What is the recommended dosing for Adderall (amphetamine and dextroamphetamine) Extended Release (ER)?

Adderall Extended-Release (ER/XR) Dosing

Start Adderall XR at 10 mg once daily in the morning, titrate by 5 mg weekly increments based on response, up to a maximum of 40-50 mg daily. 1, 2, 3

Starting Dose

• Begin with 10 mg once daily in the morning for all patients aged 6 years and older 1, 2, 3
• Morning administration is critical to minimize sleep disturbances 1, 3
• For children under 6 years, Adderall XR is not typically recommended; if needed, consider starting with immediate-release formulation at 2.5 mg 4, 5

Titration Schedule

• Increase by 5 mg weekly if symptom control is inadequate 1, 2, 3
• Allow a full week between dose adjustments to properly evaluate therapeutic response 1, 3
• Weekly telephone contact is acceptable during initial titration, with in-person visits at least monthly until symptoms stabilize 4, 1, 3
• The titration phase typically requires 2-4 weeks 4

Maximum Dose

• The maximum recommended daily dose is 40-50 mg according to current American Academy of Child and Adolescent Psychiatry guidelines 1, 2, 3
• The FDA label states 40 mg maximum, but more recent expert consensus supports up to 50 mg 4, 1, 2
• For children weighing less than 25 kg, single doses should not exceed 10 mg 1, 2, 3

Monitoring Requirements

Baseline Assessment

• Measure blood pressure, pulse, height, and weight before initiating treatment 1, 3

Ongoing Monitoring

• Weigh the patient at each visit to detect appetite suppression objectively 4, 1, 3
• Check blood pressure and pulse quarterly in adults 4, 1, 2, 3
• Systematically assess target ADHD symptoms using parent and teacher reports (rating scales when possible) 4, 1, 3
• Evaluate specific side effects at each visit: insomnia, anorexia, headaches, social withdrawal, tics, and weight loss 4, 1, 3

Special Populations

Older Adults

• Consider more conservative titration: increase by 5 mg every 2 weeks instead of weekly 1, 3
• May require starting dose of 2.5 mg (not available in XR formulation; use immediate-release) 1
• Older adults are more sensitive to both therapeutic and adverse effects due to age-related pharmacokinetic changes 1, 3

Children Under 25 kg

• Single doses generally should not exceed 10 mg 1, 2, 3

Critical Pitfalls to Avoid

• Starting too high causes unnecessary side effects and decreases adherence—always begin at 10 mg 1, 3
• Inadequate time between dose increases—allow one full week to evaluate response before advancing 1, 3
• Failing to monitor systematically—both benefits and side effects must be assessed at each dose adjustment 4, 3
• Exceeding maximum dose when ineffective—if 40-50 mg provides no benefit, switch medications rather than increasing further 4, 1, 2, 3

When Maximum Dose Fails

• If the maximum recommended dose (40-50 mg) does not provide adequate symptom control, do not increase further 1, 2, 3
• More medication is not necessarily better beyond the maximum dose 4, 1
• Switch to an alternative stimulant (e.g., methylphenidate) or consider non-stimulant medications 1, 2, 3
• Reevaluate the diagnosis and assess for comorbid conditions affecting treatment response 1, 3
• Consider adding environmental or psychosocial interventions 4, 1, 3

Duration of Action

• Adderall XR provides symptom control for approximately 10-12 hours, eliminating the need for in-school administration 6, 7
• The extended-release formulation is designed to reduce abuse potential compared to immediate-release 2