Medication Titration Plan
Please read this carefully especially section on Shared Care
Please note that I only prescribe if I have confirmed a diagnosis, I believe it is clinically indicated and not on demand.
I follow NICE guidelines regarding first and second line medications and titration. ADHD medications are controlled drugs and require additional consideration when prescribing and monitoring.
If medication is the right choice for your child then it is important to note that medication is more likely to be effective if part of a multi-modal psycho-educational approach with school and home-based ADHD specific support and behavioural strategies. Further reading: LINK1 LINK2 LINK3
Before starting medication, I will complete a risk assessment and a full physical examination that will include weight, height, and blood pressure. If there is a family history of heart problems then an ECG will need to be done prior to starting medication.
My practice is to start on the lowest dose and then slowly increase depending on response and any complications until a stable or 'optimised' dose is reached (this is called medication titration). This has to be done very carefully and with supervision.
There’s no one-size-fits-all approach and every child responds to medication differently. The dosage doesn’t depend on height, weight or age like other medications. This is because stimulant medications are influenced by other factors like your child's metabolism, genetics, medication history, and severity of symptoms.
For some there is a quick and dramatic improvement (‘lightbulb moment’) but for others it is gradual over weeks or longer. Sometimes it takes trials of different medications and dosages to find the right regime that works.
Although medication titration process may feel frustrating and confusing, I will try my best to guide you and find the best medication for your child as quickly as possible. On average it takes around 3-6 appointments (6-12 weeks) to stabilise medication whilst carefully monitoring your child's health.
Read more about medication: LINK2 (page 28-31) LINK3
Methylphenidate Information leaflet.
Elvanse Information leaflet.
Guanfacine Information leaflet
Atomoxetine Information leaflet
Standard medication titration plan:
In clinic, I will have discussed medication options and titration plan that best suits your child. Following is a summary.
In nearly all cases your child will be started on a stimulant type medication, either slow release methylphenidate or Elvanse.
Slow-release form of methylphenidate (MP MR) e.g., brands such as Medikinet XL/Equasym XL (capsules) or ConcertalXL/Xaggitin XL/Matoride XL/Other (These are tablets).
If your child has not tolerated stimulants then a non-stimulant, Guanfacine or Atomoxetine would have been recommended.
Prescription issued for 30 days. Take 1 tablet / capsule roughly same time every morning. Every 1-2 weeks the dose should be increased as agreed with Dr Nawaz.
Typical titration plan: MP MR capsules. Week1 - 10mg; Week2 - 20mg (1x20 or 2x10); Week3 -30mg (20+10) etc.
Mild side-effects (refer to information leaflet above) can occur after starting and when dose is increased but usually settle down after a few days - see information leaflet above. If they persist, this may require increasing medication every 2 weeks instead of 1, to allow your child's body more time to adjust.
If worried about severe side effects then please book a medication review appointment (Video) or stop medication pending further discussion. Most side effects will stop after not taking the medication for 24hrs.
Every 3-4 weeks please book a Medication Review video appointment - includes issuing a new prescription. 20-30 mins max. These consultations are focused only on medication titration, to discuss how the medication is working, is it wearing off too early etc.
Unless I have specifically instructed I am unable to do medication reviews / give medical advice via email. This is not good clinical practice or safe. Please book a Medication Review appointment.
For clinical safety and to assess whether treatment is working or not, it is very important that your child takes the medication as prescribed and attend the regular appointments. Book an appointment.
Repeat Prescription required in between appointments will cost £20 and posted via special delivery. For Repeat Prescriptions please click on LINK. I try to respond and post out within 48 hours but please make sure you have at least 7 days worth of medicine left.
Please note: I am unable to response to same day urgent prescription requests. I will only issue further prescriptions if review appointments are kept to schedule.
Any changes to a prescription will require a Medication Review appointment.
Presently, I am unable to send the prescription to your local pharmacy.
Likely costs regarding ADHD Medication depends on type, brand and dose but typically between £50 - £150 for a month's supply. Price can vary a bit between pharmacies so you may want to phone around, although some pharmacies will not quote over the phone.
Likely costs regarding stabilising medication depend on number of video appointments.
I try to minimise cost by offering convenient evening video appointments and do not charge for issuing prescriptions following an appointment.
Long Term
Once on a stable medication dose, I can then request shared care and on-going prescribing by your GP including referral to your local NHS ADHD care provider for on-going specialist care.
Alternatively, I would be very pleased to provide on-going specialist review.
Please note that any young person on ADHD medication requires a specialist review 4-6 monthly, either by me or your local NHS ADHD specialist. Your child will need to have weight , height and blood pressure checking at least 6-monthly.
Please note some GP's will not provide shared care from a private clinician and therefore will not take over prescribing. I would recommend discussing this with your GP prior to your first appointment with me.
I only see young people up to their 18th birthday, although, if I’ve initiated treatment before then, I would be happy to provide on going care for a short time till care has been transferred and accepted by an adult specialist.
