Written by Khalid Anwar · Last reviewed 20 August 2026
ADHD medication monitoring is an ongoing clinical process, not a single blood-pressure check. The clinician considers symptom response, day-to-day functioning, adverse effects, physical observations, adherence and the person's preferences before deciding whether treatment should continue or change.
Before medication starts
NICE recommends a review of mental and physical health, current medicines, relevant medical history, height and weight, pulse, blood pressure and cardiovascular assessment before starting ADHD medication. An ECG is not routinely required unless there is a clinical indication described in the guidance.
During titration
Titration is the period when the dose and sometimes the medicine are adjusted. Reviews should consider benefits and adverse effects at each change. The goal is not simply to reach a standard dose; it is to find an appropriate balance for the individual.
Useful information may include how long benefits last, whether important tasks or relationships have changed, appetite, weight, sleep, headaches, mood, anxiety, pulse and blood pressure. Patients should report new or worsening symptoms rather than changing the dose themselves.
Physical monitoring
NICE recommends monitoring heart rate and blood pressure before and after each dose change and every six months. Weight should also be monitored, and BMI may be considered in adults when treatment-related weight change persists. The clinician may arrange additional checks where history, symptoms or another medicine makes them necessary.
Symptoms and adverse effects
Monitoring should include effectiveness as well as safety. A medicine may improve concentration but still require review if sleep, appetite, cardiovascular observations, mood or other adverse effects become problematic. Sexual dysfunction, seizures, tics and sleep changes are among the issues addressed in NICE monitoring recommendations.
Ongoing and annual review
Treatment should be reviewed periodically to confirm that the benefits continue, adverse effects are acceptable and medication remains the person's informed choice. Responsibilities for prescriptions and monitoring must be clear when care involves both a specialist and GP. Shared care is voluntary and arrangements vary.
Seek advice between reviews
Contact the prescribing service if there are concerning side effects, a significant change in health, pregnancy or pregnancy planning, a new interacting medicine, or difficulty obtaining the prescribed product. Seek urgent medical help for severe symptoms. Do not stop or change prescribed medication without appropriate advice.
This page explains general monitoring principles and does not provide an individual schedule. Follow the plan given by the responsible prescriber.
Sources
NICE NG87 recommendations
NHS: ADHD in adults
Related guidance
Treatment and medication
Medication shortages guidance
Ongoing ADHD care
Shared-care guide
General information only; it does not replace individual medical advice, diagnosis or treatment.