What is the typical dosing for Adderall (amphetamine/dextroamphetamine) IR in adults and children with Attention Deficit Hyperactivity Disorder (ADHD)?

Adderall IR Dosing for ADHD

Start adults and adolescents ≥12 years at 5-10 mg once or twice daily in the morning, titrating by 5-10 mg weekly until symptoms are controlled, with a maximum daily dose of 40 mg; for children 6-11 years, start at 5 mg once or twice daily and increase by 5 mg weekly; for children 3-5 years, start at 2.5 mg daily and increase by 2.5 mg weekly. 1, 2

Pediatric Dosing (Ages 3-11 Years)

Children 3-5 Years Old

• Initial dose: 2.5 mg once daily in the morning 1, 2
• Titration: Increase by 2.5 mg increments at weekly intervals 1, 2
• Monitoring: Obtain ADHD rating scales from parents and teachers before each dose increase 1

Children 6-11 Years Old

• Initial dose: 5 mg once or twice daily (after breakfast and lunch) 1, 2
• Titration: Increase by 5 mg increments at weekly intervals 1, 2
• Maximum dose: Rarely exceeds 40 mg total daily dose 3, 2
• Special consideration: For children weighing <25 kg, single doses should not exceed 10 mg, and the 15-20 mg dosage steps should be omitted during titration 1, 4

Dosing Schedule

• Give first dose upon awakening 1, 2
• Additional doses (1-2) at 4-6 hour intervals to cover school day and homework periods 1, 2
• Adjust timing and strength of end-of-day dose to minimize side effects like reduced appetite at dinner and delayed sleep onset 1

Adolescent and Adult Dosing (≥12 Years)

Initial Dosing

• Starting dose: 5-10 mg once daily in the morning, or 5 mg twice daily 1, 2
• Alternative approach: Some adults may require only once-daily dosing initially, with a noon dose added if duration is insufficient 1

Titration Strategy

• Standard approach: Increase by 5-10 mg increments weekly based on symptom control and side effects 1, 2
• Forced titration trial: Alternatively, systematically trial all dose levels (2.5,7.5,10 mg per dose) for 1 week each, collecting rating scales at each level, then select the dose with most benefit and fewest side effects 1

Maximum Dosing

• Standard maximum: 40 mg total daily dose 1, 3, 4, 2
• Higher doses: Some adults may require up to 0.9 mg/kg or 40 mg total daily dose, particularly when multiple doses are needed to cover a longer workday 1
• Documentation requirement: When using higher doses, clearly document that symptoms could not be controlled at lower doses and that higher doses are not producing significant side effects 1, 3

Dosing Frequency

• Adults typically require 2-3 doses daily at 4-6 hour intervals to maintain coverage throughout the day 1, 2
• Avoid late evening doses due to insomnia risk 2

Baseline and Monitoring Requirements

Before Starting Treatment

• Obtain baseline blood pressure, pulse, height, and weight in the context of physical examination 1, 3
• Collect baseline ADHD rating scales from patients and significant others (adults) or parents and teachers (children) 1

During Titration

• Week 1: Office visit with ADHD rating scales and side effect assessment 1
• Weeks 2-3: Office visit or phone contact with rating scales and side effect monitoring 1
• Week 4+: Office visit to review all collected data and select optimal dose 1
• Monitor blood pressure, pulse, height, and weight regularly, especially at higher doses 3, 4

Clinical Considerations and Pitfalls

Response Rates and Alternatives

• Approximately 70% of patients respond to amphetamines alone 3
• Nearly 90% respond if both amphetamines and methylphenidate are tried 3, 4
• If symptoms are not adequately controlled at maximum dose, consider switching to methylphenidate or non-stimulant options 4

Side Effect Profile

• Amphetamines produce greater effects on appetite and sleep compared to methylphenidate due to longer excretion half-lives 3
• Common adverse events include gastrointestinal complications, loss of appetite, insomnia, and anorexia 1, 5
• Caution in anxiety: Amphetamines may precipitate acute anxiety symptoms in patients with comorbid anxiety disorders 6

Efficacy Evidence

• Research shows moderate effect sizes (SMD -0.51 to -0.90) for ADHD symptom reduction in adults, though evidence quality is low 7
• Mean effective doses in adult studies ranged from 10.77 mg/day to 54 mg/day 6, 8
• Positive responses can occur at relatively low doses in some individuals 6

Practical Dosing Tips

• Fixed-dose titration is more practical than weight-adjusted dosing in office practice 4
• Consider drug holidays (interrupting administration occasionally) to determine if continued therapy is necessary 2
• Timing adjustments may be needed to balance symptom control with side effect management 1