Titrating the Dose of ADHD Medication

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How do doctors know how much ADHD medication someone needs? It's usually a process of trial and error. Titrating a dose is a process doctors use to find the most effective amount of medication for a person.

A doctor will factor in your height, weight, and ADHD symptoms when titrating ADHD medication. However, because biology is an inexact science and every individual is unique, a doctor's first estimate may not be ideal for you. They will need to titrate the amount for the greatest effect with the fewest side effects.

Titration of Medication

Titration is the process of determining the medication dose that reduces your symptoms to the greatest possible degree while minimizing side effects.

When doctors titrate a dose, they are making adjustments to how much medicine you're taking. Doctors will often start you on a lower dose of medication and increase over time if your symptoms don't improve. This process may be rather quick, or it could take some time.

The purpose of titration is to find that perfect balance of a particular medicine for your body. The goal is for the medication to do its job and produce the desired effects of helping to control your symptoms. At the same time, the doctor wants to reduce or eliminate any adverse effects.

Titrating can be done for any medication that's used on a long-term basis. In addition to stimulants for attention-deficit/hyperactivity disorder (ADHD), this could include:

If medication adjustments don't create that balance of reducing your symptoms with the fewest side effects, then the doctor may choose to try another medication. With patience, time, and by working closely with a doctor, it's likely that you'll eventually find a suitable medication and dose.

Initial Dose

Once a doctor provides you with an initial prescription for ADHD medication, there should be a process of determining whether or not your dose should be increased or decreased. The doctor will also ascertain whether the medication they've prescribed is overall the best medication for you based on any side effects you experience.

You and the doctor will be working together to determine whether you're experiencing any of these effects from your ADHD medication:

  • Too little response: The medication isn't sufficiently controlling your ADHD symptoms such as inattention, impulsivity, and hyperactivity.
  • Intolerable side effects: The medication may be working, but the side effects are severe and/or intolerable.
  • Too much response: Instead of gaining greater control over your symptoms, you become passive, depressed, or unlike yourself.

To avoid such problems, if you're beginning a trial of stimulant medication, the doctor will likely start with an initial low dose of stimulant. At this point, it will largely be up to you to watch carefully to determine whether or not the medication is helping to alleviate your ADHD symptoms, whether and to what degree you're experiencing side effects, and whether any of these side effects increase or decrease over time.

Consider keeping a diary to record any improvement you notice from the medication and any side effects you experience. You might ask trusted friends or colleagues that you see on a regular basis whether they notice a difference in your behavior or mood. They may be able to provide helpful details or observations.

If your child has ADHD, you might ask their teachers or people that interact with them on a regular basis whether they've noticed any changes in your child's behavior as a result of their ADHD medication.

Potential Side Effects

With stimulant medications prescribed for ADHD like Ritalin, Concerta, and Quillivant (methylphenidate), Vyvanse (lisdexamfetamine), Focalin (dexmethylphenidate), and Adderall (dextroamphetamine-amphetamine), there are some potential side effects you should watch for.

The doctor prescribing your medication may add more side effects to this list, so write them down if needed. It's also a good idea to read through the information you receive from the pharmacy and ask any questions you may have.

Common Side Effects of Stimulant Medication

You can wait to share any mild side effects with the doctor at your next visit, but you should report any significant issues or strange symptoms immediately. Some side effects may decrease or even go away with time as your body adjusts to the medication.

Any problems you experience may be due to the dose or to an unusual reaction indicating that the medication is not the right one for you. However, don't stop taking (or have your child stop taking) the medication without talking to the doctor first, since doing so can be dangerous.

Finding the Ideal Dose

Assuming that the medication you're trying is reducing your ADHD symptoms with few or no side effects, the doctor will carefully and gradually adjust (titrate) the dose upwards to adequate levels.

Titration helps your body adapt to the medication and also helps you and the doctor find the optimal dose to improve your daily functioning. This gradual increase usually occurs every one to three weeks.

The doctor will eventually increase your dose to the highest dose that you can tolerate. If you begin to see no more improvement in your symptoms as the dose increases, the doctor will lower the dose to the previous one. Similarly, if you find that a higher dose produces too many side effects, the dose will be also lowered.

A Word From Verywell

The optimal dose of ADHD medication is one with which your daily function is significantly improved and side effects are minimized. While finding this dose can be frustrating and it may seem like nothing is working, it's important to remember that medication management is a very individualized endeavor that's based on your personal needs and responses. This is why close communication with a doctor is vital.

Think of your relationship with your doctor as a partnership. Be open and communicative about your needs and experiences, and together you will arrive at the most beneficial outcome. As you work with a doctor to find the best dose for you, remember you can talk to a mental health professional to help you manage the changes in your behavior, emotions, and mood.

6 Sources
Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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By Keath Low
 Keath Low, MA, is a therapist and clinical scientist with the Carolina Institute for Developmental Disabilities at the University of North Carolina. She specializes in treatment of ADD/ADHD.