What is the recommended daily dosage of Dexedrine Spansules (dextroamphetamine sulfate) for patients aged ≥ 12 years and how should it be titrated for children aged 6–11 years?

Maximum Daily Dose of Dexedrine Spansules

For patients aged 12 years and older, the maximum daily dose of Dexedrine Spansules is 60 mg per day, though doses rarely need to exceed 40 mg daily for ADHD; for children aged 6–11 years, start with 5 mg daily and titrate by 5 mg weekly increments until optimal response is achieved, rarely exceeding 40 mg total daily dose. 1

Dosing by Age Group

Children Ages 6–11 Years

• Initial dose: 5 mg once daily upon awakening 1
• Titration: Increase by 5 mg increments at weekly intervals until optimal symptom control is achieved 1
• Maximum dose: Only in rare cases will it be necessary to exceed 40 mg per day total 1
• Dosing schedule: Give first dose on awakening; if needed, give 1–2 additional doses at 4–6 hour intervals 1

Patients Ages 12 Years and Older

• Initial dose: 10 mg daily upon awakening 1
• Titration: Increase by 10 mg increments at weekly intervals until optimal response is obtained 1
• Usual dose range: 5 mg to 60 mg per day in divided doses, depending on individual patient response 1
• Maximum dose: The FDA label allows up to 60 mg daily for narcolepsy, though clinical guidelines for ADHD consistently recommend not exceeding 40 mg daily 2, 3, 1

Critical Maximum Dose Considerations

The 40 mg Daily Ceiling for ADHD

• The American Academy of Child and Adolescent Psychiatry establishes 40 mg per day as the maximum total daily dose for amphetamines in ADHD treatment, serving as the regulatory standard 2, 3
• Clinical practice consensus consistently limits the upper range to 40 mg total daily dose when treating ADHD 2, 3
• Exceeding 40 mg does not necessarily provide additional therapeutic benefit 2

Weight-Based Restrictions

• For children weighing less than 25 kg, individual doses should not exceed 10 mg to avoid excessive exposure 2, 3
• Extra caution is required during titration for children weighing less than 20 kg, and consider omitting the 15–20 mg dosage steps 2

When Higher Doses Are Considered

• Doses may rarely exceed 40 mg, but this requires specific documentation that symptoms could not be controlled at lower doses and that higher doses are not producing significant side effects 2, 3
• Monitor for signs of tolerance when using higher doses 3
• If 40 mg daily does not provide adequate symptom control, consider switching to an alternative stimulant medication or adding non-stimulant options rather than further dose escalation 2, 3
• Nearly 90% of children will respond if both methylphenidate and amphetamine stimulants are tried 2, 3

Mandatory Monitoring Requirements

Cardiovascular Monitoring

• Blood pressure and heart rate must be measured at each visit, especially as the dose is increased, because amphetamines produce α-adrenergic vasoconstriction and β-adrenergic cardiac stimulation 2
• Cardiovascular assessment is required at higher doses to detect hypertension and tachycardia 2

Growth and Weight Monitoring

• Weight should be recorded at every appointment to objectively evaluate appetite suppression, one of the most frequent adverse effects 2
• Height should be assessed at each visit as stimulants can affect growth parameters 2

Systematic Side Effect Assessment

• At each follow-up, systematically inquire about insomnia, reduced appetite, headaches, irritability, and mood changes 2
• During initial titration (generally 2–4 weeks), maintain weekly contact by telephone or in-person visit to monitor response and side effects 2
• If bothersome adverse reactions appear (e.g., insomnia or anorexia), reduce the dosage 1

Clinical Pearls for Dexedrine Spansules

Duration of Action

• Dexedrine Spansules demonstrate sustained effects lasting 3–6 hours longer than immediate-release formulations, with improvements in behavior ratings and locomotor activity up to 12 hours after single doses 4
• The extended-release formulation shows less robust morning effects compared to immediate-release preparations but provides more sustained afternoon coverage 4

Dosing Schedule

• Avoid late evening doses because of resulting insomnia 1
• The sustained-release formulation allows for once-daily dosing in many patients, though some may require additional doses at 4–6 hour intervals 1

Drug Holidays

• Where possible, interrupt drug administration occasionally to determine if there is a recurrence of behavioral symptoms sufficient to require continued therapy 1