What is the standard dose of extended‑release Adderall (mixed amphetamine salts) for an adult with ADHD?

Standard Dosing of Extended-Release Adderall for Adult ADHD

For adults with ADHD, start extended-release Adderall (mixed amphetamine salts XR) at 10–20 mg once daily in the morning, titrate by 5–10 mg weekly based on symptom response, and target a maintenance dose of 20–40 mg daily, with a maximum of 50 mg daily (or up to 60 mg in select cases with documented inadequate response to lower doses). 1

Initial Dosing Strategy

• Begin with 10 mg once daily in the morning as the standard starting dose for most adults, though 20 mg may be appropriate for patients with more severe symptoms or prior stimulant exposure. 1, 2
• Administer the medication early in the morning to provide symptom coverage throughout the waking day and minimize insomnia risk. 3
• The extended-release formulation provides approximately 12 hours of therapeutic effect, eliminating the need for multiple daily doses and improving adherence. 2

Titration Protocol

• Increase the dose by 5–10 mg each week until optimal ADHD symptom control is achieved without dose-limiting adverse effects. 1
• Obtain standardized ADHD rating scales from the patient (and ideally a significant other) before each dose increase to objectively track symptom improvement. 4, 3
• Stimulants produce rapid therapeutic effects within days, allowing weekly dose adjustments rather than prolonged waiting periods. 1
• Continue systematic titration until symptoms are optimally controlled—approximately 70–80% of adults achieve good response when properly titrated. 1, 2

Target Maintenance Dose

• The typical therapeutic range for adults is 20–40 mg daily, with many patients achieving optimal control at 20 mg twice daily equivalent (40 mg total daily dose). 1, 5
• In controlled trials, mean effective doses ranged from 40–60 mg daily, with higher doses (60 mg) showing particular benefit in adults with severe baseline symptoms. 2
• Some patients respond adequately to lower doses: in one study, responders achieved symptom control at a mean of only 10.77 mg/day (approximately 0.14 mg/kg/day), though this represents a minority of patients. 6

Maximum Dosing

• The standard maximum dose is 50 mg daily for most adults with ADHD. 1, 7
• Doses up to 60 mg daily are permissible when lower doses provide insufficient symptom control and no dose-limiting side effects are present; clear documentation that lower doses were inadequate is required before exceeding 50 mg. 1, 2
• In rare cases, doses up to 0.9 mg/kg or 65 mg total daily dose may be used with explicit documentation that standard doses failed. 1

Baseline Assessment Before Initiation

• Measure blood pressure and pulse at baseline, as stimulants can produce modest cardiovascular effects. 1, 4
• Obtain a detailed cardiac history including syncope, chest pain, palpitations, and family history of premature cardiovascular death or arrhythmias. 1
• Document all prior ADHD treatments, doses, duration, response, side effects, and adherence patterns. 1
• Screen for active substance use disorders, as this may warrant alternative treatment approaches. 1

Ongoing Monitoring During Treatment

• Check blood pressure and pulse at each dose adjustment during titration, then quarterly during maintenance therapy. 1, 4
• Monitor for common adverse effects including decreased appetite, insomnia, headache, dry mouth, and nervousness—most are mild to moderate in intensity. 2, 7, 8
• Track weight changes, particularly appetite suppression, which occurs in approximately 32% of patients. 8
• Assess sleep quality at each visit; insomnia affects 32–38% of patients and may require dose timing adjustments. 7, 8
• Use standardized ADHD rating scales at follow-up visits to objectively measure sustained symptom control. 4, 8

Duration of Therapeutic Effect

• Extended-release Adderall provides statistically significant symptom improvement at both 4 hours and 12 hours post-dose, confirming all-day coverage with once-daily dosing. 2
• Long-term studies demonstrate sustained efficacy for up to 24 months without evidence of tolerance development when proper dosing is maintained. 8

Contraindications

• Do not prescribe to patients with symptomatic cardiovascular disease, uncontrolled hypertension, hyperthyroidism, glaucoma, or known hypersensitivity to amphetamines. 1
• Concurrent use with MAO inhibitors or within 14 days of MAOI discontinuation is absolutely contraindicated due to hypertensive crisis risk. 1
• Active psychosis or mania are absolute contraindications to stimulant therapy. 1

Common Pitfalls to Avoid

• Starting too high (above 20 mg) leads to unnecessary side effects and decreased adherence; begin at 10 mg for most patients. 4
• Inadequate titration time—failing to allow one week between dose increases prevents accurate assessment of response at each dose level. 4
• Under-dosing—stopping titration prematurely at subtherapeutic doses (e.g., 10–15 mg) when patients could benefit from higher doses within the therapeutic range. 1
• Missing systematic side-effect assessment—not asking specifically about insomnia, appetite, headache, and cardiovascular symptoms at each visit. 4
• Continuing dose escalation without benefit—if symptoms plateau at maximum dose without improvement, switch to an alternative stimulant class rather than exceeding recommended limits. 4