How ADHD Medications are Dosed: Titration and Signs of High or Low Doses

How is your initial dose of ADHD medication determined?

Doctors will use a combination of prescribing guidelines and personal experience to decide which dose of ADHD medications to start you on. Individual factors are also considered when choosing your initial dose, such as:

• Age

• Medical history

• The severity of your ADHD symptoms

• Comorbidities

• Height and weight may also be considered for some medications

What is medication titration?

Titrating medication means changing the dose slowly over time to see how your body reacts to the drugs. In most cases, your doctor will start you with a low dose and increase your dosage every couple of weeks until you reach your “target dose.” A target dose means that you’re getting the most therapeutic effects with the fewest side effects. Medications can also be titrated down. 

Factors affecting medication titration

The way your body responds to the most common ADHD medications (stimulants) has more to do with factors like metabolism, medication history, and severity of symptoms than it does with your height or weight. 

To find your target dose, titrating can be done with any ADHD medication, including non-stimulants. Since ADHD medications are taken long-term, the goal is always to reduce the number of side effects and take the lowest dose possible for therapeutic benefits. 

What is monitored during the titration process

During the titration process, your doctor will start you on an initial lower dose and check in every week to talk about side effects and benefits in order to guide the next dosing decision. 

During this process, you and your doctors will discuss whether the dosage is:

• Not giving enough therapeutic benefits: Your symptoms don’t feel sufficiently reduced

• Too many side effects: The side effects are severe or outweigh any benefits

• Over-responding: The symptoms control is overboard, and you no longer feel like yourself

When a medication isn’t getting the desired results after two to six weeks of titrating, your doctor may choose to switch medications and go through the process again. 

Signs your ADHD medication is too high

Depending on your medication, the most common sign that your medication is too high is when you begin to experience significant, severe, or debilitating side effects that don’t subside after a week. When assessing the severity of your side effects, ask yourself questions like “do the benefits of this medication outweigh the side effects?” and “on a scale of 1 to 10, how bad are these side effects?” (1 being “no problem” and 10 being “these are absolutely awful and debilitating”). In general, side effects should be mild. 

Common signs stimulant medication is dosed too high

Common stimulants include Vyvanse, Adderall, Ritalin, and Concerta. Visit the following guide for a list of all ADHD stimulants.

• Significantly increased anxiety or depression

• Feeling “too wired”, especially into the evening

• Severe Insomnia

• New tics

• Extreme irritability or agitation 

• Hallucinations

• No appetite and significant weight loss

• No longer feel like yourself, “sparkle” is gone

Common signs non-stimulant medication is dosed too high

Common non-stimulants include Strattera and Qelbree. Visit the following guide for a list of all ADHD non-stimulants.

• Extreme fatigue (zombie-like)

• Severe gastrointestinal upset 

• Significant constipation

• Rapid pulse

Always talk to your doctor about your side effects before discontinuing your medication. Sometimes your side effects may feel extreme, but they are temporary and within the normal range. You can also call your pharmacy to discuss the normal range of side effects if your doctor is unavailable. 

Signs your ADHD medication is too low

Medication that is dosed too low is generally ineffective at controlling your symptoms. If you’ve never been on medication before, you might feel uncertain about what “symptom control” actually feels like. In addition to working with your doctor, you can take ADHD self-assessments to help you determine how much your symptoms are improving.

Common signs stimulant medication is dosed too low

• Difficulty paying attention or focusing

• Only getting symptom relief for a brief period (talk to your doctor about symptom relief expectations or check out medication durations here)

• Having difficulties with impulse control

• Getting easily distracted

• Feeling hyperactive or “on the go” 

Common signs non-stimulant medication is dosed too low

• Difficulty paying attention and avoiding distractions

• Feeling hyperactive or “on the go” 

• No significant symptom relief after two weeks on medication

Symptoms of ADHD that aren’t affected by medication

Even with an effective medication at an ideal dose, you may still have some symptoms of ADHD. The symptoms of ADHD that aren’t really influenced by medication include:

• Organization

• Sense of time or time blindness

• Forgetfulness in daily activities

Am I taking the right ADHD medication?

Sometimes even the most popular ADHD medications don’t work well for a particular person. A medication being determined “not ideal” occurs after you and your doctor have worked to find a target dose, and you are still either feeling symptoms of ADHD or experiencing too many side effects. 

In these cases, it may be something about the formulation that doesn’t jive well with you. There are now over 30 ADHD medications available, so don’t worry if the first one isn’t ideal– you have plenty of options. It’s also perfectly normal to stop or change medications over time for a variety of reasons. The most important thing is to find what works best for you and your health. 

How to get a prescription for ADHD medication

To get a prescription of ADHD medication, you will first need to be seen by a healthcare provider who can assess and diagnose your ADHD.  You will then work with your provider to begin a treatment plan which may include medications for ADHD. 

If you want to talk to a professional about which ADHD meds are best for you, Frida can help. Take our ADHD self-assessment today and learn more about how the experts at Frida can guide you through a diagnosis and get you a treatment plan with medications delivered right to your door.