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

For those who never exceed labeled dosing, what factors most strongly inform that decision (e.g., safety concerns, lack of evidence, medico-legal risk)? How do you respond when patients report that they’ve only experienced benefit from higher doses of Adderall in the past?

If you do consider higher doses in select cases, what clinical rationale guides that decision? What is the maximum Adderall dose you would consider prescribing? What monitoring strategies (e.g., vitals, EKGs) do you use when exceeding FDA-labeled doses?