What is ADHD titration, and how does it work?
What titration means, why it takes several weeks, what gets checked at each review, and what happens once you are settled on treatment.
If you're diagnosed with ADHD and decide to try medication, the next stage is called titration. It's one of the least explained parts of ADHD care, so here is what it means and what to expect, written by a pharmacist.
What titration means
Titration is the process of starting a medicine and adjusting it step by step until you and your prescriber find the balance that works: the most benefit, with side effects you're comfortable with. Everyone responds differently, so there's no way to know the right medicine or dose in advance. Titration is how you find out, safely.
Before you start
Your prescriber will check that medication is suitable for you. This normally includes:
- your physical health, especially any heart problems, fainting or palpitations
- any heart problems or sudden deaths in the family at a young age
- your mental health, sleep and appetite
- other medicines, supplements and alcohol or drug use
- your blood pressure, pulse and weight
If anything in your history needs a closer look, you may be asked to have a heart trace (ECG) or see a heart specialist before starting. This is routine caution, not a cause for alarm.
How it works, step by step
- You start on a low dose. Your prescriber explains how and when to take it and what to look out for.
- You keep simple notes. How your focus, organisation and mood are through the day, how you're sleeping and eating, and any side effects.
- You check your blood pressure and pulse. At home with a monitor, or at a local pharmacy.
- You have a review. Usually every couple of weeks, by video or phone. You go through your notes and readings together.
- The dose is adjusted, or kept the same. Sometimes a different type of medicine is tried if the first is not a good fit.
- This repeats until you and your prescriber agree you're settled.
Titration commonly takes somewhere between several weeks and a few months. It depends on how you respond, not on a fixed schedule.
What gets checked at each review
- Benefit. Are the things that brought you to the assessment easier? At work, at home, later in the day as well as the morning?
- Side effects. Common ones include reduced appetite, trouble sleeping, headaches and feeling on edge. Many settle within the first weeks, but tell your prescriber about any you notice.
- Blood pressure, pulse and weight. These are monitored during titration and then regularly afterwards.
- Mood. Any changes in mood, anxiety or irritability matter and should always be mentioned.
Tips for getting the most out of it
- Keep notes at the same time each day. A few words on your phone is enough.
- Ask someone close to you what they notice. Others often spot changes before you do.
- Do not change the dose yourself. If something does not feel right, contact your prescriber.
- Be honest about side effects and about how often you take it. Your prescriber can only adjust what they know about.
- Stopping is allowed. If medication is not for you, that's a valid outcome. Talk to your prescriber about how to stop safely.
About prescriptions
Some ADHD medicines are controlled drugs. That means stricter rules: a prescription usually covers no more than 30 days, it must be collected within 28 days of the date it was written, and the pharmacy may ask for ID when you collect it. Plan your reviews and repeat prescriptions so you do not run short, especially around holidays.
What happens once you're settled
When you're on a stable dose, titration ends and ongoing care begins. Anyone taking ADHD medication should have a review with an ADHD specialist at least once a year, plus regular blood pressure, pulse and weight checks.
At this point a private clinic can ask your GP to take over prescribing under a shared care agreement. If your GP agrees, your prescriptions move onto the NHS. If they do not, you continue with the clinic. See shared care explained.
This article is general information about how ADHD titration works. It is not medical advice. Always follow the advice of your own prescriber.