What is the usual optimal dose of Adderall (amphetamine and dextroamphetamine) for an adult patient with Attention Deficit Hyperactivity Disorder (ADHD)?

Optimal Adderall Dosing for Adult ADHD

For adults with ADHD, start Adderall at 5-10 mg once or twice daily and titrate upward in 5-10 mg weekly increments until symptoms are controlled, with most patients achieving optimal response between 40-60 mg total daily dose, though some may require up to 40 mg for amphetamine salts according to established maximum limits. 1

Starting Dose

• Begin with 5 mg of immediate-release amphetamine/dextroamphetamine (AMP/DEX) given once daily in the early morning, with a noon dose added if needed 1
• For extended-release formulations (Adderall XR), start at 10 mg once daily in the morning 2
• The lower starting dose minimizes initial side effects while allowing assessment of individual response 1

Titration Protocol

Increase the dose in 5-10 mg increments weekly based on symptom control and tolerability: 1

• Week 1: 5 mg (immediate-release) or 10 mg (extended-release)
• Week 2: 10 mg or increase by 5 mg
• Week 3: 15 mg or continue weekly 5-10 mg increases
• Continue titration until optimal symptom control is achieved 1

Alternative forced titration approach: Have the patient trial all dose levels (2.5,7.5,10 mg for immediate-release) with each dose lasting 1 week, then select the dose producing the most benefit with fewest side effects 1, 3

Target Dose Range

• Most adults achieve optimal response at total daily doses of 40-60 mg 1, 4
• The PDR-recommended maximum total daily dose is 40 mg for amphetamine salts 1
• In clinical practice, some adults may require up to 0.9 mg/kg of AMP/DEX or 40 mg total daily dose 1
• Research demonstrates efficacy at average doses of 54 mg daily (administered in two divided doses), though this exceeds standard recommendations 5
• Extended-release formulations have a maximum recommended dose of 50 mg daily for adults 2

Critical Monitoring Requirements

Before initiating treatment: 1, 3

• Obtain baseline blood pressure, pulse, height, and weight in the context of a physical examination
• Screen for hypertension and cardiac arrhythmias that would contraindicate stimulant use

During titration (weekly contact): 1

• Collect symptom ratings from the patient and significant other before each dose increase
• Systematically assess for side effects including insomnia, anorexia, headaches, social withdrawal, and weight loss
• Monitor blood pressure and pulse at each dose adjustment
• Use standardized ADHD rating scales to objectively track response 2

During maintenance (after stabilization): 1, 6

• Schedule follow-up appointments at least monthly until symptoms are fully stabilized
• Adults on stimulants should have blood pressure and pulse checked quarterly
• Monitor weight regularly as an objective measure of appetite suppression

Dosing Strategy Considerations

Adults typically require more frequent dosing than children to cover a longer functional day: 1

• Immediate-release formulations may need 2-3 doses daily
• Extended-release formulations provide 12-hour symptom control with once-daily dosing 4
• Morning administration is essential to minimize sleep disturbances 2

Amphetamines have greater effects on appetite and sleep compared to methylphenidate due to longer excretion half-lives 1, 3

When Higher Doses Are Needed

If approaching or exceeding standard maximum doses: 1

• Clearly document that symptoms could not be controlled at lower doses
• Document that higher doses are not producing intolerable side effects
• Consider that more is not necessarily better—if the top recommended dose doesn't help, a change in medication or addition of psychosocial interventions may be required 1

Common Pitfalls to Avoid

• Starting at too high a dose leads to unnecessary side effects and decreased adherence 6, 2
• Failing to systematically assess both benefits and side effects during titration 6, 2
• Not allowing sufficient time (at least one week) between dose increases to evaluate response 2
• Overlooking the importance of morning administration, which increases sleep disturbances when ignored 2
• Continuing to escalate dose when symptom control plateaus—consider switching medications or adding non-stimulant options instead 2

Evidence Quality Note

The guideline recommendations are based on the American Academy of Child and Adolescent Psychiatry practice parameters 1, with supporting research demonstrating that mixed amphetamine salts are effective and well-tolerated in adults with ADHD, producing clinically significant symptom reduction with effect sizes of 0.8 4. Research shows 70% of patients respond to amphetamines, with response rates increasing to nearly 90% when both amphetamines and methylphenidate are tried 3. However, most studies are short-term (mean 5.3 weeks) with industry funding, limiting long-term safety data 7.