When, if ever, do you consider increasing Adderall above the FDA-approved maximum daily dose of 40 mg for adult patients?

I titrate the dose based on the patient's needs, functioning, and tolerances.

I do go up to 60 mg of amphetamine salts if patients are tolerating it well, there's no treatment complicating behaviors like cannabis use, no other major comorbid conditions that may be contributing to symptoms (e.g., OSA), and there is a noticeable improvement in symptoms with dose increases.

Amphetamine is metabolized by CYP2D6, and a common genetic variation in the CYP2D6 gene is present among people who are extensive metabolizers. These individuals have higher than typical CYP2D6 liver enzyme activity. Depending on the clinical picture, it may be useful to order genetic testing to det...

I typically do not exceed dosages higher than FDA-recommended, particularly for adults, because of the risk of misuse. For adults telling me that only higher dosages have worked before, I still do not go above and rather suggest other approaches.

I do not exceed the FDA-approved maximum daily dose. In my experience, any benefits from the higher doses are countered by the increasing side effects. If the patient insists that only higher doses work for them, I generally discuss switching to another stimulant such as Vyvanse.