What is the recommended dosing for Adderall (amphetamine and dextroamphetamine) in an adult?

Adderall Dosing for Adults with ADHD

For adults with ADHD, start Adderall at 5 mg twice daily (morning and noon) and titrate by 5 mg increments weekly until optimal symptom control is achieved, with a maximum total daily dose of 40 mg. 1, 2

Starting Dose

• Begin with 5 mg of immediate-release amphetamine/dextroamphetamine given twice daily (morning after breakfast and around noon after lunch) 1
• The FDA label confirms this 5 mg starting approach for immediate-release formulations 2
• For extended-release formulations (Adderall XR), start at 20 mg once daily in the morning 3

Titration Schedule

• Increase the dose in weekly increments of 2.5 to 5 mg per dose if symptom control is not achieved 1
• Allow at least one week between dose adjustments to properly evaluate response 1, 4
• Use standardized ADHD rating scales to objectively assess response before each dose increase 4

Maximum Dose

• The regulatory maximum total daily dose is 40 mg per day for amphetamines 1, 5, 4
• Most adults achieve optimal symptom control at total daily doses between 40-60 mg, though the standard maximum remains 40 mg 4
• Doses may rarely exceed 40 mg only when symptoms cannot be controlled at lower doses and higher doses produce no intolerable side effects, but this requires specific documentation 5, 4
• If 40 mg total daily dose does not provide adequate symptom control, switch to an alternative stimulant (such as methylphenidate) rather than increasing the dose further 5, 4

Dosing Schedule for Adults

• Immediate-release formulations require 2-3 doses daily (morning, noon, and potentially late afternoon) to cover a longer adult workday 1, 4
• Extended-release formulations are dosed once daily in the morning 3
• Avoid late evening doses to prevent insomnia 2
• Morning administration is essential regardless of formulation 4

Monitoring Requirements

• Check blood pressure and pulse quarterly during maintenance therapy 1
• Assess weight at every visit to detect appetite suppression 4
• Systematically evaluate both target ADHD symptoms and side effects at each visit 1, 4
• Use standardized ADHD rating scales and self-ratings from the adult patient 1, 4

Clinical Response Data

• Long-term studies demonstrate sustained symptomatic improvement for up to 24 months with MAS XR 20-60 mg/day in adults 3
• Approximately 70% of patients respond to either amphetamine or methylphenidate alone, but nearly 90% will respond if both stimulants are tried 5, 4
• Some adults respond to relatively low doses (mean 10.77 mg/day in one study), though this represents a subset of responders 6

Common Pitfalls to Avoid

• Starting at too high a dose leads to unnecessary side effects—always begin at 5 mg and titrate gradually 1, 4
• Continuing to escalate dose when symptom control plateaus—if 40 mg provides minimal benefit, switching medications is more appropriate than further increases 5, 4
• Failing to allow sufficient time between dose increases—wait at least one week to properly evaluate response 1, 4
• Inadequate monitoring—systematic assessment using standardized rating scales is required at each dose adjustment 1, 4

Special Considerations

• Patients with comorbid anxiety may experience acute anxiety symptoms on amphetamines and may require alternative treatment 6
• The most common adverse events in adults are dry mouth (43%), insomnia (32%), anorexia/decreased appetite (32%), headache (30%), and nervousness (26%) 3
• Most adverse events are mild to moderate in intensity 3