What ADHD medication is prescribed in Scotland?

In Scotland, methylphenidate is first-line for most adults. Lisdexamfetamine (Elvanse) is second-line, typically prescribed if methylphenidate is ineffective or not tolerated. Non-stimulant options including atomoxetine and guanfacine (Intuniv) are also available, these are slower to take effect but may suit people who cannot tolerate stimulants or have certain co-occurring conditions.

How does ADHD medication titration work in Scotland?

Titration is the process of finding the right medication and dose for you. It must be initiated by a specialist (psychiatrist, or nurse prescriber working in a supervised clinical team). Titration typically involves several follow-up appointments over weeks or months, adjusting dose and timing based on your response and side effects. Once you are stable on a dose, ongoing prescribing can often be transferred to your NHS GP under a shared care arrangement.

Can my GP prescribe ADHD medication in Scotland?

Yes, in principle, via a shared care arrangement. Under shared care, your NHS GP takes over routine prescribing after a specialist has initiated treatment and completed titration. However, shared care is not guaranteed: your GP must agree to it, and some GPs decline. If your GP refuses shared care, you can continue with private prescribing, seek a second opinion within the practice, or ask the specialist to write a more detailed clinical letter explaining the arrangement.

What is the difference between stimulant and non-stimulant ADHD medication?

Stimulant medications (methylphenidate and lisdexamfetamine) work quickly, typically within 30–60 minutes, and are effective for most people with ADHD. They carry a small risk of cardiovascular side effects and may not suit everyone. Non-stimulant medications (atomoxetine, guanfacine) take longer to reach full effect, often 4–6 weeks, but do not carry the same cardiac considerations and may be preferable for people with certain co-occurring conditions, anxiety, tic disorders, or those who cannot tolerate stimulants.

Is ADHD medication prescribing different in Scotland from England?

Yes. Scotland follows Scottish Medicines Consortium (SMC) guidance rather than NICE guidance, which governs England. The clinical criteria are broadly similar, but there are differences in how shared care is implemented locally, each Scottish health board can set its own shared care policy, and not all GPs across Scotland have equivalent familiarity with ADHD shared care arrangements. Right to Choose, which allows NHS England patients to access quicker private assessment funded by the NHS, does not apply in Scotland.

ADHD medications in Scotland

What is prescribed, how it works, and what Scottish NHS guidance says

Reviewed by ADHD Scot, October 2026

This page summarises publicly available NHS Scotland medicines guidance for information only. It is not medical advice and not an advertisement. Brand names are included only to help you recognise what you may be prescribed or dispensed in NHS Scotland, not as a recommendation or endorsement of any product. Your prescribing clinician is the right person to discuss which medication and dose is appropriate for you.

How ADHD medication is prescribed in Scotland

In Scotland, ADHD medication must be initiated by a specialist, typically a consultant psychiatrist, associate specialist, or nurse prescriber with specialist ADHD training. Once a stable dose has been established, ongoing prescribing can be continued by your GP under a shared care arrangement, if accepted.

This page summarises the medications listed in the NHS Scotland Right Decisions medicines guidance for ADHD. Right Decisions is NHS Scotland's guidance platform, and this specific page is one health board's adult formulary - but it can be useful for patients to read for an understanding of how it works.

First-line: methylphenidate

Methylphenidate is the most commonly prescribed ADHD medication in Scotland. It works by increasing dopamine and noradrenaline activity in the brain.

Immediate-release tablets

Immediate-release methylphenidate typically lasts around 3–4 hours per dose, so it is usually taken two or three times a day.

Brand	Strengths
Generic methylphenidate	5mg, 10mg, 20mg tablets
Ritalin®	10mg tablets
Medikinet®	5mg, 10mg, 20mg tablets

Modified-release formulations

Modified-release (MR) formulations deliver methylphenidate throughout the day from a single morning dose. Different brands release the dose in different proportions and over different periods, which affects how long they last and when the medication reaches its peak level in the body.

Approximate methylphenidate release profiles, illustrative patient information diagram. Original work by ADHD Scot, not clinical reference material.

Illustrative diagram, original work by ADHD Scot. Release-profile proportions are taken from each product's Summary of Product Characteristics (SmPC) on the Electronic Medicines Compendium (EMC), Concerta XL, Equasym XL, and Medikinet XL, and NHS Scotland Right Decisions formulary guidance. For photographs and full product details of each tablet or capsule, see the product's patient information leaflet (PIL) on the EMC.

NHS Scotland formulary guidance groups modified-release methylphenidate by how the dose is released across the day. The immediate-release portion gives an early effect and the extended portion sustains it. Because these profiles are not interchangeable, prescribing guidance (from the Specialist Pharmacy Service and the BNF, with the MHRA cautioning against switching between products) is that MR methylphenidate is prescribed by brand name, or by generic name plus the manufacturer's name. If your pharmacy substitutes a different brand without clinical review, speak to your prescriber.

The NHS Scotland Right Decisions formulary groups them by release profile. The brands prescribed in NHS Scotland include:

Release profile	UK brands you may be prescribed	Strengths
~22–25% immediate : 75–78% extended, around 12 hours	Concerta XL®, Xenidate XL®, Xaggitin XL®	18mg, 27mg, 36mg, 54mg tablets
30% immediate : 70% extended, around 8 hours	Equasym XL®	10mg, 20mg, 30mg capsules
50% immediate : 50% extended, around 8 hours	Medikinet XL®	5mg, 10mg, 20mg, 30mg, 40mg, 50mg, 60mg capsules
50% immediate : 50% extended, around 8 hours	Focusim XL®	10mg, 20mg, 30mg, 40mg capsules

Concerta XL® is the original OROS product in the 12-hour group; Xenidate XL® and Xaggitin XL® are bioequivalent brands also prescribed across Scotland. Other bioequivalent brands are licensed in the UK and some Scottish boards list them too; because they are not interchangeable, your prescriber will name the brand and your pharmacy should dispense that brand.

For patient information leaflets (PILs) and full product details, visit the Electronic Medicines Compendium (EMC) and search by the brand name on your prescription.

Second-line: lisdexamfetamine (Elvanse®)

Lisdexamfetamine is a prodrug that the body converts into dexamfetamine, the active compound. This design makes it longer-acting (up to 13–14 hours) and gives it a slower, more gradual onset. Like all stimulant medicines it can still be misused, and it remains a controlled drug.

It is typically considered when methylphenidate has not provided adequate benefit or has caused unacceptable side effects.

Brand	Licensed for	Strengths
Elvanse®	Children aged 6 and over, and adults	20mg, 30mg, 40mg, 50mg, 60mg, 70mg capsules

Elvanse used to be sold as two brands, Elvanse for children and Elvanse Adult for adults. In 2025 these were combined into a single Elvanse range licensed for both children aged 6 and over and adults, so the separate Elvanse Adult brand has been discontinued.

The capsules can be opened and the contents dissolved in water, yogurt, or orange juice for people who cannot swallow capsules whole.

Second-line stimulant: dexamfetamine

Dexamfetamine sulfate tablets (5mg, 10mg, 20mg) remain available for people where other stimulants have not been effective. For ADHD it is licensed for children and young people aged 6 to 17, where methylphenidate has not worked well enough. It has a shorter duration of action than lisdexamfetamine and is typically taken two or three times a day.

Third-line: non-stimulant options

Atomoxetine (formerly branded Strattera®)

Atomoxetine is a non-stimulant used where stimulants are not suitable or have not worked, for example where there is a history of stimulant misuse or significant anxiety. (It is not a "safe option" for people with heart problems: like stimulants, it raises heart rate and blood pressure, and it is contraindicated in severe cardiovascular disease.) It is a selective noradrenaline reuptake inhibitor (NRI) and takes several weeks to have its full effect. It is licensed for children aged 6 and over and for adults.

Form	Strengths	Notes
Atomoxetine capsules (generic)	10mg, 18mg, 25mg, 40mg, 60mg, 80mg, 100mg	The originator brand Strattera® has been discontinued in the UK; generic atomoxetine remains available in the same strengths
Oral solution (4mg/ml)	Various volumes	NHS Scotland restricts this to people who cannot swallow capsules

Guanfacine (Intuniv®)

Guanfacine is a non-stimulant option licensed for children and young people aged 6–17. It is used where stimulants are not suitable, not tolerated, or have not been sufficiently effective. It must be used as part of a broader ADHD treatment programme that includes psychological and educational support.

Strengths	Notes
1mg, 2mg, 3mg, 4mg prolonged-release tablets (a generic brand also markets 5mg, 6mg, and 7mg)	Must not be crushed or chewed

Monitoring

NHS Scotland Right Decisions guidance recommends that before starting ADHD medication, a baseline physical assessment is carried out including weight, height (in children), blood pressure, and heart rate. These should be monitored at least every six months once medication is established. Blood pressure and heart rate are also usually checked around each change in dose, and NICE-aligned protocols weigh younger children more often (every three months for age 10 and under).

Height monitoring in children is important because stimulant medications can temporarily affect growth rate in some young people.

If you are starting a shared care agreement, speak to your GP surgery about whether the private provider's responsibility for these checks continues or transfers to the GP practice. Adults using private clinics can often self-report blood pressure, heart rate, and weight between appointments. Home blood pressure monitors are widely available from pharmacies.

Medication alongside other support

The Royal College of Psychiatrists and NHS Right Decisions guidance both note that medication alone is rarely the full picture. For children and young people in particular, medication is most effective when used alongside:

Parent training programmes
Educational support and adjustments
Cognitive behavioural therapy (CBT) adapted for ADHD, where available

For adults, psychological support (including CBT adapted for ADHD and coaching) can help with organisation, time management, and emotional regulation alongside or instead of medication.

Availability of psychological support on the NHS in Scotland is currently very limited. Many people access this privately or through peer support.

Scotland-specific clinical guidance

SIGN, Scottish Intercollegiate Guidelines Network

SIGN produces evidence-based clinical guidelines for NHS Scotland, but does not currently have a live ADHD guideline (its earlier guideline, SIGN 112, has been withdrawn). Instead, current clinical and prescribing guidance for ADHD is published board by board via NHS Right Decisions. All SIGN guidelines are free to access at sign.ac.uk.

Scottish Medicines Consortium (SMC)

The SMC evaluates new medicines and advises NHS Scotland on which should be accepted for routine use. Some medications accepted by NICE in England may have a different or delayed SMC recommendation for Scotland. If you are prescribed a medication and your GP says it is "not approved for Scotland," the SMC decision is the relevant reference. You can check decisions at scottishmedicines.org.uk.

Royal College of Psychiatrists (RCPsych)

RCPsych produces patient information reviewed by consultant psychiatrists. Their public-facing resources on ADHD in adults and ADHD in young people are written in plain English for patients and families. RCPsych Scotland is the Scottish division of the college and contributes to Scottish clinical standards.

What ADHD medication costs in Scotland

On the NHS in Scotland, ADHD medication is free. There are no prescription charges in Scotland, unlike England where there is a charge per item. For most people on an NHS prescription, the medication itself costs nothing.

You may only pay if you were diagnosed privately and are not (yet) under NHS shared care. Private cost has two separate parts:

What you pay	Who sets it	Worth knowing
A private prescription fee	The clinic or prescriber	A per-prescription charge that varies between providers — ask before you commit.
The medication itself	The pharmacy	You pay the pharmacy's own price; these vary between pharmacies, so it is worth comparing.

As a rough guide, the medicines themselves are relatively inexpensive — from around £30 a month at NHS list price (for example, Concerta XL 18mg is about £31), rising with higher doses and some brands. Because prices change and vary by product, check a live source for the current figure rather than relying on a fixed number:

BNF medicines information — search the medication, then open "Medicinal forms" to see its NHS indicative price (UK-wide reference).
Scottish Drug Tariff (Public Health Scotland) — the official list of NHS reimbursement prices for Scotland, updated monthly.

If your GP accepts shared care after a private diagnosis, prescribing transfers to the NHS and your medication becomes free again.

Medication and shared care in Scotland

A common situation in Scotland is that a specialist initiates medication but the GP declines to continue prescribing under shared care, particularly after a private diagnosis. This leaves people either paying for ongoing private prescriptions or going without medication.

See our After your diagnosis page for more information on the shared care issue and what options are available if your GP declines.