Adderall XR Starting Dose for Pediatric Patients
The starting dose of Adderall XR for pediatric patients is 10 mg once daily in the morning. 1, 2
Initial Dosing Protocol
- Start with 10 mg once daily administered in the morning for all pediatric patients with ADHD 1, 2
- Morning administration is critical to minimize sleep disturbances 1, 3, 2
- This applies to children aged 6 years and older who meet diagnostic criteria for ADHD 4, 5
Titration Schedule
- Increase by 5 mg weekly increments based on clinical response and tolerability 1, 3, 2
- Allow at least one full week between dose increases to properly evaluate therapeutic response 1, 3, 2
- Continue titration until symptoms are adequately controlled or side effects become problematic 4
- Maximum daily dose is 40 mg according to FDA labeling, though some guidelines suggest up to 50 mg in select cases 1, 2, 6
Weight-Based Considerations
- For children weighing less than 25 kg, single doses should not exceed 10 mg 1
- The 10 mg starting dose applies regardless of weight, but maximum doses are more restricted in smaller children 4
Monitoring Requirements
Before starting treatment:
- Obtain baseline blood pressure, pulse, height, and weight 4, 1
- Perform routine physical examination to screen for cardiac abnormalities 4
During titration:
- Assess ADHD symptoms using standardized rating scales from both teachers and parents 4
- Monitor for common side effects including decreased appetite, insomnia, headaches, and weight loss 1, 2
- Weekly contact (by phone or in-person) during initial titration phase 4, 1
- Weigh patients at each visit to monitor for appetite suppression 1, 2
Clinical Advantages of XR Formulation
- Once-daily dosing eliminates need for in-school administration, improving adherence and reducing potential for diversion 2, 7
- Extended duration of action provides symptom control throughout the school day and into homework hours 7, 5
- The XR formulation showed continued efficacy at 10.5 and 12 hours post-dose in analog classroom studies 7
Common Pitfalls to Avoid
- Do not start at doses higher than 10 mg - this leads to unnecessary side effects and poor medication adherence 1, 2
- Do not increase doses more frequently than weekly - insufficient time between increases prevents accurate assessment of therapeutic response 1, 3, 2
- Do not administer late in the day - this causes insomnia and sleep disturbances 1, 3, 2, 6
- Do not continue escalating beyond maximum recommended doses when ineffective - instead, consider switching to an alternative medication or adding psychosocial interventions 1, 2, 6
- Do not skip baseline cardiac screening - rare but serious cardiovascular events including myocardial infarction have been reported in adolescents taking amphetamine medications 8
When Maximum Dose Is Ineffective
- If 40 mg daily does not provide adequate symptom control, more is not better 1, 2
- Consider switching to an alternative stimulant medication (approximately 90% of children respond to either methylphenidate or amphetamine when both are tried) 4
- Reassess the diagnosis and evaluate for comorbid conditions affecting treatment response 1
- Add or intensify psychosocial and behavioral interventions 1, 2