What is the recommended starting dose of Adderall XR (amphetamine and dextroamphetamine) for an adult patient who was previously on this medication?

Starting Dose of Adderall XR for Previously Treated Patients

For an adult patient who was previously on Adderall XR, restart at 10 mg once daily in the morning, regardless of their prior dose. 1, 2

Rationale for Standard Starting Dose

• The American Academy of Child and Adolescent Psychiatry recommends a starting dose of 10 mg once daily in the morning for Adderall XR, even in patients with prior exposure 1, 2
• This conservative approach applies whether the patient is treatment-naïve or returning to therapy after a period off medication 2
• Do not assume the patient's previous dose remains appropriate - tolerance may have changed, comorbidities may have evolved, and cardiovascular status should be reassessed 2

Titration Schedule After Restart

• Increase by 5 mg weekly increments based on clinical response and tolerability 1, 2
• Allow at least one week between dose increases to properly evaluate response 2
• The maximum recommended daily dose is 50 mg 1, 2
• During initial titration, maintain weekly contact by telephone with in-person visits at least monthly until symptoms are stabilized 2

Critical Baseline Assessment Before Restarting

• Measure blood pressure and pulse at baseline, as cardiovascular status may have changed since prior treatment 2
• Document current weight, as appetite suppression effects will need monitoring 2
• Reassess for any new contraindications, particularly active substance abuse disorder, which precludes prescribing Adderall XR 2
• Screen for any cardiovascular changes that occurred during the treatment gap 2

Monitoring Parameters During Titration

• Assess target ADHD symptoms and side effects (insomnia, anorexia, headaches, social withdrawal, tics, weight loss) at each visit 2
• Check blood pressure and pulse quarterly in adults 1, 2
• Weigh the patient at each visit to monitor for appetite suppression 2
• Use standardized ADHD rating scales when possible to objectively track response 1

Common Pitfalls to Avoid

• Starting at the patient's previous dose without reassessment - this bypasses necessary safety evaluation and may cause unnecessary side effects if tolerance has decreased 2
• Failing to administer the medication in the morning, which increases risk of sleep disturbances 2
• Not allowing sufficient time between dose increases to evaluate response 2
• Continuing to increase beyond 50 mg when ineffective - instead, consider switching to an alternative medication 1, 2

Duration of Action and Practical Considerations

• Adderall XR provides 12-hour duration of action with once-daily morning dosing 3
• The extended-release formulation is designed to reduce abuse potential compared to immediate-release formulations 1
• Long-acting formulations like Adderall XR are associated with longer treatment duration and better adherence than short-acting formulations 4