ADHD Medication Titration Guide

Week 1: Starting Your Medication

What to Expect

• First dose effects: You'll likely notice SOMETHING—increased focus, alertness, calm
• Partial improvement: Starting dose rarely optimal; expect 30-50% improvement
• Side effects peak: Headache, decreased appetite, jitteriness common day 1-3
• Uncertainty: "Is this working? Is this how it should feel?" Normal questions

What to Do

• ✅ Take at same time daily: Consistency helps assessment
• ✅ Track symptoms: Use daily tracking form
• ✅ Hydrate well: 8-10 glasses water (reduces headaches)
• ✅ Eat before medication: Large breakfast before morning dose
• ✅ Be patient: First dose is just starting point
• ✅ Don't adjust dose yourself: Follow prescriber's plan

Red Flags (Call Doctor)

• Severe anxiety or panic
• Chest pain or palpitations
• Severe headache
• Allergic reaction (rash, swelling)

Week 2: First Dose Increase

What to Expect

• Better symptom control: Focus and impulse control should improve further
• Side effects may increase: But usually less severe than day 1 of starting dose
• Duration clarity: You'll notice when medication wears off
• Comparing doses: Is this better than last week?

Assessment Questions

• Is symptom improvement significantly better than Week 1?
• Are side effects tolerable?
• Does medication last long enough?
• Are you functioning better at work/school?

Decision Points

• If much better + tolerable side effects: Increase dose per plan
• If no additional improvement from Week 1: May need to stay at this dose longer or switch medications
• If worse (more side effects, less benefit): May need to go back to Week 1 dose

Weeks 3-4: Finding the Sweet Spot

What to Expect

• Benefit plateau: At some dose, additional increases don't help more (or make things worse)
• Side effects more prominent: As dose increases, side effects may limit further increases
• "This is it" moment: You'll likely feel when you hit optimal dose

Signs You've Found Optimal Dose

• ✅ Functional improvement plateau: Further increases don't improve work/school performance
• ✅ Manageable side effects: Benefits clearly outweigh negatives
• ✅ Feels sustainable: You could take this dose long-term
• ✅ Adequate duration: Covers most of day (or combination with afternoon booster works)
• ✅ Still feel like yourself: Not flat, numb, or over-stimulated

Signs Dose Is Too High

• ❌ Emotional blunting: Feel flat, less emotional, "not yourself"
• ❌ Excessive anxiety: Jittery, can't sit still, worried
• ❌ Over-focused: Stuck on unimportant tasks, can't switch
• ❌ Side effects dominate: Severe appetite loss, insomnia, irritability
• ❌ No additional benefit: Function same or worse than lower dose

Weeks 5-8: Fine-Tuning & Confirming

What to Expect

• Consistent benefit: Medication effect should be predictable
• Side effects stable: Most initial side effects resolved or stable
• Real-world testing: How does it perform across different situations?

Fine-Tuning Decisions

If Duration Too Short

• Switch to longer-acting formulation: IR → XR/LA
• Add afternoon booster: Small IR dose when long-acting wears off
• Adjust timing: Take earlier in morning for later wear-off

If Side Effects Persist

• Slight dose reduction: Try 10-20% lower
• Switch formulation: Different extended-release may have better profile
• Switch medication class: Amphetamine → methylphenidate or vice versa
• Add management strategies: See Side Effects Guide

If Benefit Inconsistent

• Check adherence: Taking at same time daily?
• Food interactions: High-fat meals can delay absorption
• Sleep: Medication works poorly when sleep-deprived
• Stress: High stress can mask medication benefit