When you start ADHD medication, there’s no way to know in advance which dose will work best for you. People respond differently to the same medicine and dose. Titration is how a specialist finds it.
What titration means
Titration means starting a medicine at a low dose and adjusting it step by step, while keeping track of benefits and side effects.
NICE says the dose should be adjusted against symptoms and side effects until the best balance is reached. It describes this as reduced symptoms, positive changes in behaviour, and improvements in education, work and relationships, with side effects you can tolerate.
The aim isn’t the highest dose. It’s the dose that works best for you.
Who manages titration
The NHS says ADHD medicines must be started and monitored by an ADHD specialist. During titration, your prescriber is responsible for your medication. That’s usually the specialist service that diagnosed you, whether NHS or private.
Your GP doesn’t normally take over prescribing until your dose is stable, and only if they agree to a shared care arrangement. See shared care.
How long it takes
There’s no fixed timescale. For methylphenidate, the NHS says you start on a low dose that’s usually increased gradually, and it may take several weeks before you feel the full effect. For some people it’s quicker, and for others it takes longer, especially if they need to try a different medicine.
Things that can affect the timeline include:
- how you respond to each dose
- side effects that need time to settle, or a change of plan
- whether the first medicine suits you
- other health conditions or medicines
- how easy it is to arrange reviews and checks
NICE suggests trying a first-line medicine for six weeks at an adequate dose before deciding it hasn’t worked well enough and considering a switch. So if you need to change medicine, titration can take a few months overall.
Monitoring during titration
Regular contact
NICE says that during titration, symptoms, impairment and side effects should be recorded at the start and at each dose change, and progress should be reviewed regularly with a specialist. It gives weekly phone contact as an example.
In practice, services arrange this in different ways. You might have video or phone reviews, questionnaires to complete, or both.
Physical checks
NICE recommends that heart rate and blood pressure are checked before and after each dose change. Weight is also monitored. Your service will explain how to do these checks. You may be asked to use a home blood pressure monitor or visit a pharmacy.
What to report at reviews
A short diary makes reviews far more useful. Try to note the following each day or two.
Benefits
- focus and concentration at work or study
- getting started on tasks and finishing them
- organisation, memory and time-keeping
- restlessness and impulsivity
- mood and emotional control
- what the people around you notice
Timing
- what time you take your dose
- when you notice it start to work
- when it seems to wear off, and whether there’s a dip or “crash” afterwards
Side effects
- sleep: getting to sleep and staying asleep
- appetite and eating, and any weight change
- headaches, stomach ache, dry mouth or nausea
- feeling anxious, irritable, low or flat
- a racing or pounding heart
Readings and other factors
- blood pressure and pulse readings, if you’ve been asked to take them
- alcohol, caffeine or other substances
- any new medicines, including over-the-counter ones
- missed doses
A simple table works well:
| Day | Dose and time | What helped | Side effects |
|---|---|---|---|
| Mon | Example: 8am | Focused in morning meeting | Less hungry at lunch |
| Tue | Example: 8am | Cleared inbox | Took longer to fall asleep |
When to get help between reviews
Don’t wait for your next review if something worrying happens.
For less urgent concerns, such as poor sleep or low appetite, contact your prescriber. Don’t change your dose or stop your medicine yourself. The NHS warns that stopping methylphenidate suddenly can cause withdrawal symptoms such as depression.
When your dose is stable
Once you and your prescriber agree the dose is right, titration ends and ongoing monitoring begins. NICE recommends:
- heart rate and blood pressure checks every six months
- weight checks every six months for adults
- a review at least once a year by a professional with ADHD expertise, to discuss whether to continue
At this point, your specialist may ask your GP to take over prescribing through a shared care agreement. BMA guidance says the stabilisation period is set by the shared care agreement and is often three months. If your GP declines, you can usually continue with private prescriptions from your specialist. See shared care.
Titration with Happy Clinic
If Happy Clinic’s consultant psychiatrists start ADHD medication after an assessment, follow-up titration reviews are arranged by video.
- Titration review: 20 minutes
- Fee: £200 per review, paid in advance
- Prescriptions: prescriptions issued in appointments are included in the fee. Pharmacy dispensing charges are not.
The number of reviews depends on how you respond, so it varies from person to person. Medication may also need physical health checks and monitoring. Fees checked September 2026. See Happy Clinic’s pricing page for current fees, or the fees page on this site.
For more on medicine options, see ADHD treatment.