Adderall to Dexedrine IR Conversion Guidelines

Introduction to Conversion

• The American Academy of Child and Adolescent Psychiatry recommends converting Adderall 30 mg IR BID (total daily dose 60 mg) to approximately Dexedrine 20 mg IR BID (total daily dose 40 mg), representing a 2:3 ratio reduction based on the higher dextroamphetamine content in pure Dexedrine formulations 1, 2

Pharmacologic Basis for Conversion

• Adderall contains a 3:1 ratio of dextroamphetamine to levoamphetamine salts, with approximately 75% of the amphetamine content being the more potent dextroamphetamine isomer, whereas Dexedrine is 100% the active d-isomer, making it more potent milligram-per-milligram 1, 2

Recommended Conversion Strategy

• The starting dose of Dexedrine should be 20 mg IR BID (total 40 mg daily), considering the patient's current total daily amphetamine dose of 60 mg of mixed amphetamine salts exceeds the recommended maximum total daily dose of 40 mg for amphetamines 1, 2, 3, 4

Titration and Monitoring Protocol

• Initial monitoring should assess symptom control and side effects within 1 week of conversion, with potential increases by 2.5-5 mg increments per dose weekly if inadequate response, not exceeding the maximum recommended total daily dose of 40 mg 1, 3, 5
• Key monitoring parameters include blood pressure, pulse, weight, and systematic assessment of insomnia, anorexia, headaches, agitation, and cardiovascular symptoms 1, 3, 4, 5

Critical Safety Considerations

• The American Academy of Child and Adolescent Psychiatry states that maximum total daily doses are 40 mg for amphetamines, and if symptom control is not achieved at this dose, alternative strategies such as switching to an alternative stimulant or adding environmental interventions should be considered 1, 3, 4

Dosing Schedule

• The recommended timing for Dexedrine doses is after breakfast and around noon/after lunch, with an optional third dose in the late afternoon if needed, using lower doses to avoid sleep disruption 1, 2, 3, 5
• Dexedrine IR typically provides 4-6 hours of coverage per dose, similar to Adderall IR, and the patient may require the same BID dosing schedule 1, 2, 3

Common Pitfalls to Avoid

• A 1:1 conversion should not be performed due to the higher potency of pure dextroamphetamine, and monitoring for increased side effects such as appetite suppression and sleep disturbances is crucial 1, 2, 5
• Documenting medical necessity is important if doses approach or exceed 40 mg daily, and assessing for tolerance at higher doses may indicate the need for medication holiday or alternative treatment 2, 3