Adzenys XR-ODT Adult Dosing for ADHD
Initial Dosing
Start Adzenys XR-ODT at 12.5 mg once daily in the morning, as this represents the standard initial dose for amphetamine extended-release formulations in adults with ADHD. 1
- The morning administration is essential to minimize sleep disturbances, which are common with amphetamine formulations due to their longer half-lives compared to methylphenidate 1
- Lower starting doses minimize initial side effects while allowing assessment of individual response 1
Titration Protocol
Increase the dose in 6.3 mg to 12.5 mg increments weekly based on symptom control and tolerability. 1
- Maintain weekly contact during initial titration to assess response and side effects 2
- Collect standardized ADHD rating scales from the patient and significant others before each dose increase to objectively track response 2, 3
- Systematically assess for specific stimulant side effects at each dose adjustment, including insomnia, anorexia, headaches, weight loss, dry mouth, palpitations, and tachycardia 3, 4
- Continue titration until optimal symptom control is achieved, which typically requires 2-4 weeks 2
Target Maintenance Dose Range
Most adults achieve optimal response at total daily doses of 40-60 mg of amphetamine salts. 1
- For Adzenys XR-ODT specifically, the therapeutic range extends up to 18.8 mg daily, though some patients may require higher doses within the amphetamine class maximum of 60 mg 1, 5
- The maximum recommended dose for extended-release amphetamine formulations is 50-60 mg daily for adults 1, 5
Critical Monitoring Requirements
Before initiating treatment, obtain baseline blood pressure, pulse, height, and weight in the context of a physical examination. 1
- Monitor blood pressure and pulse at each dose adjustment 1
- Monitor weight regularly as weight loss is a common side effect of stimulant medications 2
- Schedule follow-up appointments at least monthly after stabilization to assess ongoing efficacy, side effects, and growth parameters 2
When Adequate Response Is Not Achieved
If adequate symptom control is not achieved at the maximum dose, consider alternative treatments or adding non-stimulant medications rather than exceeding the maximum dose. 2, 3
- Document clearly that symptoms could not be controlled at lower doses before considering alternative approaches 3, 1
- Consider that more is not necessarily better—if the top recommended dose doesn't help, a change in medication or addition of psychosocial interventions may be required 1
- Lisdexamfetamine should be the preferred next option over non-stimulants if no desired benefit is observed after adequate treatment with amphetamine salts 2
Common Pitfalls to Avoid
- Starting at too high a dose leads to unnecessary side effects and decreased adherence 2, 1
- Failing to systematically assess both benefits and side effects during titration 2, 1
- Not allowing sufficient time (at least 1 week) between dose increases to evaluate response 1
- Overlooking the importance of morning administration, which increases sleep disturbances when ignored 1
- Continuing to escalate dose when symptom control plateaus—consider switching medications instead 1
- Amphetamines have greater effects on appetite and sleep compared to methylphenidate, requiring closer monitoring of these parameters 1