Starting Dose of Adderall XR
The recommended starting dose of Adderall XR is 10 mg once daily in the morning. 1, 2
Initial Dosing Protocol
Start with 10 mg of Adderall XR taken once daily in the morning upon awakening. 3, 1, 2 This recommendation comes from the American Academy of Child and Adolescent Psychiatry and represents the standard approach across multiple guidelines.
Key Administration Details
- Take the medication in the morning to minimize sleep disturbances, as late-day dosing commonly causes insomnia 1, 2
- The extended-release formulation provides therapeutic coverage throughout a typical school or work day with a single dose 4, 5
- Do not crush, chew, or divide the capsule as this destroys the extended-release mechanism 6
Titration Schedule
Increase the dose by 5 mg weekly increments based on symptom control and tolerability 3, 1, 2. This gradual approach allows proper evaluation of therapeutic response at each dose level.
- Allow at least one full week between dose increases to assess effectiveness 1, 2
- Weekly contact can be maintained by telephone during titration, with in-person visits at least monthly 3, 1
- Continue titration until symptoms resolve or the maximum dose is reached 3, 1
Maximum Dosing Limits
The maximum recommended daily dose is 40-50 mg 1, 2. If symptoms do not improve at maximum dosing, increasing further is not beneficial—instead, consider switching to an alternative medication 1, 2.
Special Population Considerations
Children with Lower Body Weight
For children weighing less than 25 kg, single doses should not exceed 10 mg 1. This means the starting dose of 10 mg XR is already at the maximum for very small children, and alternative formulations or medications may be more appropriate.
Pregnancy and Lactation
The usual starting dose remains 10 mg once daily in the morning, with weekly 5 mg titration up to 50 mg maximum 3. Monitor infants carefully for irritability, insomnia, and feeding difficulties if breastfeeding 3.
Monitoring Requirements
Baseline Assessment
Before starting treatment, obtain:
Ongoing Monitoring
At each dose adjustment and follow-up visit:
- Assess target ADHD symptoms using standardized rating scales 3, 1
- Evaluate side effects, particularly insomnia, appetite suppression, headaches, and cardiovascular changes 1, 2
- Weigh the patient at every visit to monitor for appetite suppression 1, 2
- Check blood pressure and pulse with each dose increase 2
- For adults on maintenance therapy, check vital signs quarterly 1, 2
Common Pitfalls to Avoid
Do not start at doses higher than 10 mg, as this increases the risk of side effects and may reduce medication adherence 1, 2. Starting too high is one of the most common prescribing errors.
Do not increase the dose more frequently than weekly, as insufficient time between adjustments prevents accurate assessment of therapeutic response 1, 2.
Do not continue escalating beyond maximum recommended doses (40-50 mg) when the medication is ineffective—this indicates the need for a different treatment approach rather than higher dosing 1, 2.
Do not overlook the importance of morning administration, as afternoon or evening doses predictably cause insomnia 1, 2.
Clinical Advantages of XR Formulation
The extended-release formulation provides several practical benefits:
- Once-daily dosing eliminates the need for in-school or workplace administration, improving adherence 2
- Reduced abuse potential compared to immediate-release formulations 2
- Sustained therapeutic effect lasting 8-12 hours from a single morning dose 4, 5
- Research demonstrates that a single morning dose of Adderall XR produces behavioral effects equivalent to twice-daily immediate-release methylphenidate throughout the school day 7