ADHD Medication Review in 2026: What to Do if Your Treatment Isn’t Working (or You Can’t Get It)

Why this matters now

You waited months—maybe years—for your ADHD diagnosis. You started medication with hope that life would finally feel more manageable. But now, weeks or months later, something doesn't feel quite right.

Perhaps the benefits you experienced initially have plateaued or disappeared altogether. Maybe side effects are making daily life harder rather than easier. Or perhaps you're caught in the current national medicine shortages, unable to get your usual prescription and unsure what to do next.

If any of this sounds familiar, you're not alone. Thousands of adults across the UK are navigating these exact challenges in 2026, and many feel stuck between staying on medication that isn't quite working and the fear of making things worse by changing.

As a UK ADHD nurse prescriber, I've supported hundreds of adults through these frustrations. This guide will help you understand when to consider an ADHD medication review, what safe next steps look like if you can't get your usual prescription, and how to have productive conversations with your prescriber about finding treatment that actually works for your life.

What is an ADHD medication review?

An ADHD medication review is a structured check-in with a trained ADHD prescriber to assess how well your current treatment is working. It's not just about whether you're "taking your tablets"—a good review looks at the bigger picture of your benefits, side effects, safety, and real-world functioning.

NICE guidance and NHS services recommend regular medication reviews to ensure your dose is optimised and any problems are identified early. Think of it as a health MOT specifically for your ADHD treatment rather than a quick prescription renewal.

For adults already established on medication, reviews are typically recommended every 3-6 months initially, then annually once stable. However, if things aren't working well or circumstances change significantly, you may need a review sooner.

What a good review should cover

A thorough medication review should include several important elements. Your prescriber should ask about symptom changes since you started or adjusted medication, looking at specific areas like concentration, organisation, impulsivity, and emotional regulation.

Daily functioning matters more than questionnaire scores. How is medication affecting your work or studies? Your relationships and home life? Your ability to manage tasks that used to overwhelm you? A good review explores these practical impacts in detail.

Side effects need honest discussion. Many people downplay problems because they're worried their medication will be stopped, but your prescriber needs to know about sleep difficulties, appetite changes, anxiety, mood effects, or any physical symptoms you've noticed.

Physical health checks are essential during titration and ongoing treatment. Your blood pressure, pulse, and weight should be monitored regularly. Questions about sleep quality, appetite patterns, and any cardiovascular symptoms help ensure treatment remains safe.

Ideally, your prescriber will use brief standardised questionnaires alongside a clinical interview. The Adult ADHD Self-Report Scale (ASRS) or similar tools help track changes over time and ensure nothing important is missed.

Signs your ADHD medication may need a review

Not every treatment challenge requires immediate action, but certain patterns suggest it's time for a structured review with your prescriber.

Persistent ADHD symptoms despite being on medication for several weeks at a stable dose often indicate your current treatment isn't optimised. If you're still struggling with significant inattention, losing things constantly, missing important deadlines, or finding yourself unable to start or finish tasks, your medication may need adjustment.

Many adults describe feeling like the medication helps "a bit" but doesn't deliver the level of functioning they hoped for. You might manage better than before treatment, but still feel far from where you want to be. This partial response is common and usually means your dose, formulation, or medication type needs reconsidering.

Benefits wearing off too soon is another key sign. If your medication works well for 3-4 hours but then you experience a noticeable "crash" or return of symptoms before your next dose is due, the timing or formulation may need adjustment. Modified-release and immediate-release preparations work differently, and some people need combinations to cover their whole day.

Difficult side effects that persist beyond the first few weeks suggest your body isn't adjusting as expected. Common problems that warrant review include persistent insomnia or severe sleep disruption, significant appetite loss affecting your weight or nutrition, increased anxiety or feeling "wired" rather than focused, mood dips or emotional flatness, or ongoing physical symptoms like headaches, stomach issues, or dizziness.

It's worth noting that some mild side effects in the first 1-2 weeks are normal as your body adjusts. However, if side effects are significantly impacting your quality of life, don't wait months to discuss them.

Red flags: when to act sooner

Certain symptoms require urgent medical attention rather than waiting for a routine review appointment. These include new or worsening chest pain or tightness, very rapid or irregular heartbeat that concerns you, severe mood changes or feeling hopeless, thoughts of self-harm or suicide, or feeling physically very unwell in ways you can't explain.

If you experience any of these, contact NHS 111 immediately for advice, or attend A&E if you feel unsafe or severely unwell. Don't wait for your next scheduled appointment.

For less urgent but concerning new symptoms, contact your prescriber within a few days rather than weeks. They may want to see you sooner or make temporary adjustments while you wait for a full review.

How titration and "finding the right dose" actually work

If you've heard the term "titration" and felt confused, you're not alone. Titration is simply the process of starting ADHD medication at a low dose and gradually increasing or adjusting it over weeks to find the lowest effective dose with manageable side effects.

The goal isn't to find the highest dose you can tolerate—it's to find the optimal dose that gives you the best symptom control with the fewest side effects. For some people, this might be a relatively low dose. For others, it might be higher. There's no "right" dose that applies to everyone.

Most NHS and private ADHD services expect titration to take around 8-12 weeks, though some people reach their optimal dose sooner and others need longer to try different options. During this time, you'll typically have regular check-ins (weekly or fortnightly) and complete monitoring forms tracking your symptoms and side effects.

Titration isn't always linear. Your prescriber might increase your dose for a few weeks, then reduce it if side effects emerge, or switch to a different medication or formulation if the first option doesn't suit you. This trial-and-error process can feel frustrating, but it's normal and necessary.

What you can track between appointments

The more information you can give your prescriber, the easier it is to fine-tune your treatment. Keeping a simple daily log doesn't need to be complicated—even brief notes help.

Consider tracking your daily dose and what time you took it, as timing can significantly affect how well medication works. Note periods when you felt focused and productive versus when symptoms returned. Track your energy levels throughout the day, watching for patterns or crashes. Record your appetite and approximate food intake, as significant changes can affect your overall wellbeing.

Sleep is particularly important—note what time you got to bed, how long it took to fall asleep, and how rested you felt in the morning. If you've been advised to check your blood pressure and pulse, record these regularly.

You might also use a brief symptom questionnaire like the Adult ADHD Self-Report Scale every week or two. Completing the same questionnaire at intervals helps you and your prescriber see whether things are improving, staying the same, or getting worse.

The key is sustainability. A simple note on your phone or a basic spreadsheet is better than an elaborate system you abandon after three days. Track what feels manageable and useful.

ADHD medication shortages in 2026: what's going on?

The UK has experienced significant supply issues with several ADHD medicines since 2023, and unfortunately these problems have continued into 2026. Manufacturing challenges, global demand pressures, and regulatory issues have all contributed to intermittent shortages affecting various brands and formulations.

At different times, supplies of methylphenidate (Concerta XL, Medikinet XL, Xaggitin XL, and others), lisdexamfetamine (Elvanse), and dexamfetamine have been disrupted. The specific medications affected and the severity of shortages vary by region and change month to month.

National guidance from NHS England and the Department of Health has been issued to help healthcare professionals manage these shortages, including advice on safe alternatives and switching between equivalent medications when necessary.

It's important to understand that while frustrating and disruptive, there are usually safe alternatives or temporary plans available. However, any medication changes should always be discussed and agreed with a qualified prescriber—never make switches on your own, even if a pharmacist suggests an alternative.

Practical steps if you can't get your usual medication

If your pharmacy tells you your usual ADHD medication is out of stock, there are several actions you can take before panicking or going without treatment.

Order your repeat prescription early. Don't wait until you're down to your last few tablets. Requesting prescriptions 1-2 weeks before you run out gives you time to find stock or discuss alternatives.

Contact multiple pharmacies in your area, including independent pharmacies that may have different suppliers. Some online pharmacies (registered with the General Pharmaceutical Council) may also have stock when local ones don't.

Ask about alternative strengths. If your usual strength is unavailable, your prescriber might adjust your prescription to use different tablet strengths that are in stock. For example, taking two 10mg tablets instead of one 20mg tablet.

Check if equivalent brands are available. There are multiple brands of methylphenidate and other ADHD medications. While not identical, many are bioequivalent and can be suitable alternatives under prescriber guidance.

Never buy from unregulated online sources. Websites claiming to sell ADHD medication without proper prescriptions or from outside the UK are illegal, potentially dangerous, and may sell counterfeit products. Always verify that online pharmacies are registered with the General Pharmaceutical Council—you can check this on the GPhC website.

If you genuinely cannot obtain your medication despite these steps, contact your prescriber urgently. They can either provide a prescription for an available alternative, give you advice on safe temporary measures, or prioritise an appointment to discuss next steps.

Safe options if your medication isn't working

When ADHD medication isn't giving you the results you need, there are several evidence-based options your prescriber might suggest. The key is working through these systematically with specialist support rather than making random changes.

Dose adjustment is often the first step. If you're experiencing some benefit but still struggling significantly, a modest dose increase might help. Conversely, if side effects are prominent, a dose reduction might improve tolerability while maintaining enough benefit.

Timing changes can make a surprising difference. Taking your medication slightly earlier or later, with or without food, or splitting modified-release and immediate-release preparations across the day might optimise coverage of your waking hours.

Switching between immediate-release and modified-release formulations addresses different needs. Immediate-release medications work faster but wear off sooner, while modified-release versions provide steadier, longer coverage but may feel less flexible. Some people benefit from combinations—for example, modified-release for daytime coverage plus a small immediate-release top-up for evenings.

Trying a different stimulant is appropriate when one medication causes problematic side effects but ADHD symptoms clearly respond to stimulant treatment. Methylphenidate and lisdexamfetamine/dexamfetamine work via slightly different mechanisms, and people often respond differently to each.

Considering non-stimulant medications like atomoxetine or guanfacine may be suggested if stimulants cause significant side effects, don't provide adequate benefit, or are contraindicated due to other health conditions. These medications work differently, take longer to show effects (typically 4-6 weeks), but can be very effective for some adults.

Stimulants and atomoxetine are among the most evidence-based treatments for adult ADHD, but the "right" option is highly individual. What works brilliantly for one person may not suit another, and that's completely normal.

When a full re-titration might help

Sometimes the most effective approach is starting fresh with a structured re-titration process, particularly if you've experienced significant life changes, had long gaps in treatment without clear monitoring, or never really had a proper initial titration.

Major life changes can affect how you respond to medication. Starting a demanding new job, having a baby, experiencing relationship changes, or developing new health conditions might all mean your previous medication regime no longer fits your current needs and physiology.

If you started medication through a service that offered limited titration support—perhaps just one or two appointments with minimal dose adjustments—a more thorough re-titration with comprehensive monitoring might reveal options that were never properly explored.

Long gaps in treatment can also reset things. If you stopped medication for several months or years and are now restarting, your prescriber may recommend beginning the titration process again rather than simply resuming your previous dose.

Some specialist services offer dedicated titration or medication optimisation pathways. These might be available through NHS Right to Choose (though waiting lists still apply) or through private ADHD clinics with expertise in adult medication management.

Preparing for your next medication review

A little preparation can transform a medication review from a rushed tick-box exercise into a genuinely useful conversation that leads to meaningful improvements in your treatment.

Before your appointment, spend time thinking through a few key areas. What ADHD symptoms still bother you most? Be specific—rather than "I can't focus," try "I still lose track of time and miss deadlines" or "I can concentrate at work but struggle with household tasks in the evenings."

Consider which times of day you struggle most and whether your medication seems to help during those periods. Many adults find mornings particularly difficult, while others notice benefits wearing off before the end of their working day or evening responsibilities.

Think honestly about side effects, even minor ones. Sleep changes, appetite effects, mood impacts, physical symptoms, and anything else that affects your quality of life deserves mention, even if you're not sure whether it's related to medication.

Reflect on what you hope medication will help you do more easily. Is it performing better at work? Managing household admin? Maintaining relationships? Having energy left for hobbies? Being clear about your functional goals helps your prescriber understand what "success" looks like for you.

Gather practical information if possible. Notes from work or study about performance changes, observations from family or friends about behaviour or mood changes, and any home blood pressure or pulse readings you've been asked to monitor all provide valuable objective data.

Questions you can ask your prescriber

Good medication reviews should feel like collaborative conversations rather than something happening to you. Don't be afraid to ask questions—your prescriber should welcome them.

Here are some examples that often lead to helpful discussions:

"Are my expectations about what medication can achieve realistic, or am I hoping for too much?"

"Could a different dose, timing, or formulation help with the specific problems I'm having?"

"What alternatives exist if current shortages continue to affect my medication?"

"What should I specifically monitor or track between now and our next review?"

"How will we know whether a medication change has actually helped?"

"What are the pros and cons of the options you're suggesting?"

"How long should I try a new dose or medication before we reassess?"

Your prescriber should be able to explain their reasoning clearly and help you understand the trade-offs involved in different choices. If you don't understand something, ask for clarification. If a suggested plan doesn't feel right for your life, say so—there are often multiple valid approaches.

How a specialist ADHD nurse clinic can help

Navigating medication reviews, dose adjustments, and national supply disruptions can feel overwhelming, particularly if you're trying to coordinate this through a busy NHS service with long intervals between appointments or a private psychiatrist you see only occasionally.

A specialist remote ADHD nurse-led service offers a different model focused specifically on medication management for adults who are already diagnosed. Rather than episodic contact with different clinicians, you work with the same experienced ADHD nurse prescriber who gets to know your response to treatment, your lifestyle, and your goals.

This continuity matters enormously when you're fine-tuning medication. Your nurse prescriber can offer structured medication reviews with clear monitoring plans between appointments, practical support around dose changes and formulation switches, calm, expert guidance during periods of national supply disruption when your usual medication is unavailable, and regular check-ins timed to match your needs rather than arbitrary service intervals.

Remote consultations via secure video calls mean you can access specialist support without taking time off work or travelling. You have your appointments from home, with the same clinical rigour as face-to-face reviews but far greater convenience.

For adults whose ADHD medication feels "not quite right," who are stuck with persistent side effects, or who have been affected by the current medicine shortages, working with a dedicated ADHD nurse prescriber can provide the focused, unhurried support needed to optimise treatment properly.

Get specialist medication review support

If you're an adult already diagnosed with ADHD and you're unsure whether your current medication is working as well as it should—or if you've been affected by the current shortages and don't know what to do next—we can help.

Focus Gently is a specialist ADHD nurse-led clinic supporting adults across the UK with medication reviews, titration support, and treatment optimisation. You'll work with the same experienced prescriber throughout, ensuring continuity and personalised care.

Join our priority medication review waitlist to be among the first to access our service when we launch. We'll keep you updated on availability and provide helpful ADHD medication information in the meantime.

Please note: This is not an emergency service. If you're experiencing urgent physical or mental health problems related to your medication, contact NHS 111, your GP, or emergency services immediately.

Frequently asked questions

How often should I have an ADHD medication review as an adult?

NICE guidance recommends medication reviews at least annually for adults with stable ADHD treatment. However, you should have more frequent reviews during initial titration (typically every 1-2 weeks), after any dose or medication changes (usually after 2-4 weeks), if you develop concerning side effects (as soon as possible), or if your life circumstances change significantly in ways that might affect treatment.

Many specialists recommend 3-6 monthly reviews during your first year on medication, then annually once you're stable and confident in managing your treatment. However, if something doesn't feel right, don't wait for your scheduled appointment—contact your prescriber to discuss whether an earlier review would be helpful.

What should I do if my pharmacy says there is a shortage?

First, don't panic—shortages are usually temporary and there are safe alternatives. Call other local pharmacies, including independent ones, to check stock availability. Contact your prescriber to discuss whether an equivalent alternative medication or different strength would be suitable. Never switch medications without prescriber approval, even if a pharmacist suggests an alternative. Order repeat prescriptions early (1-2 weeks before running out) to give yourself time to find stock or arrange alternatives.

Avoid unregistered online pharmacies or any source that doesn't require a valid UK prescription. If you genuinely cannot obtain your medication and cannot reach your prescriber, contact NHS 111 for advice.

Is it dangerous to stop ADHD medication suddenly?

ADHD stimulant medications are not physically addictive in the way that substances like alcohol or benzodiazepines are, so there is no dangerous physical withdrawal syndrome from stopping suddenly. However, stopping abruptly isn't usually ideal for several reasons.

You will experience an immediate return of your ADHD symptoms, which can feel very difficult if you've become accustomed to medication helping you function. Some people report temporary rebound effects such as low mood, fatigue, or increased appetite for a few days after stopping stimulants, though these settle quickly.

If you're on atomoxetine (a non-stimulant medication), it builds up in your system over weeks, and stopping suddenly means the benefits will gradually fade over 1-2 weeks rather than immediately.

Ideally, discuss any plans to stop or take breaks from medication with your prescriber. There may be situations where planned breaks are appropriate, but sudden unplanned stops due to shortages or other issues warrant a conversation about how to manage the gap safely.

Can I switch from one ADHD medication to another because of shortages?

Switching between ADHD medications should always be done under prescriber guidance, even during shortages. While many ADHD medications look similar on paper, they work slightly differently, are processed by your body differently, and require different monitoring.

Switching between different brands of the same medication (for example, different brands of methylphenidate) is usually straightforward and considered safe under prescriber instruction. However, switching between different active ingredients (for example, from methylphenidate to lisdexamfetamine) requires more careful management and monitoring.

Never make medication switches independently, even if a pharmacist suggests it or you read that two medications are "equivalent." Always contact your prescriber first to get proper guidance and an appropriate prescription.

What if I am still on a waiting list for titration or review?

Waiting for ADHD medication support can feel frustrating, particularly if you're already diagnosed and know treatment could help. While you're waiting, there are several things you can do to prepare and potentially reduce waiting times.

Keep track of your ADHD symptoms and their daily impact using a brief questionnaire like the ASRS or simple diary notes. This information will be valuable when your appointment finally comes. If you were prescribed medication by your diagnosing clinician but haven't had proper titration, speak to your GP about whether they can support basic monitoring while you wait for specialist titration.

Consider whether NHS Right to Choose might offer faster access to medication support. Some ADHD services accept Right to Choose referrals for medication management, not just initial assessment. Check whether private ADHD clinics offer medication-only support for people already diagnosed. Some services are more affordable than full assessment and diagnosis pathways.

If your symptoms are severely impacting your safety, work, or wellbeing while you wait, speak to your GP about interim support or whether your situation qualifies as urgent. Don't suffer in silence—there may be options you haven't explored yet.

This article is for information only and does not replace individualised medical advice from a qualified healthcare professional. If you have concerns about your ADHD medication, please consult your prescriber. In emergencies, contact NHS 111 or emergency services.