How are 30 mg tablets of Adderall (amphetamine and dextroamphetamine) prescribed for an adult patient with Attention Deficit Hyperactivity Disorder (ADHD), either once or twice daily?

Adderall 30 mg Dosing for Adult ADHD

For adults with ADHD, Adderall 30 mg tablets should be prescribed as twice-daily dosing (15 mg in the morning and 15 mg at midday), though once-daily dosing may be sufficient for some patients depending on symptom coverage needs and individual response. 1

Standard Dosing Approach

Twice-Daily Dosing (Preferred Initial Strategy)

• Start with divided dosing: The FDA label recommends administering amphetamines in divided doses throughout the day, with the first dose given upon awakening and additional doses at 4-6 hour intervals. 1
• For a 30 mg total daily dose: This translates to 15 mg in the morning and 15 mg at noon/early afternoon to provide coverage throughout the working day. 2
• Avoid late evening doses: Late dosing should be avoided due to resulting insomnia. 1

Once-Daily Dosing (Alternative for Select Patients)

• Some patients may require only once-daily dosing: The American Academy of Child and Adolescent Psychiatry notes that children treated with amphetamines may require only once-a-day dosing, and this principle can extend to adults with shorter coverage needs. 2
• Consider once-daily if: The patient has a shorter workday, experiences intolerable rebound effects with divided dosing, or achieves adequate symptom control with morning-only administration. 2

Titration to 30 mg

Starting Point

• Begin at 5-10 mg daily: Adults should start with 5 mg of amphetamine, with titration upward in 5-10 mg intervals each week until symptoms are controlled. 2
• Initial divided dosing: Start with 5 mg twice daily (morning and midday) to assess tolerability. 3

Reaching 30 mg

• Weekly increases: Increase by 5-10 mg increments weekly based on clinical response and side effect profile. 2
• Typical progression: 5 mg BID → 10 mg BID → 15 mg BID (30 mg total daily dose). 2
• Response assessment: The mean effective dose in clinical trials ranged from 10.77 mg/day for low-dose responders to 54 mg/day for standard responders, indicating 30 mg falls in the mid-therapeutic range. 3, 4

Monitoring Requirements

During Titration

• Weekly contact: Maintain telephone or office contact during initial titration to assess response and side effects. 5
• Systematic side effect assessment: Specifically ask about insomnia, decreased appetite, headaches, weight loss, anxiety, and cardiovascular symptoms at each contact. 5, 6
• Rating scales: Use standardized ADHD rating scales from the patient and significant others to objectively track response. 5

After Stabilization at 30 mg

• Monthly follow-up: Schedule appointments at least monthly to assess ongoing efficacy, side effects, and vital signs. 5, 7
• Cardiovascular monitoring: Check blood pressure and pulse at each visit, as stimulants can affect these parameters. 7
• Weight monitoring: Track weight regularly as weight loss is a common side effect. 5

Clinical Considerations at 30 mg

Efficacy Expectations

• Moderate therapeutic dose: 30 mg total daily dose represents a moderate therapeutic dose, below the typical maximum of 40-60 mg/day for adults. 2, 1
• Response rate: Approximately 54-70% of adults respond positively to amphetamine salts at therapeutic doses. 3, 4
• Symptom reduction: Expect approximately 42% reduction in ADHD symptom severity at effective doses. 4

Common Pitfalls

• Anxiety precipitation: Amphetamines may precipitate acute anxiety in vulnerable individuals, particularly those with comorbid anxiety disorders (occurred in 4 of 7 patients with anxiety in one study). 3
• Inadequate coverage: If twice-daily dosing doesn't provide adequate coverage for a full workday, consider adding a small afternoon dose (e.g., 10 mg AM, 10 mg midday, 10 mg mid-afternoon) rather than switching to once-daily. 2
• Tolerance monitoring: Document clearly if higher doses are needed, ensuring symptoms couldn't be controlled at lower doses and higher doses aren't producing side effects like weight loss, blood pressure increase, or agitation. 2

When 30 mg Is Insufficient

• Maximum doses: Adults may require up to 0.9 mg/kg of amphetamine or 40 mg total daily dose, though some may need up to 60 mg for narcolepsy. 2, 1
• Alternative strategies: If 30 mg doesn't provide adequate control, increase in 10 mg increments weekly, consider switching to extended-release formulations for smoother coverage, or add non-stimulant medications as adjunctive therapy. 2, 8