• The XR formulation provides 12-hour coverage with once-daily dosing, eliminating need for in-school administration 6