How to take and send your observations during titration

These readings are what keep your medication safe.

What we need, and why

Titration is the process of adjusting your medication dosage to find what works for you. Throughout it, we monitor your health to make sure the medication is both safe and effective.

We do that through three readings:

• Blood pressure
• Pulse
• Weight, plus height for children and young people

We ask for these before you start taking anything, so we understand what is normal for your body and whether ADHD medication will be safe for you. These are your baseline observations.

Most ADHD medications can slightly affect blood pressure and pulse. That is usually nothing to worry about, as long as the readings stay within a healthy range. Some medications can also affect appetite, which is why we monitor weight, and height in young people, to make sure growth and nutrition stay healthy.

Your obs are also how we find the lowest possible dose. The goal is maximum control of your symptoms with the minimum impact on your body.

When to take your readings

Measure your blood pressure and pulse while the medication is active in your system. Around one or two hours after you have taken it works well.

You will need a blood pressure monitor with an upper arm cuff. Smart watches and similar devices are not accurate enough for this.

Many people buy their own monitor, which usually costs somewhere between £15 and £40 and makes checking at home quick. If that is not possible, most local pharmacies will check your blood pressure and pulse free of charge, and some GP surgeries have machines in their waiting rooms.

How to get an accurate reading

• Sit down, and put the cuff around your left upper arm
• Rest your arm on a table, at roughly the same level as your heart
• Avoid caffeine, nicotine, heavy meals and exercise for at least 30 minutes beforehand
• Sit quietly for about five minutes before you start
• Try not to talk or move while the reading is being taken
• Take three readings, and send us either the lowest one or an average of the three

If there is a lot of difference between your readings, or you are unsure which to submit, just talk it through with us at your next appointment.

Please send weight, and height for children and young people, in metric. Kilograms and centimetres rather than stones, pounds, feet and inches, so we can track even small changes accurately.

How to send them to us

Before each review appointment we will email you a secure online form.

This is the best way to send your obs, because they upload securely and directly into our clinical system, which means your prescriber can review them ahead of your appointment.

We do need them before your appointment, not after it.

The readings we would want to look at

Safe limits vary from person to person, and we always check your observations before issuing another prescription. In general, we would want to take a closer look at the following.

Adults and young people aged 13 and over

• Systolic blood pressure, the top number, above 135
• Diastolic blood pressure, the bottom number, above 85
• Blood pressure lower than 90 over 60
• Resting heart rate above 100 beats per minute
• Resting heart rate below 60 beats per minute

Children aged 5 to 12

• Blood pressure above 115 on the top number, or above 75 on the bottom number
• Resting heart rate above 120 beats per minute

Resting heart rate on the lower side, by age

• Aged 5 to 6, below 75 beats per minute
• Aged 7 to 8, below 70 beats per minute
• Aged 9 to 10, below 60 beats per minute

If you are worried about a reading

If you are concerned about your readings or about any side effects, email our duty team and a clinician will respond within one working day.

Please remember that Oakdale is not a crisis service.

For adults, if blood pressure goes above 180 over 120 and you have chest pain, shortness of breath or symptoms of a stroke, contact NHS 111, call 999 or go to A&E.

For children aged 12 and under, if blood pressure is 140 over 90 or above, seek urgent advice from NHS 111 or their GP.

Why sending them on time matters

We know that remembering observations can be genuinely difficult, especially when life is busy, and especially because of the ADHD symptoms themselves.

But these checks are what allow medication to be prescribed safely. If we do not receive your observations, we are not able to issue your next prescription until we do.

If they arrive late, we will arrange your prescription as soon as we have reviewed them, though the delay may mean you run out before the new prescription arrives. Sending them on time is the simplest way to avoid that.

Talk to us

Thank you for reading, and we look forward to supporting you through your titration.

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