What is the starting dose of Adderall (amphetamine and dextroamphetamine) IR for an adult female with Attention Deficit Hyperactivity Disorder (ADHD)?

Starting Dose for Adderall IR in Adult Females with ADHD

For immediate-release Adderall in adult females with ADHD, start with 5 mg twice daily (total 10 mg/day), then titrate upward by 5 mg increments weekly based on response and tolerability. 1, 2

Initial Dosing Strategy

• Begin with 5 mg twice daily of immediate-release Adderall rather than the 10 mg once-daily starting dose recommended for extended-release formulations 1, 2

• Administer doses in the morning and early afternoon to minimize sleep disturbances, avoiding late-day dosing 1

• The immediate-release formulation allows for more flexible dosing adjustments compared to extended-release products, which is particularly useful during initial titration 2

Titration Protocol

• Increase the dose by 5 mg increments weekly (e.g., 5 mg BID → 10 mg BID → 15 mg BID) based on symptom control and side effect profile 1

• Assess both therapeutic response and adverse effects before each dose increase using standardized ADHD rating scales 1

• Allow at least one week between dose adjustments to properly evaluate response at each dose level 1

• The typical effective dose range in clinical trials was 54 mg/day (administered as 27 mg twice daily), though individual needs vary 3

Monitoring Requirements

• Check blood pressure and pulse at baseline and with each dose increase, as stimulants predictably elevate these parameters 1

• Use standardized ADHD rating scales (such as the Conners' Adult ADHD Rating Scale) to objectively track symptom improvement 1, 3

• Schedule follow-up appointments at least monthly until symptoms are stabilized 1

Common Pitfalls to Avoid

• Do not start at excessively high doses (e.g., 20-30 mg BID initially), as this increases side effects and reduces medication adherence 1

• Avoid dosing too late in the day, which commonly causes insomnia—the last dose should typically be given no later than early afternoon 1

• Do not increase doses too rapidly without allowing adequate time to assess response; premature escalation can lead to unnecessary side effects 1

• Ensure the patient is taking the medication consistently before concluding it is ineffective and increasing the dose 1

Sex-Specific Considerations

• While the evidence does not indicate different starting doses for females versus males, the American College of Obstetricians and Gynecologists provides specific guidance for women of reproductive age regarding pregnancy planning and contraception counseling when initiating stimulant therapy 4

• If the patient is pregnant or planning pregnancy, discuss the risk-benefit profile, including the small increased risks for gastroschisis (aOR 3.0) and preeclampsia (aRR 1.29), balanced against the risks of untreated ADHD 4

Maximum Dosing

• The maximum recommended daily dose is 50 mg for adults, though most patients respond to lower doses 1

• If inadequate response occurs at maximum dosing or intolerable side effects develop, consider switching to a different stimulant formulation or adding a non-stimulant medication like atomoxetine 1