ADHD medication

Summary about ADHD medication

• Who starts treatment? A specialist. Ongoing prescriptions may be taken over by your GP under shared care once titration and stabilisation are complete. 

• Adults (18+) – first line: Lisdexamfetamine or methylphenidate. If one is ineffective after ~6 weeks at an adequate dose, switch to the other. If both are ineffective or not tolerated, consider atomoxetine. Dexamfetamine can be considered if lisdexamfetamine helps but its longer action is not tolerated. 

• Children & young people (≥5 yrs): Start with methylphenidate; consider lisdexamfetamine if response is inadequate. If stimulants aren’t tolerated/ineffective, consider atomoxetine or guanfacine. Dexamfetamine may suit some who respond to lisdexamfetamine but cannot tolerate its longer effect. Medication is not used in under‑5s without a second specialist opinion. 

• Safety checks: Baseline review (including mental/physical health, pulse/BP, height/weight, cardiovascular assessment), then regular monitoring of weight, blood pressure and pulse; ECG not routine unless risk factors. 

• Psychosis/mania: If an acute psychotic or manic episode occurs, stop ADHD medication and only consider restarting after recovery, weighing risks and benefits. 

Important: Medication is one part of care. Psychological and practical supports are usually recommended alongside medicine. 

Who can prescribe ADHD medication, and how shared‑care works

• Initiation & titration: A specialist service starts medication and adjusts dose over several weeks. 

• Shared care: Once stable, the specialist can hand prescribing/monitoring to your GP under a Shared Care Protocol (SCP), with clear roles and safety parameters. Different ICBs publish their SCPs (examples linked in NHS formularies). 

• NHS choice: In England, you generally have a Right to Choose provider for your first mental‑health appointment if your GP refers you; ask your GP how this applies locally to ADHD pathways. 

Medicines used for ADHD (NICE‑aligned)

Stimulants

• Methylphenidate (IR/MR)

  Often first choice in children/young people; first‑line alternative for adults. Can be combined as MR + IR to extend coverage. 

• Lisdexamfetamine

  First line for adults; consider in children/young people who don’t respond sufficiently to methylphenidate after ~6 weeks. 

• Dexamfetamine

  Consider if lisdexamfetamine works but the longer effect is not tolerated (adults), or where noted for children/young people. 

Non‑stimulants

• Atomoxetine

• Option if stimulants are not tolerated or not effective after adequate trials in adults or children/young people. 

• Guanfacine

  Option for children/young people when stimulants are unsuitable/ineffective. Do not offer guanfacine to adults without tertiary ADHD service advice (off‑label). 

There’s no single “best” medicine—choice depends on age, response, side‑effects, duration needed across the day, diversion risk and co‑existing conditions. Your prescriber will tailor this with you. 

What to expect before starting medication

Your team should complete a baseline assessment covering:

• confirmation that medication is appropriate right now

• mental‑health review (including substance‑misuse/diversion risk)

• physical health: height, weight, pulse, blood pressure and a cardiovascular assessment

• medicines history and potential interactions

Routine ECG is not required unless there are red‑flag cardiac features or certain co‑morbidities/medications; refer to cardiology if these are present. 

Monitoring & reviews

• During titration: symptoms and adverse effects are tracked at each dose change; titrate to the lowest effective dose. Modified‑release once‑daily options can improve adherence and reduce misuse risk. 

• Ongoing: check weight (children more often; adults at least 6‑monthly) and blood pressure/pulse at dose changes and every 6 months once stable. Consider BMI review in adults if weight changes. 

• Annual review: at least once a year, discuss whether to continue, adjust or trial planned breaks if appropriate (especially for growth effects in children). 

Side effects & safety notes (high‑level)

Common effects can include reduced appetite/weight loss, dry mouth, insomnia or mild increases in pulse/BP with stimulants; guanfacine can lower BP/pulse. Your clinician balances benefits and risks and adjusts dose or medicine if needed. Seek urgent advice for chest pain, fainting, sustained tachycardia or marked BP rise. 

• Psychosis/mania: pause ADHD medication during an acute psychotic or manic episode; consider restart only after recovery. 

• Diversion/misuse: clinicians may favour modified‑release stimulants and avoid preparations that can be injected/insufflated if misuse risk is present. 

• Co‑existing conditions: people with anxiety, tic disorders or autism are usually offered the same medication choices as others; care plans are individualised. 

• Driving: declare if ADHD symptoms or medication affect safe driving. 

• Pregnancy/breastfeeding: decisions are individual; discuss risks/benefits with your specialist if you’re planning pregnancy, pregnant or breastfeeding. (NICE advises shared decision‑making and regular medication review.) 

This page is information only and isn’t medical advice. Always follow your own clinician’s guidance.

NHS vs private routes

• NHS: GP referral to a specialist ADHD service. In England you may have a Right to Choose provider for your first appointment—ask your GP how this applies locally. 

• Private: You can self‑fund NICE‑aligned assessment, titration and monitoring. Ensure the provider issues a comprehensive report and can set up shared care with your GP when appropriate. 

FAQs

Which ADHD medication is first‑line for adults?

Lisdexamfetamine or methylphenidate. If one is ineffective after a 6‑week adequate trial, switch to the other; if both fail or aren’t tolerated, consider atomoxetine. 

What about children and young people?

Start with methylphenidate (≥5 years). If inadequate, consider lisdexamfetamine; if stimulants aren’t tolerated/ineffective, consider atomoxetine or guanfacine. Dexamfetamine may help some who respond to lisdexamfetamine but can’t tolerate its longer effect. Medication is not used in under‑5s without a second specialist opinion. 

Who prescribes and monitors long‑term?

A specialist starts and stabilises treatment; a GP may continue under shared care. 

What checks are needed?

Baseline physical and cardiovascular review, plus ongoing weight, pulse, BP checks and at least annual medication review. Routine ECG isn’t needed unless there are specific risk factors. 

What if I have an episode of mania or psychosis?

ADHD medicines should be stopped during the episode; consider restarting only after recovery, based on risks/benefits.