What is the recommended dosing for Adderall (amphetamine and dextroamphetamine) IR in a male patient?

Adderall IR Dosing for Adult Males

For adult males with ADHD, start Adderall IR at 5 mg twice daily (morning and early afternoon), then titrate upward in 5 mg weekly increments based on symptom control, up to a maximum of 40-50 mg total daily dose. 1, 2

Initial Dosing Strategy

• Begin with 5 mg twice daily (typically after breakfast and lunch) to minimize sleep disturbances and assess initial tolerability 2
• Morning administration of the first dose is critical to avoid insomnia 2
• The second dose should be given in early afternoon (around 11:30 AM to 12:00 PM), not late afternoon, to prevent sleep interference 3

Titration Protocol

• Increase by 5 mg increments weekly if symptom control remains 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 2
• Systematically assess both benefits and side effects at each dose adjustment 2

Maximum Dosing Limits

• The maximum total daily dose is 40-50 mg according to current American Academy of Child and Adolescent Psychiatry guidelines 1, 2
• For adults, doses may be calculated up to approximately 1.0 mg/kg per day 1
• If maximum doses prove ineffective, do not exceed these limits—instead, consider switching to an alternative stimulant or adding non-pharmacological interventions 1, 2

Essential Monitoring Parameters

Baseline Assessment

• Blood pressure and pulse (critical given amphetamines increase SBP by ~2 mmHg and DBP by ~2 mmHg, with heart rate increases of ~4 beats per minute) 2, 4
• Height and weight 2

Ongoing Monitoring

• Check blood pressure and pulse quarterly in adults on stimulants 1, 2
• Weigh at each visit to monitor for appetite suppression 2
• Assess target ADHD symptoms using standardized rating scales when possible 1, 2
• Monitor for common side effects: insomnia, anorexia/decreased appetite, headaches, abdominal pain, and weight loss 5

Critical Pitfalls to Avoid

• Starting at too high a dose, which increases side effects and reduces adherence 2
• Failing to allow sufficient time between dose increases (minimum one week) to properly evaluate response 2
• Dosing too late in the day, which causes insomnia—avoid doses after early afternoon 2
• Continuing to escalate beyond maximum recommended doses when ineffective—this increases cardiovascular risk without additional benefit 1, 2, 4
• Neglecting cardiovascular monitoring—amphetamines consistently elevate blood pressure and heart rate, increasing risk of adverse cardiovascular events 4

When Treatment Fails at Maximum Dose

• Do not exceed 40-50 mg total daily dose even if symptoms persist 1, 2
• Consider switching to an alternative stimulant medication rather than exceeding recommended maximums 1
• Re-evaluate the diagnosis and assess for comorbid conditions affecting treatment response 2
• Add or intensify behavioral/psychosocial interventions 2

Special Considerations for Males

• Adult males may require doses toward the higher end of the therapeutic range (approaching 1.0 mg/kg/day) compared to children 1
• Screen for substance use disorder before prescribing, as amphetamines are DEA Schedule II controlled substances with high abuse potential 6
• The standard recommended dosage range for humans with ADHD is 5-60 mg daily, though staying within the 40-50 mg maximum is recommended for safety 6