Adderall 15 mg Dosing in Adult ADHD Titration
No, the 15 mg dose is NOT skipped in adult ADHD titration protocols—adults should titrate upward in 5-10 mg increments weekly, which means 15 mg is a standard intermediate dose between 10 mg and 20 mg. 1
Standard Adult Titration Protocol
For adults with ADHD, the American Academy of Child and Adolescent Psychiatry recommends starting at 5 mg of amphetamine/dextroamphetamine and increasing in 5-10 mg increments each week until symptoms are controlled. 1
Key Differences from Pediatric Protocols
The confusion about skipping 15 mg likely stems from pediatric protocols, where this dose is specifically omitted in children weighing less than 45 pounds (20 kg). 1 However, this weight-based restriction does not apply to adults or older adolescents.
Adults follow a more flexible titration schedule: 1
- Start at 5 mg once or twice daily
- Increase by 5-10 mg increments weekly
- Continue until optimal symptom control is achieved
- This naturally includes 15 mg as a valid intermediate dose
Target Dose Range for Adults
Most adults achieve optimal response at total daily doses of 40-60 mg, though the maximum recommended dose is 40 mg for immediate-release amphetamine salts. 2 Some adult patients may require up to 0.9 mg/kg of amphetamine/dextroamphetamine or 40 mg total daily dose. 1
Clinical Trial Evidence
Research supports flexible dosing in adults. A controlled trial demonstrated efficacy at an average dose of 54 mg daily (administered in two doses), with titration up to 30 mg twice daily. 3 Long-term studies have shown sustained benefit with doses ranging from 20-60 mg daily over 24 months. 4
Monitoring During Titration
Before each dose increase, systematically collect symptom ratings from the patient and significant others, and assess for side effects including insomnia, decreased appetite, blood pressure changes, and agitation. 1, 2
Required Assessments
- Baseline blood pressure, pulse, height, and weight before starting treatment 1
- Blood pressure and pulse monitoring at each dose adjustment 2
- Quarterly vital sign checks during maintenance treatment 1
- Standardized ADHD rating scales to objectively track response 2
Common Pitfalls to Avoid
Starting at too high a dose leads to unnecessary side effects and decreased adherence. 2 The 5 mg starting dose minimizes initial adverse effects while allowing assessment of individual response. 2
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 (weight loss, blood pressure increase, or agitation). 1, 2
Adults typically require more frequent dosing than children to cover a longer functional day—immediate-release formulations may need 2-3 doses daily. 2 These higher total daily doses are reached because adults need more dosings to cover a longer day, not because they require higher individual doses. 1
When to Stop Escalating
If adequate symptom control is not achieved at the maximum dose, consider switching medications or adding non-stimulant options rather than continuing to escalate. 2 Approximately 70% of patients respond to a single stimulant, and nearly 90% will respond if both amphetamine and methylphenidate formulations are tried. 1