What are the dosing guidelines for Adderall (amphetamine and dextroamphetamine) XR?

Adderall XR Dosing Guidelines

Start Adderall XR at 10 mg once daily in the morning, increase by 5 mg weekly increments based on response, up to a maximum of 40-50 mg daily. 1, 2

Starting Dose

• Begin with 10 mg once daily in the morning for all patients aged 6 years and older 1, 2
• Morning administration is mandatory to prevent sleep disturbances 1, 2
• Take with or without food—unlike immediate-release amphetamines, Adderall XR maintains consistent drug exposure regardless of high-fat breakfast 3

Titration Protocol

• Increase by 5 mg weekly based on symptom response and tolerability 1, 2
• Allow a full week between each dose adjustment to properly evaluate therapeutic effect 1, 2
• Weekly telephone contact is acceptable during initial titration, with mandatory in-person visits at least monthly until symptoms stabilize 4, 1
• Use standardized ADHD rating scales at each dose level to objectively measure improvement 4, 1

Maximum Dose

• The maximum recommended daily dose is 40-50 mg 1, 2, 5
• Recent American Academy of Child and Adolescent Psychiatry guidelines support up to 50 mg daily 1, 2, 5
• For children weighing <25 kg, do not exceed 15 mg as a single dose 5
• Adults may occasionally require up to 1.0 mg/kg per day, but this should not exceed 50 mg total 5

Monitoring Requirements

Baseline Assessment

• Blood pressure and pulse 1, 2
• Height and weight 1, 2
• Baseline ADHD symptom severity using standardized rating scales 4, 1

Ongoing Monitoring

• At each visit: Weight assessment to detect appetite suppression 1, 2
• Quarterly for adults: Blood pressure and pulse checks 1, 5
• At each dose adjustment: Systematic evaluation of target ADHD symptoms and side effects including insomnia, anorexia, headaches, social withdrawal, tics, and weight loss 1, 2

Special Populations

Children <25 kg

• Single doses should not exceed 15 mg 5
• Consider more conservative titration with smaller increments 4

Older Adults

• Start at lower doses (consider 5 mg or even 2.5 mg if using immediate-release formulation cut in half) 1, 5
• Increase by 5 mg every 2 weeks instead of weekly due to age-related pharmacokinetic changes 1, 2
• More sensitive to both therapeutic and adverse effects 1, 2

Pregnant Women

• Maximum dose remains 50 mg with careful risk-benefit analysis 4, 5
• Untreated ADHD in pregnancy carries risks including spontaneous abortion and preterm birth 5
• Discontinuing treatment can worsen mental health outcomes and functional impairment 5

Critical Pitfalls to Avoid

• Starting too high: Leads to unnecessary side effects and medication non-adherence 1, 2
• Inadequate time between increases: Must allow one full week to evaluate response at each dose level 1, 2
• Exceeding maximum dose when ineffective: If 40-50 mg provides no benefit, switch to an alternative stimulant (approximately 90% of patients respond when both methylphenidate and amphetamine are tried) rather than increasing further 4, 1, 2
• Failing to monitor systematically: Both benefits and side effects must be assessed at each dose adjustment using objective measures 1, 2
• Ignoring food timing: While Adderall XR is less affected by food than immediate-release formulations, consistent morning administration optimizes therapeutic effect 3

When Maximum Dose Fails

• Do not increase beyond 50 mg—more medication is not better beyond this threshold 1, 2, 5
• Switch to an alternative stimulant (methylphenidate-based products) as nearly 90% respond when both stimulant classes are tried 4
• Reevaluate the diagnosis and assess for comorbid conditions (anxiety, depression, learning disabilities) affecting treatment response 1, 2
• Consider non-stimulant medications (atomoxetine, guanfacine, clonidine) 4
• Add environmental or psychosocial interventions 2

Efficacy Timeline

• Therapeutic effects last throughout the entire school/work day with once-daily morning dosing 6, 7
• Significant improvement observed across morning, afternoon, and late afternoon periods 7
• Dose-related improvements occur consistently across all measures of efficacy 6, 7
• In adolescents, all doses from 10-40 mg showed statistically significant improvement over placebo within the first week 6