ADHD Medications
A guide to the medications used to treat ADHD in adults, covering what they do, how to take them, what to expect, and what the side effects are.
This guide covers the medications we use most commonly to treat ADHD at BGM Medical. It is intended to sit alongside, not replace, the advice from your own doctor. Your prescription, dose, and management plan will always be tailored to you. If anything here raises a question about your own treatment, please ask us.
Starting ADHD medication
Medication is the most effective evidence-based treatment for ADHD in adults. It does not work for everyone, but for the majority of people it makes a meaningful difference to attention, organisation, impulse control, and emotional regulation.
Lisdexamfetamine & Methylphenidate
First-line treatment for most adults. Work by increasing dopamine and noradrenaline availability in the brain. Effect is often felt from the first dose.
Atomoxetine & Guanfacine
Used when stimulants are not suitable or not well tolerated. Taken every day without breaks and take several weeks to reach full effect.
Before we start: family cardiac history
All stimulants have a mild effect on heart rate and blood pressure. Before starting, please think about whether anyone in your close family has had heart problems, including pacemakers, sudden cardiac arrest, unexplained fainting or palpitations, or conditions such as Long QT syndrome. If you are aware of anything like this, let us know so we can factor it into the decision.
What is titration?
Titration is the process of finding the right dose for you. There is no universal dose. The right amount depends on your weight, your individual response, and what you are trying to achieve.
Week 1–2
Start low
We begin at a low dose and ask you to monitor how you feel, including attention, sleep, appetite, and any side effects.
Week 2–4
Review & adjust
You check in with us. We review your notes and adjust the dose upward if needed and if side effects allow.
Week 4–8
Finding the right level
We continue adjusting at each review, looking for the point where effect is good and side effects are manageable.
Week 6–12
Stable dose
Once we reach a stable dose that is working well, we move to longer-term review appointments.
Important: Do not change your dose without speaking to your doctor first. If the current dose is not working, or side effects are troublesome, contact us and we will adjust the plan together.
Lisdexamfetamine
StimulantElvanse (Vyvanse in the US)
Our usual first-line stimulant in adults. Longer-acting with a smoother, steadier effect and fewer dips compared to methylphenidate.
Why we tend to use this first
Both lisdexamfetamine and methylphenidate are first-line options and the evidence does not give a completely clear-cut answer as to which is better. However, lisdexamfetamine tends to produce fewer dips and is generally better tolerated in adults. The best available evidence, from the Cochrane systematic review of pharmacological treatments for ADHD in adults, which pools all major studies, suggests lisdexamfetamine is better tolerated in adults. As a result it is the stimulant we tend to try first, though this is always an individual discussion.
How it works
Lisdexamfetamine is a prodrug, meaning it is inactive until converted by the body into dexamphetamine. This gradual, rate-limited conversion produces a smoother release than older amphetamine preparations.
Time to effect
Works from the first dose at an effective level. Duration is typically 12 to 14 hours.
How to take it
- Take once in the morning, with or without food.
- Capsules can be opened and dissolved in water if swallowing is difficult.
- Take early in the day to avoid affecting sleep.
What to expect
A smooth, consistent effect covering a full working day. Fewer rebound dips than shorter-acting preparations. Often preferred for people who need all-day cover.
Common side effects
Methylphenidate
StimulantRitalin · Concerta XL · Medikinet · Equasym · Xenidate XL
One of the first-line medications for ADHD. Well studied and fast-acting. More commonly used as first line in children. Available in short-release, modified-release, and long-release forms.
How it works
Blocks the reuptake of dopamine and noradrenaline, making more of these neurotransmitters available in the areas of the brain involved in attention and executive function.
Time to effect
Works from the first dose at an effective level.
How to take it
- Take in the morning. Medikinet must be taken with food; Concerta can be taken either way.
- Do not take after mid-afternoon, as it may interfere with sleep.
- Do not crush or chew extended-release tablets.
- If you miss a dose, skip it. Do not double up.
What to expect
Many people describe a sense of clarity and finding it easier to start and stay on tasks. The effect wears off as the medication leaves your system, which is normal. Some people notice a brief "rebound" dip in mood as it wears off. This usually settles; if it is troublesome, we can adjust the timing or switch to a longer-acting formulation.
Common side effects
Atomoxetine
Non-stimulantStrattera
A non-stimulant taken every day that builds up over several weeks. A good option when stimulants are not suitable.
How it works
Selectively inhibits the reuptake of noradrenaline. Works differently to stimulants, which is why it is an option when stimulants are not tolerated or are not appropriate.
Time to effect
Takes 4–8 weeks to reach full effect. Some people do not see the full benefit until 10–12 weeks. Patience is required.
How to take it
- Take once or twice daily, with or without food.
- If taken twice daily: morning and early evening.
- Take at the same time each day.
- Do not stop because it is not working in the first week. Give it time.
What to expect
A steady background improvement rather than an on/off effect. Not a controlled drug, which makes prescribing and supply more straightforward than for stimulants.
Common side effects
Rare but important: Atomoxetine carries a small risk of increased suicidal ideation, particularly in young adults when first starting. If you notice a significant change in your mood or have any thoughts of self-harm, stop the medication and contact us or 111 immediately.
Guanfacine
Non-stimulantIntuniv
Particularly helpful for emotional dysregulation. Often combined with a stimulant for people who need extra support with emotional regulation.
How it works
Acts on alpha-2A adrenergic receptors in the prefrontal cortex, the area most associated with executive function, impulse control, and emotional regulation.
Time to effect
Takes several weeks to reach full effect. Taken every day without breaks.
How to take it
- Take once daily in the evening. Guanfacine can cause drowsiness, and evening dosing usually helps.
- Do not take with a high-fat meal, as it significantly increases absorption.
- Do not stop suddenly. Guanfacine must be tapered under medical supervision. Stopping abruptly can cause a rebound rise in blood pressure.
What to expect
A gradual improvement in emotional reactivity and impulse control. Often used alongside a stimulant rather than as a standalone treatment.
Common side effects
Because guanfacine affects blood pressure and heart rate, we monitor these at review appointments. Do not stop taking it without speaking to us first.
Practical tips
These apply to all ADHD medications, not just one in particular.
Give it time
Most medications need several weeks at the right dose to show their full effect. Try not to judge too early.
Keep notes
A simple daily log during titration, noting how you felt, when you took it, and sleep quality, makes review appointments far more useful.
Watch vitamin C
Citrus juices and some fizzy drinks can reduce the absorption of amphetamine-based medications. Avoid around the time you take your dose.
Limit alcohol
Alcohol and stimulants interact unpredictably. Avoid or minimise while adjusting your dose.
Medication breaks
Stimulants can be taken as needed. Some people take breaks at weekends. Whether this suits you depends on your situation, so discuss it with your doctor first.
Other medications
Always tell your doctor about any other medications, supplements, or herbal remedies you are taking. Some interact with ADHD medications.
Driving
Most people find medication improves their ability to drive safely. In the early days of adjusting your dose, be cautious. If you feel drowsy or unusual, do not drive.
When to contact us
Contact us or NHS 111 urgently if you experience:
- Chest pain, palpitations, or a very fast or irregular heartbeat
- Significant mood changes, anxiety, or any thoughts of self-harm
- A sudden change in mood or behaviour that feels out of character
Contact us at your next opportunity if:
- Side effects are not improving after 2–3 weeks
- You feel the medication has stopped working or was never effective
- You need a dose adjustment or prescription review
- You want to stop, reduce, or switch medication