ADHD medication, titration and ongoing care
If you have been diagnosed with ADHD and are considering medication, this page explains what happens next.
From pre-prescribing health checks through to titration, ongoing monitoring and shared care, you will know what each stage involves and what decisions you will be asked to make.
Is medication right for you?
An ADHD diagnosis does not automatically mean medication is the right option for you.
Treatment should reflect how ADHD affects your everyday life, your clinical history, your priorities and your preferences. Options can include psychoeducation, psychological support adapted for ADHD, organisational strategies, sleep and lifestyle advice, workplace adjustments and medication.
Where ADHD symptoms are causing significant impairment, medication may be considered as part of your treatment plan. Your clinician will explain the options and make the decision with you.
Understanding ADHD medication
There are two main types of medication used to treat ADHD: stimulants and non-stimulants.
The medication that may be suitable for you depends on your symptoms, health history, other medication, previous treatment and how you respond. Your prescriber will discuss the appropriate options with you.
Stimulant medication
Stimulants are usually considered first-line medication for adults with ADHD where clinically appropriate.
They affect brain pathways involving dopamine and noradrenaline and can help reduce core ADHD symptoms. Your prescriber will decide whether a stimulant is suitable for you.
Non-stimulant medication
Non-stimulant medication may be considered where stimulants are unsuitable, not tolerated or have not provided sufficient benefit.
These medicines work differently from stimulants and may take longer to reach their full effect.
Short-acting formulations
Short-acting medication works for a more limited period and may offer greater flexibility in how treatment is scheduled.
How long an individual dose lasts varies according to the medication, dose and person.
Long-acting formulations
Long-acting medication is designed to provide coverage over a longer part of the day and may reduce the need for doses during work or other daily activities.
The duration of effect varies between medicines and between individuals.
This information is for general guidance only. Your prescriber will recommend treatment based on your individual clinical needs, health history, other medication and preferences. Specific medication choices are not recommended on this page.
What happens if you decide to start medication?
If you decide to explore medication after your diagnosis, you will have an appointment with one of our qualified prescribers.
Before anything is prescribed, we complete a pre-prescribing assessment. This includes relevant physical health checks, medication and medical history, and any further investigations that may be clinically indicated.
If medication is appropriate, treatment usually starts at a low dose and is adjusted gradually. Your prescriber will review how you are responding, monitor side effects and physical health, and adjust treatment where needed. This process is called titration.
The titration process
Titration is the process of finding a medication and dose that gives you the best possible benefit with side effects that remain acceptable.
It is not a single appointment. Your prescriber reviews how you are responding, checks relevant physical health measures and adjusts treatment where clinically appropriate.
Titration takes different lengths of time for different people. Some people respond well to their first medication, while others need changes to the dose or medication before treatment is stabilised.
Pre-prescribing health assessment
Before medication is prescribed, your prescriber completes the required health and safety checks. These include blood pressure, heart rate, height and weight, relevant medical and psychiatric history, medication interactions and any other factors that could affect treatment. Further investigation, such as a cardiology opinion, is arranged where clinically indicated. Your prescriber will explain the treatment options, benefits, risks and monitoring requirements before you decide whether to proceed.
Regular titration reviews
Reviews take place regularly during the initial titration period. Your prescriber will ask about symptom improvement, everyday functioning and side effects, and review relevant physical health measurements. Your dose may be increased, maintained, reduced or changed depending on your response.
Dose and medication review
Titration continues until your prescriber is satisfied that treatment is providing appropriate benefit and is well tolerated. If the medication is not suitable, your prescriber may discuss a different dose, formulation or medication. Progress and the clinical reasoning for any changes are recorded throughout.
Stabilisation and ongoing monitoring
Once your medication and dose are stable, your monitoring schedule becomes less frequent. Ongoing reviews continue to assess symptoms, everyday functioning, physical health, adherence and side effects, and to confirm that treatment remains appropriate.
Shared care may be considered
Once you have been stable on your current medication and dose for at least three months, with satisfactory monitoring and no outstanding concerns, we can ask your GP whether they are willing to accept a shared care arrangement. Shared care is at your GP practice's discretion and cannot be guaranteed. If they decline, we can continue private prescribing and monitoring where appropriate.
What if the first medication is not right for me?
Not every ADHD medication is effective or well tolerated for every person.
If your initial medication is not providing enough benefit, causes unacceptable side effects or is otherwise unsuitable, your prescriber will review the situation with you. Depending on your clinical needs, this may involve adjusting the dose, changing the formulation or considering another medication.
Needing to try more than one option does not mean treatment has failed. Titration continues while there is a clinically appropriate reason to adjust or review treatment.
