Titration: what it is and how it works

Summary: Titration is how we find the right ADHD medication and dose for you – usually over about 12 weeks. Our team will check in regularly, adjust your treatment, and help you find a medication that's safe, stable, and effective. 

• What is titration?

• How titration works

• How to access medication longer term

• FAQs 

This article only applies to patients diagnosed with ADHD, or ADHD together with other conditions like autism – where treatment is often different. 

Everyone’s body responds to medication differently. Titration is how we find the right ADHD medication – and the best dose of it – for you.  

Titration usually takes about 12 weeks. Throughout, your clinician will keep a close eye on how you’re getting on and adjust your medication along the way. The goal is to find the dose that helps the most, with as few side effects as possible. 

• Before you start medication, your clinician will look over your medical history to make sure it's safe to begin treatment. If anything else’s needed – like a heart scan (ECG) or new blood pressure readings – we'll let you know as soon as we can.

• When everything’s in place, we’ll ask you to fill out some forms in our patient portal. Once those are done, we’ll book all your titration appointments in one go – so you’ll know exactly what’s coming when. 

• At your first appointment, you'll discuss the medications available, your treatment goals, and what to expect.

• You’ll start on a low dose to give your body time to adjust. You’ll also get clear guidance on how and when to take your medication. ADHD medications are controlled substances, so prescriptions are issued one month at a time.

• Meeting your clinician
  Over the next few weeks, you and your clinician will discuss how you’re getting on. Titration appointments are usually every four weeks and take place over the phone. Your clinician will probably adjust your medication based on your symptoms. The goal is to find your "optimal dosage" – the amount of medication that relieves your symptoms but reduces the risk of side effects.

• Recording your symptoms
  Between appointments, it’s really helpful to note down any symptoms or changes and share these with your clinician when you meet.

• Raising questions or concerns
  We want you to feel in control of your treatment, so please don’t hesitate to ask questions or raise any concerns during your appointments. If a medication or dosage isn’t right for you, your clinician will work with you to find the best solution. You also might not need or want to take ADHD medication every day – you can find guidance around this here. 

For a walkthrough of each appointment and how to prepare for these, see our article “What to expect during titration”.

Once you’ve completed titration and you’ve been on a stable dose of medication for over eight weeks, you'll need to sort out how you'll access it going forward. There are two options available: shared care with your GP or arranging a private prescription through us.

• Shared care: If your GP agrees to shared care, you'll pay the NHS prescription rate (currently £9.90 per item, or free if you're eligible). Find out more about shared care here.

• Private: If you'd prefer to continue with us privately, we charge £20 per prescription. The cost of the medication is paid directly to the pharmacy. See more information on our “Managing ADHD medication and prescriptions” page. 

How long does titration take? 

It usually takes 12 weeks, though it can take a bit longer if more adjustments to your medication are needed. 

How does the titration process differ for private and NHS Right to Choose patients? 

The process is the same, but private patients have a clinical review of their medical history and three titration appointments. NHS Right to Choose patients have an extra appointment. They also have access to up to nine appointments in total. Annual reviews are also free for NHS Right to Choose patients.  

What happens if my medication isn't stable after 12 weeks? 

You’re welcome to book additional appointments with us. Private patients can purchase these as needed. NHS Right to Choose patients have access to up to nine appointments during titration, but more can be made available if you need them.