What are the recommended starting doses of Adderall immediate‑release (mixed‑amphetamine salts) and gabapentin, including dosing for children aged 6 years and older and adjustments for impaired renal function?

Starting Doses for Adderall IR and Gabapentin

Adderall Immediate-Release (Mixed Amphetamine Salts)

Children Aged 6 Years and Older

Begin with 5 mg once or twice daily in the morning, then titrate upward by 5 mg increments each week based on symptom response and tolerability. 1

• Initial dose: 5 mg once daily (or 2.5 mg twice daily for very young or sensitive children) 1
• Titration schedule: Increase by 5 mg weekly until optimal symptom control is achieved 1, 2
• Target therapeutic range: Most children require 10–40 mg total daily dose, divided into 2–3 doses 1
• Maximum dose: Rarely exceed 40 mg/day in children; doses above this threshold require clear documentation that lower doses were insufficient 1
• Timing: Administer first dose upon awakening (ideally after breakfast), with optional second dose 4–6 hours later to maintain coverage through afternoon 1

Adults

Start with 10 mg once daily in the morning, then increase by 5–10 mg weekly until symptoms are controlled or side effects emerge. 1, 2

• Initial dose: 10 mg once daily in the morning 1, 2
• Titration protocol: Increase by 5 mg increments weekly; more rapid titration (every 3 days) is permissible in urgent situations 2
• Therapeutic range: 10–50 mg total daily dose, typically divided into 2 doses (morning and early afternoon) 1, 2
• Maximum dose: 50 mg/day represents the absolute ceiling in clinical practice; doses of 40 mg are the FDA-approved maximum, but 50 mg may be used when lower doses fail and no intolerable side effects occur 1, 2
• Dosing strategy: Systematic titration to the lowest effective dose is superior to weight-based (mg/kg) calculations, as response variability does not correlate with body weight 1

Critical Monitoring During Initiation

• Cardiovascular: Measure blood pressure and pulse at baseline and with each dose adjustment 1, 2
• Symptom tracking: Obtain standardized ADHD rating scales weekly during titration from both patient and collateral sources (parents, teachers, or partners) 1, 2
• Side effects: Assess appetite, sleep quality, mood changes, and cardiovascular symptoms before each dose increase 1, 2
• Growth parameters: Track height and weight at every visit in pediatric patients 1

Common Pitfalls to Avoid

• Do not assume 5 mg is adequate in children or 10 mg in adults—70–80% of patients respond optimally only when proper titration protocols are followed to higher therapeutic doses 1
• Do not use weight-based dosing as the primary strategy—systematic weekly titration based on clinical response is the evidence-based approach 1, 2
• Do not skip weekly symptom assessments—objective rating scales are essential to guide dose adjustments and avoid both under-dosing and over-dosing 1, 2
• Do not continue escalating if a lower dose was effective—some patients experience paradoxical worsening of focus at higher doses due to overstimulation; return to the previously effective dose immediately 2

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Gabapentin

Starting Dose (General Adult and Pediatric ≥6 Years)

The question requests gabapentin starting doses, but the provided evidence focuses exclusively on ADHD medications and does not contain gabapentin dosing information. Based on general medical knowledge (not cited evidence):

• Adults: Typically 300 mg once daily on day 1, then 300 mg twice daily on day 2, then 300 mg three times daily on day 3, with further titration as needed
• Children ≥6 years: Dosing is weight-based and indication-specific; consult FDA labeling or pediatric neurology guidelines for precise recommendations
• Renal impairment: Dose reduction is mandatory; creatinine clearance dictates the adjustment schedule

Note: The evidence provided does not address gabapentin dosing, so these recommendations are derived from standard clinical practice rather than the cited guidelines. For authoritative gabapentin dosing, refer to FDA prescribing information or neurology/pain management guidelines.