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

Adderall Dosing Recommendations

Starting Doses

For immediate-release (IR) Adderall, start with 5 mg twice daily in adults or 2.5 mg twice daily in children, given after breakfast and lunch; for extended-release (XR) formulation, start with 10 mg once daily in the morning. 1

• Morning administration is strongly recommended to minimize sleep disturbances 1
• Children may require the lower 2.5 mg starting dose, which often necessitates cutting a 5 mg tablet 2
• XR formulations are designed to reduce abuse potential compared to IR formulations 2

Titration Protocol

Increase the dose in 5-10 mg weekly increments for IR formulations or 5 mg weekly increments for XR formulations based on clinical response and tolerability. 3, 1

• Allow at least one full week between dose increases to properly evaluate response 1
• During initial titration, maintain weekly contact (can be by telephone), with in-person visits at least monthly until symptoms stabilize 1
• For older or frail patients, use a more conservative titration schedule of 5 mg increases every 2 weeks instead of weekly 1

Maximum Dosing

The maximum total daily dose is 40-50 mg for both IR and XR formulations according to current American Academy of Child and Adolescent Psychiatry guidelines. 1, 2

• The Physician's Desk Reference lists 40 mg as the maximum 1
• More recent guidelines suggest up to 50 mg daily for adults 1, 2
• For children weighing less than 25 kg, single doses should not exceed 10-15 mg 1, 2
• Adult doses may be calculated up to approximately 1.0 mg/kg per day 2

Critical Dosing Principle

If the maximum recommended dose does not provide adequate symptom control, do not exceed these limits—instead, switch to an alternative stimulant medication or add non-stimulant options. 3, 1, 2

• Exceeding recommended doses does not necessarily provide additional therapeutic benefit 3
• Higher doses increase cardiovascular risks (hypertension, tachycardia), tolerance, and dependence 3
• Consider adding environmental or psychosocial interventions 3

Monitoring Requirements

Check blood pressure and pulse at baseline and regularly during treatment (quarterly for adults), and monitor weight at each visit to assess for appetite suppression. 1, 2

• Baseline assessment should include blood pressure, pulse, height, and weight 1
• Systematically assess both target ADHD symptoms and side effects (insomnia, anorexia, headaches, social withdrawal, tics, weight loss) 1
• Use standardized ADHD rating scales when possible to evaluate efficacy 2

Common Pitfalls to Avoid

• Starting at too high a dose, which leads to unnecessary side effects and decreased adherence 1
• Failing to allow sufficient time between dose increases to properly evaluate response 1
• Not systematically assessing both benefits and side effects during titration 1
• Continuing to increase doses beyond maximum recommendations when ineffective—this increases risks without additional benefit 3, 1
• Overlooking morning administration timing, which is critical to minimize sleep disturbances 1

Special Populations and Considerations

• Avoid prescribing Adderall XR to adults with active substance abuse disorder due to abuse potential 1
• Older adults are more sensitive to both therapeutic and adverse effects due to age-related pharmacokinetic changes 1
• Never crush Adderall XR capsules or tablets, as this destroys the sustained-release mechanism and can result in dangerous immediate release of the full dose 2
• IR tablets can be safely cut for dose titration when finding the optimal therapeutic dose 2
• If crushing IR tablets is necessary for patients who cannot swallow pills, mix with a small amount of soft food immediately before administration and consume the entire dose promptly 2