Can I take two 10mg amphetamine salts (amphetamine) extended release (ER) capsules if I don't see much improvement with my current dose?

Do Not Double Your Dose Without Medical Supervision

You should not take two 10mg amphetamine salts ER capsules (20mg total) without first consulting your prescribing physician, as proper dose titration requires systematic increases of 5mg weekly increments with monitoring for both efficacy and side effects. 1, 2, 3

Why Self-Adjusting Your Dose Is Problematic

Proper Titration Protocol

• The FDA-approved starting dose for amphetamine salts is 10mg once daily in the morning, with increases of 5mg at weekly intervals until optimal response is achieved 3
• The American Academy of Child and Adolescent Psychiatry emphasizes that dose increases should occur in 5-10mg increments with at least one week between adjustments to properly evaluate therapeutic response and side effects 1, 2
• Doubling your dose from 10mg to 20mg represents a 10mg jump, which exceeds the recommended 5mg increment and bypasses the necessary evaluation period 1

Maximum Dosing Limits

• The maximum recommended total daily dose for amphetamine preparations is 40mg, with clinical consensus often limiting the upper range to 40mg 2, 3
• The FDA label specifies that "only in rare cases will it be necessary to exceed a total of 40mg per day" 3
• If maximum recommended doses don't provide adequate symptom control, increasing beyond these limits does not necessarily provide additional therapeutic benefit - "if the top recommended dose does not help, more is not necessarily better" 2

Risks of Improper Dose Escalation

Cardiovascular and Other Adverse Effects

• Higher doses of amphetamine increase the risk of cardiovascular effects including hypertension and tachycardia 2
• Amphetamines are associated with increased withdrawal due to adverse events, with a risk ratio of 2.69 compared to placebo 4
• Common side effects that worsen with higher doses include decreased appetite, insomnia, and headaches 1, 2

Tolerance and Dependence

• Higher doses increase the potential for tolerance and dependence 2
• However, evidence suggests there is little development of tolerance to stimulant effects on ADHD symptoms over time when properly dosed 1

What You Should Do Instead

Systematic Evaluation Approach

• Schedule an appointment with your prescribing physician to discuss inadequate symptom control 1, 2
• Your physician should assess both therapeutic effects and side effects before considering any dose increase 1
• Vital signs including blood pressure and pulse should be monitored at baseline and with each dose increase 1, 2

Proper Next Steps if 10mg Is Insufficient

• If 10mg is truly inadequate after at least one week of treatment, the appropriate next step is increasing to 15mg (a 5mg increment), not 20mg 1, 3
• Your physician should use standardized rating scales to objectively measure changes in ADHD symptoms 5
• Morning administration should be maintained to minimize sleep disturbances 1

Alternative Strategies if Maximum Doses Fail

• If symptom control is not achieved at maximum recommended doses, consider switching to an alternative stimulant medication (such as methylphenidate) rather than exceeding amphetamine dose limits 2, 5
• Non-stimulant options like atomoxetine, bupropion, or viloxazine may be more appropriate for some patients 6, 5
• Adding environmental or psychosocial interventions, including cognitive behavioral therapy or dialectical behavior therapy, can augment medication effects 6, 5

Common Pitfalls to Avoid

• Starting at too high a dose leads to unnecessary side effects and decreased medication adherence 1, 5
• Not allowing sufficient time (at least one week) between dose increases prevents proper evaluation of response 1, 5
• Continuing to increase dose beyond maximum recommendations when not effective - this is when alternative medications should be considered instead 1, 2
• Taking doses in the late afternoon or evening can cause insomnia 1, 3

Duration of Effect Considerations

• Amphetamine salts ER is designed to provide symptom control for up to 12 hours with once-daily dosing 7
• The extended-release formulation provides a gradual ascending increase in amphetamine plasma concentration throughout the day 1
• If you're experiencing symptom breakthrough before 12 hours, this should be discussed with your physician as it may indicate need for dose adjustment or timing modification, not simply doubling the dose 7