What is the recommended dosing for immediate release (IR) Adderall (amphetamine and dextroamphetamine)?

Adderall IR Dosing

For immediate-release (IR) Adderall, start with 5 mg twice daily (after breakfast and lunch) in adults or 2.5 mg twice daily in children, then increase by 5 mg weekly increments based on response, up to a maximum of 40 mg total daily dose. 1, 2

Initial Dosing Strategy

• Start with 5 mg twice daily in adults or 2.5 mg twice daily in children, typically administered after breakfast and after lunch 1, 2
• Morning and midday administration is critical to minimize sleep disturbances 2
• The short duration of action (approximately 4 hours per dose) necessitates multiple daily doses 1

Titration Protocol

• Increase in weekly increments of 5-10 mg per dose if symptom control is inadequate 1, 2
• Allow at least one full week between dose increases to properly evaluate therapeutic response 2
• During initial titration, maintain weekly contact (can be by telephone) with in-person visits at least monthly until symptoms stabilize 1, 2

Maximum Dosing Limits

• The maximum total daily dose is 40 mg according to the Physician's Desk Reference 1, 2
• More recent guidelines suggest up to 50 mg daily may be appropriate in some adults 2, 3
• For children weighing less than 25 kg, single doses should not exceed 10 mg 1, 2, 3
• Expert consensus often limits single doses to 25 mg when using multiple daily doses 1

Critical Caveat on Maximum Dosing

• If the maximum recommended dose does not provide adequate symptom control, increasing the dose further is not recommended 1, 2
• Instead, consider switching to an alternative stimulant medication or adding environmental/psychosocial interventions 1, 2
• "More is not necessarily better" when maximum doses are ineffective 1

Monitoring Requirements

Baseline Assessment

• Measure blood pressure, pulse, height, and weight before initiating treatment 2

Ongoing Monitoring

• Systematically assess target ADHD symptoms from both parents and teachers using specific questions or standardized rating scales 1, 2
• Obtain self-ratings from adolescents and adults 1
• Weigh patients at each visit to objectively monitor for appetite suppression 1, 2
• Specifically ask about known side effects: insomnia, anorexia, headaches, social withdrawal, tics, and weight loss 1, 2
• Adults should have blood pressure and pulse checked quarterly by either the treating physician or primary care physician 1, 2

Common Pitfalls to Avoid

• Starting at too high a dose leads to unnecessary side effects and decreased medication adherence 2
• Not allowing sufficient time between dose increases prevents proper evaluation of therapeutic response 2
• Overlooking morning administration timing increases risk of sleep disturbances 2
• Continuing to escalate doses beyond maximum recommendations when ineffective, rather than switching medications 1, 2
• Failing to systematically assess both benefits and side effects during the titration phase 2

Alternative Formulation Consideration

• If midday dosing becomes problematic (e.g., school administration issues, adherence concerns), consider switching to extended-release formulations like Adderall XR, which provides once-daily dosing with 8-12 hour duration 4, 5
• Extended-release formulations also reduce potential for abuse compared to IR formulations 4