Medications for Tics
The goal of treatment with medications is to reduce tics to a point that they are no longer causing distress to the patient or interfering with function. The medications we have currently available for TS are not cures and the tics may not completely resolve. Tics still wax and wane in frequency and severity and fluctuations will continue to occur whether or not medication is used.
Sometimes, what may seem to be an initial response to a medication may simply have been a coincidence if tics were beginning to wane at the same time the medication was introduced. All treatments have potential side effects or risks and a doctor will weigh what is known about the potential benefit of a therapy versus the potential risks for the individual patient. Once a medication plan is decided, a doctor will monitor the patient’s response and any adverse reactions. It is important to note that medications may take some time to work. It is not unusual to have to go through some trial and error to determine which medication (or combination of medications) works best for the patient as each patient will respond differently.
Haloperidol (Haldol), pimozide (Orap), and aripiprazole (Abilify) are currently the only medications approved by the U.S. Food and Drug Administration (FDA) to treat tics. However, physicians may start with “off-label” use (not FDA approved specifically for treatment of tics) of guanfacine or clonidine, both of which are alpha- adrenergic agonist medications that are approved for use in the treatment of high blood pressure. These medications have been found to be moderately effective in reducing tics and to be better tolerated.
For a full summary on the available evidence on different medications for Tourette Syndrome, please view the 2019 American Academy of Neurology Tourette Treatment Guidelines (ref below)
American Academy of Neurology (2019). Practice Guideline: The treatment of tics in people with Tourette syndrome and chronic tic disorders. Minneapolis, MN: Author. Retrieved from www.aan.com/Guidelines/home/GetGuidelineContent/964.
Medications for co-occurring conditions
Co-occurring conditions, such as ADHD and OCD, often require medication, which can improve quality of life in patients with TS. It is not unusual for the treatment of these conditions to result in a reduction of tics. Inattention, impulsivity, and hyperactivity are common symptoms seen in patients with ADHD and can be an obstacle for school-aged children. Stimulant medications, such as methylphenidate, can be effective in children who have TS and ADHD. Other non-stimulant medications, such as guanfacine, clonidine, and atomoxetine, may also be beneficial. Selective serotonin reuptake inhibitors (SSRIs), such as fluoxetine, sertraline, and fluvoxamine, are effective in youth and adults with anxiety/OCD. Side effects are generally tolerable. Be aware of the risks and benefits of these medications and share this information with your healthcare provider.