About This Calculator

The Adderall XR® Dose Calculator is a clinical support tool designed to provide standard dosing recommendations for Adderall XR® (mixed salts of a single-entity amphetamine product) in the treatment of Attention-Deficit/Hyperactivity Disorder (ADHD). It aligns with the FDA-approved prescribing information to determine appropriate starting doses, titration schedules, and maximum doses based on patient age and treatment history.

Outputs

After entering the required patient data, the calculator provides a clear, concise dosing regimen summary, which includes:

• Patient Category: Identifies the patient population (e.g., Pediatric, Adult, Treatment-Naïve).
• Recommended Dosing: Details the specific starting dose, titration instructions, and maximum recommended daily dose.
• Switching Guidance: Offers specific instructions for patients converting from Adderall® immediate-release or other CNS stimulants.
• Clinical Notes: Provides important context or limitations for the recommended dose, drawn from clinical trial data.

How to Use

To use the calculator, follow these simple steps:

1. Enter Patient Age: Input the patient’s age in years. The calculator is intended for patients 6 years of age and older.
2. Select Patient Status: Choose whether the patient is new to treatment (“Treatment-Naïve”) or switching from Adderall® IR or another stimulant medication.
3. Calculate Dose: Click the “Calculate Dose” button to generate the dosing recommendation based on the provided information.

Dosing Overview

Dosing for Adderall XR® is tailored to the patient’s age and should be individualized according to their therapeutic needs and response.

• Children (6-12 years): The recommended starting dose is 10 mg once daily in the morning. The dose can be increased by 5 mg or 10 mg at weekly intervals. The maximum recommended dose is 30 mg/day.
• Adolescents (13-17 years): The recommended starting dose is 10 mg/day. If needed, this can be increased to 20 mg/day after one week. The target and maximum dose is 20 mg/day.
• Adults (18+ years): The recommended dose is 20 mg/day. Higher doses have not been shown to be more effective and are associated with a greater incidence of adverse effects.

Switching Medications

The calculator provides guidance for two common switching scenarios:

• From Adderall® (Immediate-Release): Patients can be switched to Adderall XR® at the same total daily dose, administered once in the morning. For instance, a patient taking 10 mg of Adderall® IR twice daily (20 mg total) would switch to 20 mg of Adderall XR® once daily.
• From Other Stimulants: No specific conversion ratio exists. A conservative approach is recommended, which involves discontinuing the previous stimulant and initiating Adderall XR® at the standard starting dose for the patient’s age group, followed by careful titration.

Missed Dose

If a dose of Adderall XR® is missed, it should be taken as soon as it is remembered. However, if it is late in the afternoon or evening, the missed dose should be skipped to avoid potential sleep disturbances. Patients should not take two doses at once to make up for a missed one.

Safety Alerts

Adderall XR® has an FDA Black Box Warning regarding its high potential for abuse and dependence. Clinicians should assess the risk of abuse prior to prescribing and monitor for signs of misuse during therapy. Serious cardiovascular events, including sudden death, stroke, and myocardial infarction, have been reported in association with CNS stimulant use at recommended doses. It is crucial to screen patients for pre-existing cardiac conditions before initiating treatment.

Frequently Asked Questions

Why is the calculator only for ages 6 and up?
The safety and effectiveness of Adderall XR® have not been established in children under 6 years of age, and it is not recommended for this population according to the FDA label.

What is the starting dose for a 10-year-old child?
For children aged 6-12, the recommended starting dose is 10 mg once daily in the morning.

Why is the recommended adult dose only 20 mg/day?
In pivotal clinical trials for adults with ADHD, doses above 20 mg/day did not show increased effectiveness but were linked to a higher rate of adverse reactions. Therefore, 20 mg/day is the recommended maintenance dose.

How do I convert a patient from Adderall IR 15 mg twice daily?
The total daily dose is 30 mg (15 mg x 2). The patient can be switched to Adderall XR® 30 mg once daily in the morning.

Can I use this calculator for patients with kidney problems?
This calculator provides standard dosing. For patients with severe renal impairment (GFR 15 to <30), the starting dose should be reduced. The calculator does not adjust for renal function; consult the prescribing information for specific guidance.

Can the Adderall XR® capsule be opened?
Yes. If a patient cannot swallow the capsule whole, it can be opened and the entire contents sprinkled onto a spoonful of applesauce. This mixture should be consumed immediately without chewing.

Does food affect Adderall XR® absorption?
A high-fat meal can delay the time it takes to reach peak concentration in the blood by about 2.5 hours but does not affect the overall absorption.

Is this calculator a substitute for professional medical advice?
No. This tool is for educational and informational purposes only and is not a substitute for independent clinical judgment. All treatment decisions must be made by a qualified healthcare professional.

References

1. Adderall XR® Prescribing Information. U.S. Food and Drug Administration. Revised: October 2023. Accessed [current month, year].
2. Takeda Pharmaceuticals U.S.A., Inc. Official Website. Accessed [current month, year].
3. Drugs@FDA: FDA-Approved Drugs. U.S. Food and Drug Administration. Accessed [current month, year].
4. Faraone, S. V., Biederman, J., & Mick, E. (2006). The age-dependent decline of attention deficit hyperactivity disorder: a meta-analysis of follow-up studies. Psychological medicine, 36(2), 159–165.