Compare ADHD medicines
Stimulant vs non-stimulant ADHD medication: how do prescribers choose?
Stimulants can help on the day you take a dose. Non-stimulants usually need regular treatment over weeks before their benefit can be judged. The choice depends on your age, health, previous response and side effects.
Written and clinically reviewed by Adam OdusholaADHD Advanced Practitioner and Clinical Prescribing Pharmacist
Last updated: Last reviewed: Next review:Key points
- Stimulants: a dose can help that day.
- Non-stimulants: improvement is usually assessed over weeks of regular treatment.
- The choice depends on your age, health, previous response and side effects.
- Guanfacine must be reduced gradually when stopping.
What are the main differences?
| Feature | Stimulants | Non-stimulants |
|---|---|---|
| Examples | Methylphenidate, lisdexamfetamine, dexamfetamine | Atomoxetine, guanfacine |
| Assessing benefit | A dose can help that day; finding the right treatment can still take weeks | Improvement is usually assessed over weeks |
| Daily pattern | Depends on the medicine and release formulation | Regular daily treatment |
| Important unwanted effects | Appetite loss, sleep problems and changes in pulse or blood pressure | Depend on the medicine; atomoxetine and guanfacine have different profiles |
| Stopping | Agree a plan with your prescriber | Guanfacine must be reduced gradually; atomoxetine has different stopping advice |
Sources: NICE guideline NG87: Attention deficit hyperactivity disorder: diagnosis and management, recommendations; Atomoxetine: Summary of Product Characteristics; Intuniv (guanfacine): Summary of Product Characteristics.
What is usually offered to adults?
Methylphenidate or lisdexamfetamine is usually considered first. Atomoxetine is an option when these are not tolerated or adequate trials have not helped enough.
Dexamfetamine may be considered when lisdexamfetamine helps but its longer effects are unsuitable.
Guanfacine is not a routine licensed adult ADHD treatment in the UK. NICE recommends advice from a tertiary ADHD service, meaning a specialist service for more complex treatment decisions.
What is usually offered to children and young people?
Methylphenidate is usually considered first. Subsequent options depend on response and tolerability.
NICE recommends atomoxetine or guanfacine when methylphenidate or lisdexamfetamine cannot be tolerated, or adequate trials of both have not helped enough.
NICE recommendations and product licences are not identical. For example, some recommendations include five-year-olds, while the relevant product licences start at six.
Does non-stimulant mean safer?
No. Both groups require appropriate checks and follow-up.
Atomoxetine can increase pulse or blood pressure and can affect sleep. Guanfacine can cause sleepiness, low blood pressure and a slow pulse. The right choice depends on your individual risks and benefits. See atomoxetine vs guanfacine.
Sources: Atomoxetine: Summary of Product Characteristics; Intuniv (guanfacine): Summary of Product Characteristics.
Common questions
What if stimulants don’t work or don’t suit me?
You do not have to try every stimulant first. If you cannot tolerate methylphenidate or lisdexamfetamine, or 6-week trials of both at an adequate dose have not helped enough, NICE recommends atomoxetine for adults, and atomoxetine or guanfacine for children and young people. If one or more stimulants and a non-stimulant have not worked, your specialist should seek a second opinion or refer you to a tertiary ADHD service. Your specialist should explain the reason for each choice.
Can non-stimulants be taken only on demanding days?
They are generally prescribed as regular daily treatment. Do not use them as occasional top-ups or arrange breaks yourself.
Can medication replace other support?
Medication can be one part of treatment. Adjustments at work or school, practical strategies and psychological support may still be useful.
Sources
This page is written for educational purposes and does not constitute medical advice. Always follow the guidance of your prescriber or pharmacist. If you have concerns about your medication, contact your clinical team.
About this page
- Written and clinically reviewed by
- Adam OdusholaADHD Advanced Practitioner and Clinical Prescribing Pharmacist
- First published
- Last updated
- Last reviewed
- Next review
“Last updated” is when the content last changed. “Last reviewed” is when it was last checked against current sources.
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