Attention- Deficit Hyperactivity Disorder (Adhd) Quantity Limitation Certification Faxback Form Page 2

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QUANTITY LIMITS
Medication
Quantity Limit per Day
Recommended Dosing per
Max Daily Dose/Maximum Dose
Name/Strength
FDA Label
Studied per FDA Label
Adderall (amphetamine/ dextroamphetamine)
5mg
ADHD: 40mg/day
ADHD (Pediatric and Adults):
Not to exceed 40mg/day except
7.5mg
3 tablets
Narcolepsy: 60mg/day in
only in rare cases
10mg
divided doses
12.5mg
Narcolepsy: 60mg/day in divided
15mg
2 tablets
doses
20mg
3 tablets
30mg
2 tablets
Adderall XR (amphetamine/ dextroamphetamine ER)
5mg
Pediatric (6-17 yoa): 30mg QD
Pediatric (6-17 yoa): 10mg to
40mg per day studied; no
10mg
Adults: 20mg QAM
adequate evidence that doses
15mg
1 capsule
greater than 20mg/day conferred
20mg
additional benefit
25mg
30mg
Adults: 20mg to 60mg per day
studied; no adequate evidence that
doses greater than 20mg/day
conferred additional benefit
Concerta (methylphenidate ER)
18mg
1 tablet
Pediatric (6-12yoa): 18mg to
Pediatric (6-12yoa): Doses greater
27mg
54mg once daily
than 54mg per day have not been
studied and are not recommended
36mg
2 tablets
Pediatric (13-17yoa): 18mg to
54mg
1 tablet
72mg once daily
Pediatric (13-17yoa): Doses
greater than 72mg per day have
Adults (18-65yoa): 18mg to
not been studied and are not
72mg once daily
recommended
Adults (18-65yoa): Doses greater
than 72mg per day have not been
studied and are not recommended
Daytrana (methylphenidate transdermal patch)
10mg/9hr
Doses greater than 30mg/9hr were
not studied
15mg/9hr
1 patch
10mg to 30mg/9hr patch
20mg/9hr
30mg/9hr
DextroStat (dextroamphetamine)
5mg
2 tablets
Narcolepsy: 5-60mg/day in
ADHD: Per FDA label, only in
divided doses
rare cases will it be necessary to
10mg
6 tablets
exceed a total of 40 mg per day.
ADHD: 40mg/day
Dexedrine (dextroamphetamine ER)
5mg
3 capsules
Narcolepsy: 5-60mg/day in
ADHD: Per FDA label, only in
divided doses.
rare cases will it be necessary to
10mg
4 capsules
exceed a total of 40 mg per day.
15mg
4 capsules
ADHD: 40mg/day
2
November 2014

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