ADHD Medication Titration in the UK: A Step-by-Step Guide
Titration is the process of finding your optimal ADHD medication dose — one of the most important, and often most drawn-out, parts of the ADHD care pathway. This guide explains what titration involves, the typical UK timeline, your options on the NHS versus privately, and the critical link to the shared care agreement that follows.
This guide is for informational purposes only and does not constitute medical or legal advice. Always consult your GP, ICB, or a qualified specialist about your individual circumstances.
What Is ADHD Medication Titration?
Titration is the process of starting ADHD medication at a low dose and gradually increasing it over several weeks or months until you find the dose that provides the best symptom control with the fewest side effects. There is no standard dose — everyone's optimal point is different.
Titration is conducted by a specialist prescriber: a consultant psychiatrist, a nurse prescriber, or a pharmacist independent prescriber (PIP). You will typically have regular check-in appointments — weekly or fortnightly — to review how you are responding before any dose increase.
Which Medications Are Titrated?
The most commonly titrated ADHD medications in the UK are:
- Lisdexamfetamine (Elvanse / Vyvanse) — a prodrug amphetamine; often first-line for adults.
- Methylphenidate extended-release (Concerta XL, Medikinet XL, Xenidate XL) — widely used, multiple formulations.
- Methylphenidate immediate-release (Ritalin, Equasym) — shorter-acting; used for fine-tuning.
- Dexamfetamine (Dexedrine) — for patients who do not respond to lisdexamfetamine.
- Atomoxetine (Strattera) — non-stimulant option; slower onset, used where stimulants are unsuitable.
- Guanfacine (Intuniv) — non-stimulant, typically used as an add-on or for children.
How Long Does Titration Take?
Timeline varies significantly between NHS and private pathways:
- NHS titration: typically 3–12 months after diagnosis, often longer due to appointment backlogs and waiting lists between dose increases.
- Private psychiatrist-led titration: typically 6–12 weeks for straightforward cases with weekly or fortnightly video check-ins.
- Pharmacist independent prescriber (PIP) titration: often the fastest route — some PIPs offer flexible same-week appointments with no waiting list.
- Complex cases (co-morbidities, medication sensitivities, need to trial multiple drugs): can extend to 6+ months regardless of pathway.
What Happens at Each Titration Appointment?
Baseline assessment
Your prescriber documents your current ADHD symptom severity, blood pressure, heart rate, weight, and any existing health conditions that affect prescribing decisions.
Starting dose prescribed
You receive a starter prescription at a low dose. Your prescriber explains what to expect, potential side effects, and when to contact them if you have concerns.
Regular reviews
At each review appointment (weekly or fortnightly), you and your prescriber assess symptom control, side effects, sleep, appetite, and cardiovascular observations. Dose is adjusted up or down accordingly.
Optimal dose confirmed
Once you and your prescriber agree on a stable dose with good efficacy and acceptable side effects, titration is complete. Your prescriber writes a titration summary letter.
Transition to shared care
Your specialist writes to your GP requesting a shared care agreement — transferring ongoing prescribing to the NHS. If your GP refuses, see our shared care guide for the next steps.
How Much Does Private Titration Cost?
Private ADHD titration costs typically range from £300–£500 total, depending on the number of appointments required and the provider's fee structure:
- Follow-up/review appointments: typically £75–£150 each.
- Some providers offer a flat-fee titration package covering all appointments until stability is reached.
- NHS Right to Choose: if your assessment was RTC-funded, check whether your provider's NHS contract includes titration — some do, most do not.
- Pharmacist prescribers: often charge less per appointment than psychiatrist-led services.
Always confirm in writing before starting titration exactly what is included in your provider's fees. Ask specifically: "Are all follow-up appointments included until I reach a stable dose?"
Can a Pharmacist Prescriber Do Titration?
Yes — and this is one of the most significant under-utilised options in UK ADHD care. Pharmacist Independent Prescribers (PIPs) with ADHD specialisation hold full prescribing authority for Schedule 2 controlled drugs, which includes all first-line ADHD stimulants.
PIPs can conduct titration independently, without requiring a psychiatrist referral, and typically offer faster access, more flexible appointment times, and lower per-appointment fees. They are significantly underrepresented in existing ADHD directories.
Frequently Asked Questions
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