ADHD Medication: What You Need to Know
Information for patients of the ADHD clinic, St John Joondalup
This information is for you to keep. Please read it carefully and discuss any questions with your treating doctor. It is general information about ADHD medication and does not replace the advice you are given about your own treatment.
Important: This information is designed for patient’s I have seen and treated, and it acts as a supplement to our clinical consultation. It is not intended to act as a stand alone document and should not be used for general patient advice or information.
Two kinds of ADHD medication
There are two broad groups, and they work differently.
Stimulants — lisdexamfetamine, dexamfetamine, methylphenidate. These work within hours, are usually taken in the morning, and wear off during the day. They are the most effective option for most adults and are usually tried first. They are Schedule 8 controlled medicines, which brings extra rules described in section 6.
Non-stimulants — atomoxetine, guanfacine. These work continuously rather than in a daily cycle, and take weeks rather than hours to reach full effect. They are not controlled medicines, so the prescribing and pharmacy rules are much simpler.
Non-stimulants may be chosen where stimulants haven't worked or weren't tolerated, where there is significant anxiety, where there is a reason to avoid a controlled medicine, or where round-the-clock coverage matters more than daytime peak effect. Sometimes the two are used together.
People respond very differently to ADHD medication. It is not possible to predict in advance which medication or dose will suit you. Finding the right one often takes more than one attempt, and that is normal rather than a sign that treatment is failing.
Do not change your dose without discussing it with your prescribing doctor.
Starting and adjusting your medication
Treatment usually begins at a low dose and is adjusted according to:
improvement in your ADHD symptoms and day-to-day functioning
how long the benefit lasts
side effects
blood pressure, heart rate and weight
your own treatment goals
The aim is not the highest dose you can tolerate. It is the lowest dose that gives useful functional benefit with acceptable side effects.
Stimulants can be assessed within days of a dose change. Non-stimulants need patience — atomoxetine may take 4 to 6 weeks, sometimes longer, before the full benefit is clear, and guanfacine also builds gradually. Stopping a non-stimulant after a fortnight because "it isn't working" is the most common reason people miss out on a medication that would have suited them.
Common side effects
Most side effects are mild, and many settle within the first few weeks. Some need a change of dose, timing or medication.
Stimulants
Reduced appetite or weight loss — eat a good breakfast before your morning dose. Keep to regular meals even when you don't feel hungry, and make use of your appetite returning in the evening.
Difficulty sleeping — take your medication at the prescribed time and avoid later doses than advised. Reducing afternoon caffeine often helps.
Dry mouth — drink water regularly; sugar-free gum or lozenges may help.
Anxiety, jitteriness or feeling wound up — tell your doctor if this persists. The dose or medication may need adjusting.
Irritability or low mood as the medication wears off — sometimes called the rebound or "crash". Discuss the timing with your doctor; a different formulation may help.
Headache — often settles as your body adjusts. Keep well hydrated.
Nausea or stomach discomfort — taking your medication with or after food usually helps.
Increased heart rate or blood pressure — monitored at each review.
Atomoxetine
Nausea, stomach upset or reduced appetite, particularly in the first few weeks — taking it with food helps
Tiredness or sleepiness
Dry mouth
Increased heart rate or blood pressure
Sexual difficulties or difficulty passing urine — less commonly discussed, but worth raising if it happens
Mood changes — tell your doctor promptly about new or worsening low mood, agitation or thoughts of self-harm
Guanfacine
Drowsiness and tiredness, especially in the first few weeks — this is the most common reason people stop it. Be particularly careful about driving during this period.
Low blood pressure, dizziness on standing, slow heart rate
Dry mouth
Headache or stomach upset
Do not stop guanfacine abruptly. Stopping suddenly can cause a rebound rise in blood pressure and heart rate. If you want to stop, speak to your doctor so it can be reduced gradually.
5. Serious side effects
Serious adverse effects are uncommon, but you should know what to look for.
Call 000 or go to an Emergency Department immediately if you develop:
severe chest pain
severe shortness of breath
collapse or loss of consciousness
severe agitation, or loss of contact with reality
immediate risk of harm to yourself or someone else
Stop your medication and seek urgent medical advice if you develop:
new or significant palpitations, or an irregular heartbeat
thoughts of suicide or self-harm — contact your GP today, or call Lifeline on 13 11 14 (24 hours) or the Mental Health Emergency Response Line on 1300 555 788 (Perth metro, 24 hours). In an emergency call 000.
severe or unusual aggression, or marked change in behaviour
hallucinations, paranoia or other psychotic symptoms
symptoms suggesting mania — markedly elevated or unusually irritable mood, greatly reduced need for sleep, racing thoughts, or markedly reckless behaviour
on atomoxetine: yellowing of the skin or eyes, dark urine, unexplained flu-like symptoms or upper abdominal pain — these can indicate a rare liver reaction and need same-day assessment
If you are unsure whether something is serious, seek medical advice rather than waiting for your next appointment.
Driving and your licence
If you hold a WA driver's licence, you must notify the Department of Transport and Major Infrastructure (DTMI) of your ADHD diagnosis and treatment.
Under WA law, you are required to report any long-term medical condition — or treatment for one — that may affect your ability to drive safely. Not notifying is an offence and can carry a fine. If you are involved in a crash and have not reported a relevant condition, your insurance position may also be affected.
How to notify: complete the online form on the DTMI website, or download the Notification of Driving Impairment form (M109A) and return it by post or fax. You can also write to them directly.
Notification does not mean you will lose your licence. DTMI's stated aim is to help people keep driving for as long as it is safe to do so. In many cases no action is taken at all. DTMI may ask for further medical information, and may occasionally apply a condition to your licence, such as periodic medical review. No details of your medical condition appear on your licence card.
Do not drive if you feel sedated, dizzy, agitated, unwell, or otherwise uncertain about your ability to drive safely. This is most likely when you first start a medication, when a dose changes, or when a medication wears off.
Untreated ADHD can itself affect attention, impulsivity and reaction time. Effective treatment often improves driving. But medication can also cause side effects, so both matter.
Commercial and heavy vehicle drivers are held to a higher standard and may need a formal fitness-to-drive assessment. Tell your doctor if you drive for work.
Schedule 8 rules — stimulants only
Stimulants are Schedule 8 controlled medicines and are subject to specific rules in WA. These do not apply to atomoxetine or guanfacine.
Your stimulant prescribing is recorded in ScriptCheckWA, which WA Health maintains and which prescribers and pharmacists involved in your care can access.
In WA, only one doctor may be responsible for your stimulant prescribing at a time.
Take your medication exactly as prescribed. Do not increase the dose or change the schedule without your doctor's approval.
Never sell, give away or share your medication. This is a criminal offence, not just a clinical concern.
Keep it secure. Lost, damaged or stolen stimulant medication cannot routinely be replaced early. If it is stolen, report it to police and contact your doctor.
Repeats. Paper and computer-generated stimulant repeats must generally stay at the pharmacy that dispensed the original. If you need to change pharmacy, the repeat can be transferred directly between pharmacies. Fully electronic prescriptions do not have this restriction.
Dispensing intervals. Your prescription specifies how often a repeat may be dispensed — usually around monthly. This interval is a legal requirement, not pharmacist discretion, and repeats cannot be dispensed early. Plan ahead rather than presenting on the day you run out.
Travelling with your medication
Within Australia
Carry your medication in its original labelled packaging, along with your prescription or a letter from your doctor. Rules for controlled medicines differ between states, so if you're travelling with a stimulant it's worth checking the requirements of the state you're visiting.
If you'll be away when a repeat is due, tell your doctor before you go. In WA a prescriber can endorse a script to allow the pharmacy to dispense all remaining repeats at once, and WA Schedule 8 prescriptions are valid for six months. This has to be arranged in advance — a pharmacy cannot do it on request.
Overseas
Check the destination country's rules well before you travel. Some countries restrict or entirely prohibit ADHD stimulants, and penalties can be severe. Requirements differ between medications — a country that permits one stimulant may ban another. Check with that country's embassy or consulate.
Take enough for the whole trip; refilling overseas is often difficult or impossible. Carry a letter from your doctor on practice letterhead setting out your diagnosis, the medication, the dose and the quantity you're carrying, and keep everything in original labelled packaging in your hand luggage.
PBS medicines may only be taken overseas for your own use, or for an immediate family member travelling with you. Taking them for anyone else carries severe penalties (fines or imprisonment).
If a medication isn't permitted where you're going, speak to your doctor well in advance about alternatives.
Alcohol, caffeine and other substances
Caffeine adds to stimulant effects — increased heart rate, anxiety, jitteriness, poor sleep. Consider cutting back when starting treatment, particularly later in the day.
Alcohol impairs judgement and worsens both sleep and ADHD symptoms, and its effects can be less predictable alongside medication. Keep intake low, and never drive after drinking.
Cannabis and other recreational drugs — please tell your doctor. This matters for your safety and may affect which medication is appropriate and how closely you're monitored. Combining prescribed stimulants with illicit stimulants such as methamphetamine or cocaine substantially increases cardiovascular and psychiatric risk.
Other medicines and supplements — tell your doctor and pharmacist about everything you take, including over-the-counter products, supplements and herbal medicines. Some interact with ADHD medication.
Pregnancy and breastfeeding
If you are pregnant, planning a pregnancy, or breastfeeding, tell your doctor.
ADHD medication in pregnancy and breastfeeding requires an individual assessment of the benefits and risks in your circumstances. There is no single right answer, and it is not a conversation to have in a hurry.
Do not start, stop or change medication because of pregnancy without discussing it first.
Treatment beyond medication
Medication is one part of managing ADHD, and for most people it works best alongside other approaches.
Understanding ADHD. Learning how it affects attention, motivation, organisation, time management and emotional regulation is itself useful — a great deal of what people experience as personal failure turns out to be a recognisable pattern.
ADHD coaching. Practical strategies for organisation, planning, procrastination and time management. Coaching is not a regulated profession, so check the qualifications and experience of anyone offering it.
Psychological therapy. Cognitive-behavioural approaches adapted for ADHD can help with executive functioning, emotional regulation, anxiety, mood and long-standing behavioural patterns.
ADHD WA — education, support groups and resources for adults with ADHD. (08) 6457 7544 · adhdwa.org