Your Guide to Titration for ADHD Medication – Frida

Titration is the process of adjusting the amount of your medication to find the right dosage.
The titration process for long-acting stimulants (such as ADHD medication) is all about figuring out what works best for you!
Depending on the severity of your ADHD symptoms, you may require more or less of a medication to get good coverage and control of your ADHD symptoms.
We “start low and go slow” through the titration process to ensure you are feeling well on your medication before increasing the dose.
Typically, the beginning titration doses are not quite enough to provide adequate ADHD symptom control.

You may be instructed by your clinician to either do self-titration (increasing of your own dose) between appointments or to wait until your follow up appointment to make any adjustments

In all cases, you will only want to self-titrate your long acting stimulant medication, not any medication that is meant to treat depression or anxiety. Please do not self-titrate either your depression or anxiety medication or your stimulant medication unless this was pre-arranged with your clinician.

Goals of ADHD Treatment

The ideal "zone" of medication is when you are getting good control of your ADHD symptoms but are not feeling overstimulated.
Try to find the lowest dose of medication that still provides good symptom relief!

Self-Titration

If your clinician has recommended you participate in self-titration, the information below outlines the things to keep in mind. Please ensure to follow the specific self-titration instructions outlined by your clinician.

It is best to base the need for adjustments off of consistent symptoms you observe over many days and not off of the experience of a single day.
As you are titrating, remember you can stay at each titration longer than the given schedule and if you are unsure if you are getting good coverage at a specific titration, you can always hold where you are and discuss with your nurse at your next follow up.

Consider increasing dose as instructed by your clinician if:

You’re not feeling like there’s enough of a change in your symptoms
You feel like the medication is not lasting long enough:

You can either increase your dose without increasing how often you take your medication, or try taking another smaller dose 1 to 2 hours after your first dose of the day. For example, if your total dose is 40mg Vyvanse daily, you could try taking 30mg first thing in the morning followed by 10mg 1-2 hours later to see if coverage improves.

It’s important to note that taking stimulant medication later in the day can affect your sleep, so if you’re going to try taking more later in the day, we still strongly recommend taking the larger dose early in the morning.

Do not exceed the maximum daily dose prescribed by your Frida clinician.

When to not titrate up (increase your dose):

If your blood pressure is equal to or greater than 140/90 multiple days in a row
If you have a decreased appetite and are steadily losing weight
If you are having a hard time managing side effects of your stimulant medication (heart racing, feeling jittery or can not sit still or sleep)

Keep a journal

We recommend keeping a journal about the following symptoms to help determine if your dose is working for you:

effects of focus, distractibility, organization, memory, and social impulsivity
effects on emotional regulation
duration of how long the medication is lasting - make note of how you feel when it is wearing off
how it is affecting your sleep and, if there are difficulties, how you feel when trying to fall asleep
any side effects you may be experiencing

What to never do:

It can take days, weeks, or even months to find the right dosage. That’s because it takes more than just a day or two to understand how different amounts feel.

Do not make drastic changes on a day-to-day basis.
Never increase your dose past the recommendation of your prescriber.
Please refer to your prescription for the maximum dose you should trial before your next appointment.
It is also recommended to stay at a dosage for at least 7-10 days before you try increasing it.
Follow your prescriber's recommendations for how long to maintain a dose before increasing again.

What if I feel like I need to stop taking my medication?

Reach out to Frida to be sure that your clinician knows that you are stopping medication and why.
It is safe to discontinue a long acting stimulant medication abruptly, recognizing the benefits of the medication will no longer be present.
It is not advised to abruptly stop your antidepressant or anti-anxiety medication (SSRI, SNRI or Wellbutrin) as it could lead to uncomfortable withdrawal symptoms. We recommend discussing a slow decrease of these medications. However, this is not life threatening so an abrupt stop can occur if required.

If you have not been recommended to self-titrate and feel your dose is too low, speak with your Frida clinician about your dose at your next appointment. You may reach out to book an earlier appointment if you feel it’s necessary.