What is the recommended starting dose of Adderall XL (amphetamine and dextroamphetamine)?

Adderall XL Starting Dose

Start Adderall XR at 10 mg once daily in the morning for both adults and children aged 6 years and older. 1, 2

Initial Dosing by Age Group

Children (Ages 6 and Older) and Adults

• Begin with 10 mg once daily in the morning 1, 2
• This starting dose applies to both pediatric patients (6+ years) and adults 1, 2
• Morning administration is essential to minimize sleep disturbances 1, 2

Young Children (Ages 3-5)

• For the rare cases requiring treatment in children ages 3-5, the immediate-release formulation is preferred, starting at 2.5 mg daily 3
• Extended-release formulations are not typically recommended for this age group 3

Titration Schedule

Increase the dose by 5 mg weekly increments based on clinical response and tolerability 1, 2

• Allow at least one full week between dose increases to properly evaluate therapeutic response and side effects 1
• Weekly contact can be maintained by telephone during initial titration, with in-person visits at least monthly until symptoms stabilize 1
• Assess both target ADHD symptoms and side effects (insomnia, anorexia, headaches, social withdrawal, tics, weight loss) at each adjustment 1

Maximum Dosing

• The maximum daily dose is 40-50 mg for adults 1, 2
• The FDA label indicates 40 mg as the maximum per the Physician's Desk Reference, though more recent guidelines suggest up to 50 mg for adults 1
• For children weighing less than 25 kg, single doses should not exceed 10 mg 1

Monitoring Requirements

Baseline Assessment

• Measure blood pressure, pulse, height, and weight before initiating treatment 1

Ongoing Monitoring

• Check blood pressure and pulse quarterly in adults 1
• Weigh patients at each visit to objectively monitor for appetite suppression 1
• Systematically evaluate target ADHD symptoms using specific questions directed at patients, parents, and teachers 1

Special Population: Older Adults

For older adults, use a more conservative titration schedule 1, 2

• Increase by 5 mg every 2 weeks instead of weekly 1, 2
• Older adults are more sensitive to both therapeutic and adverse effects due to age-related pharmacokinetic changes 1, 2
• Monitor vital signs particularly carefully in this population 2

Critical Pitfalls to Avoid

• Starting at too high a dose leads to unnecessary side effects and decreased medication adherence 1, 2
• Failing to systematically assess both benefits and side effects during titration results in inappropriate medication adjustments 1, 2
• Not allowing sufficient time (at least one week) between dose increases prevents accurate assessment of response 1, 2
• Overlooking morning administration timing increases risk of sleep disturbances 1, 2
• Continuing to increase the dose beyond maximum recommendations when ineffective—more is not necessarily better 1

When Maximum Dose Is Ineffective

If the maximum recommended dose does not provide adequate symptom control, consider switching medications rather than exceeding the maximum dose 1, 2

• Reevaluate the diagnosis and assess for comorbid conditions affecting treatment response 1, 2
• Consider alternative stimulant formulations or adding non-stimulant medications like atomoxetine 2
• Incorporate environmental and psychosocial interventions 1