What is the recommended dose for Adderall (amphetamine and dextroamphetamine)?

Recommended Dose for Adderall

Start with 5 mg twice daily (immediate-release) or 10 mg once daily in the morning (extended-release), then increase by 5 mg weekly increments based on response, up to a maximum of 40-50 mg per day for adults. 1, 2, 3

Initial Dosing

Immediate-Release (IR) Formulation

• Start with 5 mg twice daily (after breakfast and lunch) for adults 1, 3
• For children ages 6 and older, start with 5 mg once or twice daily 3
• For children ages 3-5, start with 2.5 mg daily 3

Extended-Release (XR) Formulation

• Start with 10 mg once daily in the morning for both adults and children 1, 4, 3
• Morning administration is essential to minimize sleep disturbances 1, 4

Titration Protocol

• Increase by 5 mg weekly for both IR and XR formulations if symptom control is inadequate 1, 2
• Allow at least one full week between dose increases to properly evaluate response 1, 2
• For IR formulations, doses are typically given 2-3 times daily (morning, noon, and potentially late afternoon) at 4-6 hour intervals 1, 3
• For XR formulations, maintain once-daily morning dosing throughout titration 4

Maximum Dosing

• The FDA-approved maximum is 40 mg per day according to the Physician's Desk Reference 1, 3
• More recent clinical guidelines suggest a maximum of 50 mg per day for adults 1, 2
• Most adults achieve optimal symptom control at 40-60 mg total daily dose, though standard maximum remains 40-50 mg 2
• Do not exceed 40 mg per day in children - only in rare cases is this necessary 3

Monitoring Requirements

Baseline Assessment

• Measure blood pressure, pulse, height, and weight before starting 1

Ongoing Monitoring

• Check blood pressure and pulse at each dose adjustment, then quarterly once stabilized 1, 2
• Weigh patients at every visit to detect appetite suppression 1, 2
• Systematically evaluate target ADHD symptoms using standardized rating scales 2, 4
• Assess side effects including insomnia, anorexia, headaches, social withdrawal, tics, and weight loss 1

When Maximum Dose Fails

If 40-50 mg provides inadequate symptom control, switch to an alternative medication rather than increasing the dose further. 1, 2

• Consider switching to methylphenidate-based stimulants 2
• Consider adding non-stimulant medications like atomoxetine 4
• Approximately 70% respond to either amphetamine or methylphenidate alone, but nearly 90% respond if both are tried 2
• Reevaluate the diagnosis and screen for comorbid conditions affecting treatment response 4

Special Population Considerations

Older Adults

• Use more conservative titration: increase by 5 mg every 2 weeks instead of weekly 1, 4
• Monitor vital signs more closely due to age-related pharmacokinetic changes 4
• Older adults are more sensitive to both therapeutic and adverse effects 1, 4

Substance Abuse History

• Avoid prescribing Adderall XR to adults with active substance abuse disorder due to abuse potential 1

Critical Pitfalls to Avoid

• Starting too high: Beginning above 5-10 mg leads to unnecessary side effects and poor adherence 1, 2, 4
• Rushing titration: Not allowing at least one week between dose increases prevents proper response evaluation 1, 2, 4
• Afternoon/evening dosing: Causes insomnia - always dose in the morning 1, 4
• Exceeding maximum without switching: If 40-50 mg is ineffective, more is not better - change medications instead 1, 2
• Inadequate monitoring: Failing to systematically assess both benefits and side effects at each adjustment 1, 2, 4
• Ignoring weight loss: Not weighing patients at each visit misses significant appetite suppression 1, 2