Adderall XR Dosing Recommendations
Start Adderall XR at 10 mg once daily in the morning, titrate by 5 mg weekly increments based on response and tolerability, up to a maximum of 50 mg daily. 1
Starting Dose
- Begin with 10 mg orally once daily in the morning for all patients regardless of age (adults, adolescents, and children over 6 years) 1, 2
- Administer in the early morning to minimize sleep disturbances 1, 3
- Adult dosing is not weight-based for ADHD treatment 2
Titration Schedule
- Increase by 5 mg weekly increments if symptoms are not adequately controlled and the medication is well-tolerated 1, 2
- Allow at least one week between dose increases to properly evaluate therapeutic response and side effects 2, 3
- Continue titration until optimal symptom control is achieved or dose-limiting side effects occur 1
Maximum Doses
- Adults: 50 mg daily maximum 1, 2
- Adolescents (13-17 years): 40 mg daily maximum in controlled trials, though 50 mg may be used in clinical practice 4
- Children: 40 mg daily maximum for those weighing >25 kg; lower maximum (35 mg) for children <25 kg 1
Monitoring Requirements
- Obtain ADHD rating scales from teachers and parents (for children) or from the patient and significant other (for adults) before each dose increase 1, 2
- Assess vital signs (blood pressure and pulse) at baseline and with each dose adjustment, as stimulants can elevate cardiovascular parameters 1, 2, 3
- Monitor weight regularly, as decreased appetite and weight loss are common side effects 1, 2, 3
- Systematically evaluate for side effects including insomnia, irritability, decreased appetite, headache, and abdominal pain 1, 2, 4
Duration of Action
- Adderall XR provides 12-hour duration of action with once-daily dosing 5
- The extended-release formulation shows a delayed time to maximum concentration (Tmax) of approximately 3 hours longer than immediate-release formulations 6
- A single morning dose maintains behavioral effects throughout the entire school day period 7
Common Pitfalls to Avoid
- Do not use weight-based dosing for adults, as this approach is not supported by evidence and may lead to inappropriate dosing 2
- Do not administer doses late in the day, as this causes insomnia 2, 3
- Do not increase doses too rapidly without allowing sufficient time (at least one week) to evaluate response 2, 3
- Do not exceed maximum recommended doses (50 mg for adults, 40 mg for adolescents/children); if inadequate response at maximum dose, consider switching to an alternative stimulant rather than exceeding limits 1, 3
- Do not rely solely on subjective reports—use standardized ADHD rating scales to objectively guide treatment decisions 2
Special Populations
Pregnancy and Lactation
- Usual starting dose remains 10 mg once daily in the morning, titrated by 5 mg weekly up to 50 mg maximum 1
- Amphetamines do not appear to be associated with major congenital malformations, though there may be small increased risks for gastroschisis, preeclampsia, and preterm birth 1
- Hale lactation risk category: L3 1
- Monitor breastfed infants carefully for irritability, insomnia, and feeding difficulty 1
Treatment-Naive vs. Previously Treated Patients
- The same starting dose (10 mg) and titration schedule (5 mg weekly) apply regardless of prior stimulant exposure 1, 4
- When switching from another stimulant (e.g., methylphenidate), discontinue the previous medication abruptly without tapering and start Adderall XR at 10 mg—no direct dose equivalency exists between methylphenidate and amphetamine salts 8