What is Titration?
Medication titration is the process of starting and adjusting the type or dose of medication to find the most effective preparation that provides maximum benefits with the least possible side effects.
The National Institute for Health and Care Excellence (NICE) state that medication should only be initiated and reviewed by a healthcare professional experienced in diagnosing and managing ADHD. If you already have a diagnosis of ADHD from The Edinburgh Practice or from elsewhere, and you are considering starting medication, you can complete a self-referral form to request medication titration.
Throughout titration you will attend regular appointments with one of our Consultant Psychiatrists, Specialty Doctors or Advanced Practice Clinical Pharmacists, who will adjust and monitor your medication until you reach a stable and optimal dose. Consultations can be offered remotely and/or in person.
The Titration Process at The Edinburgh Practice
If you have been diagnosed out with The Edinburgh Practice, we will request that you provide your ADHD Assessment report alongside any other relevant documents. Our Clinical Lead will review your diagnostic report to ensure that it meets best practice guidelines and that all information required is provided. Please note we cannot progress your referral until we receive your assessment report.
Initial Consultation
Once your referral has been accepted, you will be offered an initial consultation with our Advanced Practice Clinical Pharmacist, Consultant Psychiatrists or Speciality Doctors. Our Clinical Lead will advise you on the most appropriate professional based on your individual medical history.
This appointment will enable us to review your diagnosis of ADHD, medical history and physical health and we will advise as to whether it is appropriate for you to start medication. If appropriate, you will discuss the medication options available to you based on your individual clinical history and NICE guidelines. The clinical rationale, benefits and any side effects of the medication will be discussed with you so you can make a fully informed choice.
Before starting medication, we will obtain baseline physical observations including blood pressure, pulse, height and weight. You may be asked to provide results of an ECG and/or blood tests. Once your baseline observations have been received, these will be reviewed by your clinician and if your observations are within the expected range, you will be ready to safely start the treatment process, and you can receive your first prescription.
Titration Review Appointments
During the titration process, you will meet with your clinician for review appointments every 3-4 weeks to monitor your progress and to adjust your medication where necessary. Your physical observations will be reviewed prior to each new prescription and at each review appointment.
Post-titration Medication Reviews
The length of the titration process differs from person to person, however the process usually takes a minimum of 8-12 weeks. You will be fully titrated when your body has adjusted to the new medication, and you have found your optimal dose.
Once you have completed titration and are on a stable dose, you no longer require medication reviews every 3-4 weeks. Your clinician will advise on how often you require medication reviews post-titration based on your individual clinical care needs, for example this may be every 3 or 6 months.
Prescriptions
During titration you do not need to request prescriptions as you will receive these at your review appointments. After titration is complete, we ask that you request prescriptions via the client portal.
If you do not wish to run out of medication, please ensure you request your prescription 14 days before your medication is due to be refilled. It can be helpful to set a reminder to prompt you to request your prescription on time.
Shared Care
Shared care is when your NHS GP agrees to enter into a collaborative care agreement with a doctor at The Edinburgh Practice following completion of titration. In shared care the GP is responsible for providing your prescriptions, whilst you receive monitoring from The Edinburgh Practice at agreed intervals (for example every 3 or 6 months).
We are aware that as of June 2024 many GP practices across Scotland are no longer accepting shared care requests from private healthcare providers. Many GP practices in Scotland are no longer providing shared care to clients with a private ADHD diagnosis due to lack of funding and expertise in the field of ADHD care. If you would like to have the option of shared care, we advise that you liaise with your GP prior to commencing medication with The Edinburgh Practice to find out whether your GP practice will be able to provide shared care for you. The decision of whether GP practices accept clients for shared care is at the discretion of the GP practice.
GP Communication
We must write to your GP when we are prescribing medication regardless of whether your GP agrees to shared care, this is for safety reasons, so that the professionals involved in your care are aware of your diagnosis and any medication that you are prescribed.