What we check before treatment starts 

If you’ve been diagnosed with ADHD, medication may be one of the treatment options available to you. 

Many people can take ADHD medication safely and find that it helps. However, before treatment begins, your clinician will need to check that it’s safe and appropriate for you. 

This does not mean they’re looking for reasons to prevent you from having treatment. The aim is to understand your health, identify any possible risks and find the safest way forward. 

Why do we carry out safety checks? 

ADHD medication can affect things such as: 

  • heart rate and blood pressure 
  • appetite and weight 
  • sleep 
  • mood and emotional wellbeing 
  • some existing health conditions 

Medication can also interact with alcohol, recreational drugs and other medicines. 

Before treatment starts, we may ask about: 

  • your physical health 
  • your mental health 
  • any medication you currently take 
  • alcohol or drug use 
  • pregnancy 
  • your height, weight, blood pressure and pulse 
  • any specialist care you currently receive 

Most people will be able to start ADHD medication safely. 

When something needs further consideration, it does not always mean that treatment will never be possible. We may simply need more information, specialist advice or time for another condition to become more stable. 

When might medication need to wait? 

There are some circumstances in which we may not be able to start ADHD medication straight away. 

This is usually because a condition is active, uncontrolled or unstable, or because medication could make it worse. 

Your clinician will look at your individual circumstances rather than making a decision based on one piece of information alone. 

Heart and circulation conditions 

We may not be able to start ADHD medication if you have certain significant heart or circulation conditions, including: 

  • serious heart rhythm problems, such as atrial fibrillation, ventricular tachycardia or Wolff-Parkinson-White syndrome 
  • heart failure 
  • a previous heart attack 
  • moderate or severe ischaemic heart disease 
  • angina 
  • hypertrophic cardiomyopathy 
  • severe heart valve disease 
  • uncontrolled high blood pressure 
  • an uncontrolled fast heart rate 

If you have previously received treatment for a heart condition, such as an ablation or valve replacement, medication may still be possible. 

However, we may first need information or advice from your cardiologist or another specialist involved in your care. 

Neurological conditions 

We may also need to take extra care or seek specialist advice if you have certain neurological conditions, including: 

  • an ischaemic stroke 
  • poorly controlled grand mal epilepsy 
  • a seizure within the past six months 
  • a brain aneurysm 
  • a cerebral arteriovenous malformation 

Having another neurological condition in your medical history does not always mean ADHD medication is unsuitable. 

We may simply need more information before making a decision. 

Other physical health conditions 

ADHD medication may not be safe to start if you have: 

  • poorly controlled benign intracranial hypertension 
  • untreated closed-angle glaucoma 
  • uncontrolled open-angle glaucoma 
  • uncontrolled hyperthyroidism 
  • end-stage renal failure 
  • a body mass index, or BMI, below 17 

If your BMI is between 17 and 18.5, we may need evidence that this is normal for you and that there is no current or recent concern about an eating disorder. 

Mental health and emotional wellbeing 

Your mental health is just as important as your physical health. 

We may not be able to start ADHD medication straight away if you are currently experiencing: 

  • a high risk of suicide 
  • serious ongoing self-harm 
  • an eating disorder that is not well controlled 
  • uncontrolled psychosis 
  • uncontrolled mania 

This does not mean you are being refused care. 

The immediate priority is making sure you are safe and appropriately supported before starting medication that could affect your mood, appetite, sleep or emotional stability. 

Alcohol, recreational drugs and other medicines 

We may not be able to start ADHD medication if there is: 

  • ongoing use of illicit drugs 
  • alcohol dependence 
  • heavy alcohol use 

This is because there may be additional risks involving side effects, interactions, misuse or dependence. 

It’s important to be honest with your clinician. The information you share will help them make a safer decision, rather than being used to judge you. 

We will also review any prescription medicines, over-the-counter products and supplements you take. 

If you take two or more medicines that increase the risk of serotonin syndrome, we may need to discuss changes before ADHD medication can begin. 

What happens during pregnancy? 

We would not usually start ADHD medication during pregnancy. 

Please tell your clinician if you are: 

  • pregnant 
  • planning a pregnancy 
  • trying to conceive 
  • unsure whether you may be pregnant 

They can talk to you about your circumstances and discuss the safest available options. 

What if stimulant medication is not suitable? 

Some people may still be able to take ADHD medication, even when a stimulant medicine is not considered the safest option. 

In these circumstances, your clinician may discuss a non-stimulant medicine, such as atomoxetine. 

The best treatment choice will depend on: 

  • your medical history 
  • your current health 
  • your ADHD symptoms 
  • possible risks and side effects 
  • other medicines you take 
  • your individual preferences 

Medication is not one-size-fits-all. The aim is to find the treatment option that’s safest and most appropriate for you. 

Something here applies to me — what happens next? 

There’s no need to assume that treatment will be impossible. 

Depending on your circumstances, we may: 

  • ask you for more information 
  • request information from your GP or specialist 
  • wait until another condition is better controlled 
  • discuss non-stimulant treatment 
  • seek advice from the wider clinical team 
  • recommend a different treatment plan 

Sometimes the answer may be “not yet” rather than “no”. 

What should I have ready for my appointment? 

It can help to prepare: 

  • a current list of your medicines and supplements 
  • details of any heart, neurological or serious physical health conditions 
  • information about current mental health concerns 
  • your height and weight, if known 
  • recent blood pressure or pulse readings, if available 
  • the names of any specialists involved in your care 

You do not need to decide for yourself whether medication is safe. 

Your role is simply to give your clinician an accurate picture of your health so they can advise you properly. 

Starting treatment safely 

ADHD medication is safe and effective for many people. 

The checks carried out before treatment are not there to exclude people unnecessarily. They help make sure medication is started carefully, with the right information and support in place. 

A health condition does not always close the door on treatment. It may simply mean that we need to take a different route. 

You may find it helpful to download and keep our website guide: 

ADHD Medication: Who Can Safely Start Treatment? 

If you are unsure whether anything in this article applies to you, speak to your clinician. They will talk it through with you and help decide the safest next step.