How can It help?
How Does ADHD Medication Work?
- Stimulants increase dopamine levels, improving focus and reducing impulsivity.
- Non-stimulants regulate norepinephrine to enhance cognitive function, making them suitable for individuals who do not tolerate stimulants well or have cardiovascular concerns.
Types of Medication
- Methylphenidate-based (e.g., Ritalin, Concerta, Medikinet) – Available in:
- Short-acting (4-hour)
- Intermediate-acting (8-hour)
- Long-acting (12-hour) formulations.
- Lisdexamfetamine/Dexamphetamine-based (e.g., Elvanse, Amfexa) – Typically long-acting but can be supplemented with short-acting dexamphetamine if needed.
- Atomoxetine (Strattera) – A norepinephrine reuptake inhibitor, effective for ADHD but takes longer to work.
- Guanfacine (Intuniv) – A non-stimulant that helps with impulsivity and emotional regulation.
What is ADHD Medication Titration?
- Starting at a Low Dose
- Initially, a clinician prescribes a low dose of the chosen medication to assess how the body responds.
- This helps minimize side effects and allows for gradual adjustments.
- Monitoring Symptoms and Side Effects
- The patient records improvements in focus, impulsivity, and energy levels as well as any side effects like appetite changes, sleep disturbances, or increased heart rate.
- Regular check-ins (weekly or biweekly) with a specialist help track progress.
- Gradual Dose Adjustments
- The clinician increases or adjusts the dosage incrementally based on feedback.
- If side effects become problematic, the dose may be lowered or a different medication may be tried.
- Exploring Different Medications (if needed)
- If the first medication does not provide the desired effect or causes intolerable side effects, a different formulation (e.g., switching from a stimulant to a non-stimulant) may be considered.
- Some patients require short-acting medication alongside a long-acting one for better symptom management.
- Finding the Optimal Dose
- Once the right dosage and medication are found, the patient is considered “stable”, meaning symptoms are well-managed without significant side effects.
- A final review ensures the chosen medication works consistently throughout the day.
- Titration typically takes 4 to 12 weeks, but it varies based on individual response.
- Some people find the right dose quickly, while others may need multiple adjustments over several months.
- Ensures maximum effectiveness with minimal side effects.
- Helps tailor medication to individual needs.
- Prevents taking too much or too little medication.
- Reduces the risk of adverse effects, such as sleep disturbances or heart rate issues.
- Once stable on medication, follow-up reviews are scheduled every 6 months (or sooner if needed).
- If symptoms change over time, medication can be adjusted accordingly.
- Some individuals may transition to shared care with their GP, allowing NHS prescriptions (if approved).
What Is the Difference Between a Private Prescription and a Shared Care Prescription?
- Issued by a private clinician.
- You pay for both the consultation and the full cost of the medication at a pharmacy.
- The price varies depending on the medication and pharmacy rates.
- Your private ADHD specialist works with your NHS GP to transfer prescribing responsibility.
- If your GP agrees, they will prescribe your medication through the NHS, meaning you only pay the standard NHS prescription charge.
- GPs are not obligated to accept shared care agreements with private providers.
How Do Private Prescriptions Work?
- Pay for a consultation with your ADHD specialist.
- Receive a private prescription, which you can take to a pharmacy.
- Pay the full cost of the medication (prices vary between pharmacies).
Specialist Follow-Up and Our Services
- We offer four types of follow-up appointments, ranging from £35 to £145, depending on the consultation length.
- Once stable on medication, we provide a free review every six months to ensure continued effectiveness.
- We always request shared care from your GP once you are stable, but NHS GPs are not required to accept this arrangement.
ADHD Medication FAQ
Whether we are going down the ‘shared care’ route to prescribing or prescribing purely on a private basis, we always follow what’s in the national guidelines for ADHD and in the UK, we follow the NICE Guidelines, which states that, ‘All medication for ADHD should only be initiated by a healthcare professional with training and expertise in diagnosing and managing ADHD’, which would NOT be your GP. Our Clinical Specialists with Prescribing Qualifications will always write your prescriptions until your treatment is stable.
Let’s break the costs down for you. There are 2 options for a private prescription.
Option 1:
You receive your private prescription from ADHD Direct in the form of a paper prescription posted either to you or directly to your chosen pharmacy. This option costs £20 for the prescription. This covers the prescription fee and Royal Mail recorded delivery. You will then purchase the medication at your pharmacy, which will include the medication cost plus the pharmacy’s private dispensing charge.
Option 2:
ADHD Direct can post your prescription to ITH Health (formerly PPG) in London. They will dispense your medication and deliver it directly to your home address via DPD. ITH Health will invoice you for the cost of the medication and their dispensing fees. This option removes the need to take the prescription to a pharmacy, reducing the number of steps for you. The cost to have the prescription written is still £20.
The national guidance and local shared care agreements stipulate that the private service (that’s us) must regularly review your medication to ensure it’s effective, safe and make any adjustments as required.
Good news: we’ll only see you when it’s necessary. If your treatment is stable, you’ll usually be reviewed every 6 months for a child, and every 6 or 12 months for an adult. Even better, some of these appointments may be free. If you’re stable at your medication review and neither you nor your clinician expect any changes over the next 6 to 12 months, you may be advised to book your next review with one of our Clinical Assistants, and these appointments are free of charge.
If you experience side effects or any complications at any point, you’ll need a review with one of our Specialists instead.
At ADHD Direct, we’re committed to your wellbeing. We understand that once your medication is stable, the cost of ongoing review appointments can become difficult. That’s why we offer eligible reviews free of charge. We also recognise that the NHS may not always be able to take over your care right away, and our goal is to make this part of your healthcare as accessible as possible.
However, if you develop any side-effects or any other complications, then you will need to have a review appointment with one of our Specialists.
At ADHD Direct, we are committed to your well-being. We understand that once you have achieved stability with your medication, the ongoing costs of medication review appointments can be challenging. That’s why we offer these appointments to you free of charge. We recognise that the NHS may not always have the capacity to fully take over your care, and our aim is to make this aspect of your healthcare as accessible as possible for you.
The guidelines state that an ECG is not routinely required before starting ADHD medication unless there is a significant family or personal history that may indicate an underlying cardiac condition. This includes:
• Congenital heart disease or previous cardiac surgery
• Sudden death in a first-degree relative under 40 years that may suggest a cardiac condition
• Shortness of breath on exertion compared with peers
• Fainting during exercise or in response to sudden fright or loud noise
• Rapid, regular palpitations that begin and end abruptly
• Chest pain that may be cardiac in origin
• Signs of heart failure
• A heart murmur identified during examination
We will always carry out a structured review of your cardiac history and record baseline measurements, including blood pressure, pulse, and weight (plus height for children). These measurements will be monitored at agreed intervals for as long as you remain on ADHD medication.
If at any stage we believe you require further cardiac assessment, we will advise you to see your GP in the first instance.
