Converting Adderall 15mg TID to Adderall XR
Convert Adderall immediate-release 15mg three times daily (total daily dose 45mg) to Adderall XR 40mg once daily in the morning, as this represents the closest equivalent within the maximum recommended daily dose of 40-50mg. 1, 2, 3
Conversion Rationale
The current regimen provides a total daily dose of 45mg (15mg × 3 doses). When converting from immediate-release to extended-release formulations, the goal is to match the total daily dose while recognizing that Adderall XR provides approximately 12 hours of symptom control through its dual-release mechanism. 4
Recommended Conversion Approach
Start with Adderall XR 40mg once daily in the morning as the initial conversion dose, since this is the closest equivalent to the current 45mg total daily dose and remains within the maximum recommended range of 40-50mg daily. 1, 2, 3
Administer the dose in the morning to minimize sleep disturbances, as this is a critical timing consideration for extended-release stimulants. 1, 2, 3
Monitor response for at least one week before making any dose adjustments, as this allows adequate time to evaluate both therapeutic effects and side effects. 1, 2
Alternative Consideration
If 40mg proves insufficient after one week of monitoring, you may increase to Adderall XR 45mg once daily, which matches the exact previous total daily dose. While the maximum recommended dose is typically stated as 40-50mg, recent American Academy of Child and Adolescent Psychiatry guidelines support up to 50mg daily. 1, 2
Critical Monitoring Parameters
Assess blood pressure and pulse at the conversion visit and with any subsequent dose adjustments. 1, 2
Evaluate target ADHD symptoms and side effects systematically, particularly insomnia, anorexia, headaches, social withdrawal, tics, and weight loss. 1, 2
Weigh the patient at each visit to monitor for appetite suppression, which is a common adverse effect. 1, 2
Check blood pressure and pulse quarterly once the dose is stabilized. 1, 2
Common Pitfalls to Avoid
Do not simply add up the total daily dose and exceed 50mg - if 40-50mg of Adderall XR does not provide adequate symptom control, switch to an alternative medication rather than increasing the dose further. 1, 2, 3
Do not administer the XR formulation later in the day - morning administration is essential to prevent insomnia due to the 12-hour duration of action. 1, 2, 3, 4
Do not make dose adjustments before allowing one full week to evaluate the response to the new formulation. 1, 2
Do not assume the conversion will be perfectly equivalent - individual responses vary, and some patients may require fine-tuning of the dose after conversion. 5
Advantages of XR Formulation
Once-daily dosing improves medication adherence by eliminating the need for multiple doses throughout the day, particularly avoiding in-school or workplace administration. 3
Reduced abuse potential compared to immediate-release formulations due to the extended-release delivery system. 3
Provides approximately 12 hours of symptom control through a dual-release mechanism, offering more consistent coverage throughout the day. 4