What are the guidelines for midday dosing of Adderall (amphetamine and dextroamphetamine) for Attention Deficit Hyperactivity Disorder (ADHD)?

Adderall Midday Dosing for ADHD

Adderall can be dosed at midday (noon) if the morning dose does not provide adequate symptom control throughout the school or work day, with the midday dose typically given 4-6 hours after the first morning dose. 1, 2

Standard Dosing Schedule

The FDA-approved dosing regimen for Adderall involves giving the first dose upon awakening, with additional doses (1 or 2) administered at intervals of 4 to 6 hours. 2

• For children 6 years and older with ADHD, start with 5 mg once or twice daily, increasing by 5 mg weekly until optimal response is achieved 2
• The typical pattern is to start with a morning dose and add a noon dose if symptoms are not controlled through the entire school day 1
• A third dose after school (around 4 PM) may be added to help with homework and social activities 1
• Maximum daily dose rarely needs to exceed 40 mg in children, though some adults may require up to 40-50 mg total daily dose divided across multiple administrations 1, 3, 2

Clinical Evidence for Midday Dosing

Research demonstrates that twice-daily Adderall dosing (morning and midday) is not always necessary, as a single morning dose often provides coverage throughout the entire school day. 4

• A controlled study showed that one morning dose of Adderall (0.3 mg/kg) produced behavioral effects equivalent to twice-daily methylphenidate and lasted throughout the school-day period 4
• The duration of action increases with higher doses of Adderall, with peak effects and duration both dose-dependent 5
• Effects typically begin within 1.5 hours of administration and can last 6-8 hours or longer depending on dose 5

When to Add Midday Dosing

Add a midday dose when:

• Morning dose wears off before the end of the school/work day, as evidenced by return of ADHD symptoms in the afternoon 1
• Rating scales from teachers show poor afternoon performance despite adequate morning control 1
• The patient requires symptom coverage for homework, after-school activities, or evening driving (particularly relevant for adolescents) 1

Alternative to Midday Dosing

Before adding a midday dose, consider increasing the morning dose, as evidence shows this can extend duration of action. 1

• Titrate the morning dose upward in 5 mg increments weekly before resorting to multiple daily doses 1, 2
• Long-acting formulations (such as Adderall XR or lisdexamfetamine/Vyvanse) eliminate the need for midday dosing entirely and should be considered first-line to avoid school-based medication administration 1, 6

Monitoring Requirements

Obtain standardized ADHD rating scales from both parents and teachers before each dose adjustment to objectively guide titration decisions. 1

• Assess blood pressure, pulse, height, and weight at each visit, as stimulants affect cardiovascular parameters and growth 1, 6
• Rating scales can be collected via phone contact between visits if needed 1
• Document that higher total daily doses are necessary because lower doses failed to control symptoms and that the higher doses are not producing side effects (weight loss, blood pressure elevation, agitation) 1

Timing Considerations

Avoid late evening doses due to insomnia risk. 2

• The last dose should typically be given no later than 3:30-4:00 PM to minimize sleep disruption 1, 4
• If evening symptom coverage is needed (for homework or family activities), a smaller afternoon dose (0.15 mg/kg) may be preferable to a full dose 4

Special Populations

For adolescents, ensure medication coverage extends into late afternoon/evening hours to address driving safety concerns. 1

• Consider longer-acting preparations or strategic timing of short-acting afternoon doses for adolescents who drive 1
• Monitor adolescents closely for signs of medication diversion or misuse, as this is a particular concern in this age group 1