Most Common Maintenance Dose of Adderall for Adult ADHD
The most common maintenance dose of Adderall (mixed amphetamine salts) for adults with ADHD is 20 mg twice daily (40 mg total daily dose), not 15 mg twice daily. 1, 2
Evidence Supporting 20 mg BID as Standard Maintenance Dose
The 2002 American Academy of Child and Adolescent Psychiatry practice parameter explicitly outlines a titration protocol showing 20 mg (of dextroamphetamine/amphetamine) dosed twice daily as the final titration step in their standardized dosing table, with maximum daily doses for adults reaching up to 40 mg for DEX/AMP. 1
Adults typically require total daily doses of 10-50 mg of mixed amphetamine salts for optimal symptom control, with many patients needing 20-40 mg daily. 2 The titration protocol starts at 2.5 mg BID and progresses through 5 mg BID, 7.5 mg BID, and culminates at 10 mg BID (20 mg total per dose, 40 mg daily) as the standard maximum in the initial titration phase. 1
Clinical Trial Data Confirming Dosing Patterns
A 24-month open-label extension study of MAS XR enrolled 223 adults who started at 20 mg/day and titrated up to 60 mg/day for optimal therapeutic effects, demonstrating that 20 mg represents a common starting point for maintenance dosing. 3
In a controlled crossover trial, the average effective oral dose was 54 mg administered in 2 daily doses (approximately 27 mg BID), with medication titrated up to 30 mg twice daily maximum. 4 This further supports that maintenance doses commonly exceed 15 mg BID and cluster around 20-30 mg BID.
Dosing Algorithm for Adults
Start with 5 mg of amphetamine salts, titrating upward in 5-10 mg intervals each week until symptoms are controlled. 1 The progression typically follows:
- Week 1: 5 mg BID (10 mg daily)
- Week 2: 10 mg BID (20 mg daily)
- Week 3: 15 mg BID (30 mg daily)
- Week 4: 20 mg BID (40 mg daily) - most common maintenance dose 1, 2
Maximum daily doses for adults generally reach 40 mg for amphetamine salts, though some patients may require up to 0.9 mg/kg or 65 mg total daily dose with clear documentation that lower doses were insufficient. 1
Why 20 mg BID Rather Than 15 mg BID
The standardized titration table in the AACAP guidelines omits 15 mg as a dosing step entirely, progressing directly from 10 mg to 20 mg doses. 1 This reflects clinical practice patterns where 20 mg BID represents the therapeutic target for most adults requiring higher-dose stimulant therapy. 2
Response rates of 70-80% are achieved when stimulants are properly titrated, and clinical trials consistently demonstrate that effective doses cluster around 40-60 mg total daily (20-30 mg BID). 3, 4, 5
Critical Monitoring During Titration
Obtain weekly symptom ratings during dose adjustment, specifically assessing ADHD symptom control, side effects like insomnia or appetite suppression, and cardiovascular parameters (blood pressure and pulse). 1, 2
If the patient shows room for improvement at 20 mg BID without prohibitive side effects, further titration to 25-30 mg BID may be appropriate, as maximum doses can reach 60 mg daily in clinical practice. 1, 3