What is the typical dosage regimen for Adderall (amphetamine and dextroamphetamine) IR in adults and children with Attention Deficit Hyperactivity Disorder (ADHD)?

Most Common Adderall IR Dosage Regimen

For adults with ADHD, start Adderall IR at 5 mg once or twice daily in the early morning (with a noon dose if needed), then titrate upward in 5-10 mg weekly increments until symptoms are controlled, with most patients achieving optimal response between 40-60 mg total daily dose. 1

Starting Dose

• Begin with 5 mg once daily in the early morning, adding a noon dose if needed to cover the full functional day 1
• The lower starting dose minimizes initial side effects while allowing assessment of individual response 1
• Adults typically require more frequent dosing than children (2-3 doses daily with immediate-release formulations) to cover a longer functional day 1

Titration Protocol

• Increase the dose in 5-10 mg increments weekly based on symptom control and tolerability 1
• Maintain weekly contact by telephone during initial titration, which typically requires 2-4 weeks to reach optimal dosing 2
• Collect symptom ratings from the patient and significant others before each dose increase 1
• Systematically assess for side effects by asking specific questions about insomnia, anorexia, headaches, and weight loss 2

Target Dose Range

• Most adults achieve optimal response at total daily doses of 40-60 mg 1
• The maximum recommended dose is 40 mg for immediate-release amphetamine salts 1
• Clinical trial data shows 70% of patients respond positively at an average dose of 54 mg daily (administered in 2 divided doses) 3
• Some patients respond to relatively low doses (mean 10.77 mg/day in one study), though this represents suboptimal dosing for most patients 4

Dosing Schedule Considerations

• Morning administration is essential to minimize sleep disturbances 1
• Immediate-release formulations typically require 2-3 doses daily to maintain coverage throughout the functional day 1
• Amphetamines have greater effects on appetite and sleep compared to methylphenidate due to longer excretion half-lives 1

Critical Monitoring Requirements

• Before initiating treatment, obtain baseline blood pressure, pulse, height, and weight in the context of a physical examination 1
• During titration, monitor blood pressure and pulse at each dose adjustment 1
• Use standardized ADHD rating scales to objectively track response 1
• Monitor weight regularly as weight loss is a common side effect 2

When Higher Doses Are Needed

• If approaching or exceeding standard maximum doses, clearly document that symptoms could not be controlled at lower doses and that higher doses are not producing intolerable side effects 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
• If adequate symptom control is not achieved at maximum dose, consider alternative treatments or adding non-stimulant medications 2

Common Pitfalls to Avoid

• Starting at too high a dose leads to unnecessary side effects and decreased medication adherence 1
• Failing to systematically assess both benefits and side effects during titration 1
• Not allowing sufficient time (typically 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

Special Populations

• Screen for substance abuse disorder, as prescribing psychostimulants to adults with comorbid substance abuse requires particular caution 5
• Adderall may precipitate anxiety in vulnerable individuals with comorbid anxiety disorders 4
• Adults with ADHD are unreliable reporters of their own behaviors; obtain collateral information from family members or close contacts when possible 5