From the Guidelines
Titration of extended-release Adderall should begin with a low dose of 5-10 mg once daily in the morning, with gradual increases of 5-10 mg weekly until optimal symptom control is achieved or side effects become problematic, as recommended by the most recent guidelines 1. The goal of titration is to achieve maximum benefit with minimum adverse effects, and this approach is supported by strong recommendations from clinical practice guidelines 1. When titrating extended-release Adderall, it is essential to monitor patients for effectiveness in improving focus, attention, and executive function, as well as for potential side effects like increased heart rate, blood pressure, insomnia, decreased appetite, and anxiety. Some key points to consider during titration include:
- Starting with a low dose and gradually increasing it to minimize side effects
- Monitoring patients regularly to assess vital signs, weight, and mental health status
- Adjusting the dose based on individual patient response and tolerability
- Considering the use of extended-release formulations, such as Adderall XR, which provide approximately 12 hours of coverage and reduce the need for multiple daily doses. The primary care clinician should work closely with the patient to titrate doses and achieve optimal symptom control, as recommended by clinical practice guidelines 1. Regular follow-up appointments should be scheduled to assess the patient's response to treatment and make any necessary adjustments to the dose or treatment plan. By following this approach, clinicians can help patients with ADHD achieve optimal symptom control while minimizing the risk of adverse effects. It is also important to note that the maximum recommended daily dose is 60 mg for adults, though most patients respond to 20-40 mg daily, and that the extended-release formulation contains mixed amphetamine salts that are released in two phases, providing more consistent coverage throughout the day 1.
From the Research
Titration of Extended Release Adderall
- The pharmacokinetic properties of extended-release Adderall (SLI381) were assessed in a study published in the Journal of the American Academy of Child and Adolescent Psychiatry 2.
- The study found that SLI381 showed extended time to maximum concentration (Tmax) values compared with Adderall, making it suitable for once-daily dosing.
- However, the study also noted substantial intersubject variability in pharmacokinetic parameters, highlighting the need for individual dose titration.
- The d- and l-isomer concentrations of SLI381 were highly correlated and approximated a 3:1 ratio.
Key Findings
- A study published in The lancet. Psychiatry found that amphetamines, including extended-release Adderall, led to increments in haemodynamic values in children and adolescents, adults, or both 3.
- Another study published in The Annals of pharmacotherapy found that lisdexamfetamine, mixed amphetamine salts, and methylphenidate were effective in reducing ADHD symptoms in adults, with lisdexamfetamine showing the largest effect size 4.
- A review published in Brain and behavior discussed the misuse of prescription stimulants, including extended-release Adderall, and the associated risks of adverse effects, including psychosis, myocardial infarction, and sudden death 5.
- A study published in Psychiatry (Edgmont (Pa. : Township)) found that common side effects of ADHD medications, including extended-release Adderall, included loss of appetite, sleep problems, and mood disturbances, with only 21% of side effects considered very bothersome or extremely bothersome 6.