Dextroamphetamine Dosing and Titration Guidelines

Introduction to Dosing

The American Academy of Child and Adolescent Psychiatry recommends starting with 2.5 mg daily for children aged 3-5 years, 5 mg once or twice daily for children 6 years and older, and 10 mg daily for adults and adolescents 12 years and older 1, 2

For children weighing less than 25 kg, single doses should generally not exceed 10 mg of dextroamphetamine, as recommended by the American Academy of Child and Adolescent Psychiatry 1
The maximum total daily dose rarely exceeds 40 mg for children 6 years and older, according to the American Academy of Child and Adolescent Psychiatry 2

The American Academy of Child and Adolescent Psychiatry recommends a standard titration approach, starting at the recommended initial dose based on age and increasing weekly by 2.5-5 mg increments depending on age group 1, 2
The forced titration trial approach involves the patient taking all dose levels with each dose lasting 1 week, with rating scales collected at each dose level, as recommended by the American Academy of Child and Adolescent Psychiatry 2

The American Academy of Child and Adolescent Psychiatry recommends obtaining baseline blood pressure, pulse, height, and weight in context of physical examination before starting treatment 1
Standardized ADHD rating scales from parents and teachers should be used before each dose increase, as recommended by the American Academy of Child and Adolescent Psychiatry 2

Dextroamphetamine and mixed amphetamine salts produce greater effects on appetite and sleep compared to methylphenidate due to longer excretion half-lives, according to the American Academy of Child and Adolescent Psychiatry 1
Approximately 70% of children respond to either dextroamphetamine or methylphenidate alone, and nearly 90% respond if both are tried, as reported by the American Academy of Child and Adolescent Psychiatry 2
When using higher total daily doses, it is essential to clearly document that symptoms could not be controlled at lower doses and higher doses are not producing side effects, as recommended by the American Academy of Child and Adolescent Psychiatry 2