List of Specific Medications for Tics
Antihypertensives (aka Alpha 2 Agnosists)
These medications are used to decrease high blood pressure, but have also been found to result in mild to moderate reductions in tics for some individuals. They have also been found to be mildly effective to reduce ADHD symptoms (especially in combination with a stimulant medication). Here are the two antihypertensives used for tics:
Guanfacine (brand name = Intuniv/Tenex)
Clonidine (brand name = Catapres)
Side effects: The main two side effects are drowsiness and dizziness. Usually, these side effects decrease within a few weeks of starting the medication. If drowsiness does continue beyond a few weeks, it can get in the way of functioning and may be a reason to try a different medication (especially if there do not seem to be significant reductions in tics). Many psychiatrists/neurologists will use Guanfacine before trying Clonidine because they find less drowsiness with Guanfacine. Also, Guanfacine only needs to be taken 1-2 times per day compared to 3-4 times per day with Clonidine.
Neuroleptics (AKA Antipsychotics or Dopamine Antagonists)
These medications are used to treat various health and mental-health difficulties, but are most well known for their role in the treatment of Schizophrenia/Psychosis, hence the name antipsychotics. Certain neuroleptics can also be quite effective in the treatment of tic disorders. The drugs work decreasing the brain’s use of a chemical called dopamine, which is used to control body movements. Tics are thought to be caused by an excess amount of dopamine in the areas of the brain that control movements. Decreasing the brains cells’ abilities to pick up dopamine with neuroleptics can decrease tics. There are two types of neuroleptics, typical and atypical. In many ways, these two types of neuroleptics are similar, but there are a few differences. Atypical neuroleptics were developed later than typical neuroleptics. While they have the same side effects, some of the more problematic side effects are different between the two types of neuroleptics. See below for a list of specific side effects following the two lists of different neuroleptics used for tics:
Haloperidol (brand name = Haldol) – According to research, this is the most effective medication known for tics; studies have suggested an average of a 66% reduction in tics (results vary for different people).
Pimozide (brand name = Orap)
There are many other typical Neuroleptics, but these are the main two used for tics.
Common side effects: dry mouth, drowsiness, tremors, muscle stiffness or cramping, and weight gain (much less weight gain compared to atypical neuroleptics)
Less common side effects: extrapyramidal symptoms, tardive dyskinesia, and neuroleptic malignant syndrome (all discussed below).
Extrapyramidal Symptoms (EPS) – this is on the common side effects list for individuals with psychosis. However, neuroleptics for tics are usually given at much lower doses than neuroleptics for psychosis, so this side effect tends to be less common/less severe. EPS are a group of movement symptoms that include:
Parkinsonism – tremor symptoms and decreased movements with symptoms looking similar to Parkinson’s (symptoms will fade and then disappear if the medication is stopped)
Akathisia –an internal feeling of uncomfortable restlessness; many individuals with psychosis will stop taking neuroleptics because of this side effect
Dystonias – a tightening of muscles while twisting the body and briefly freezing in an uncomfortable position (dystonic tics are also a complex motor tic associated with TS; see list of possible tics)
Acute Dystonic Reaction – severe muscle spasms where it can be difficult to move the neck, face, or other parts of the body
Tardive Dyskinesia (TD) – repetitive, involuntary, purposeless movements; common TD symptoms are tongue protrusions (sticking out tongue), lip pursing and lip smacking. TD side effects seem quite rare with individuals with tics on typical neuroleptics. Most individuals develop TD only after multiple decades of neuroleptic use and at much higher dose levels than those typically used for individuals with tics. If you suspect TD symptoms are occurring, you should let the prescribing doctor know right away. While the symptoms will usually go away after awhile when the medication is decreased or changed, they can become permanent. Within my TS-specialty clinic at Rutgers, I only know of one case over the past 8 years where TD symptoms appeared in reaction to Orap. I sent the family straight to their psychiatrist, who began tapering off Orap; the TD symptoms disappeared.
Neuroleptic Malignant Syndrome (NMS) – Very rare side effect that involves a fever, rigid muscles, and changes in mental state (e.g. delirium, disorientation). While this condition is rare, it can be fatal. You should take someone with these symptoms to the emergency room.
Side effects: The side effects are the same as for typical neuroleptics, but occur to differing degrees. They also occur to differing degrees within the various atypical neuroleptics, so it is important to learn about the unique side effect profiles for each one. Overall, extrapyramidal symptoms (EPS) tend to be lower with atypical neuroleptics. Since EPS side effects can lead to great discomfort, this is a significant difference. Also, it has been argued that Tardive Dyskinesia is less of a concern with atypical neuroleptics. Unfortunately, weight gain tends to be more severe with atypical neuroleptics. As a recent-occurring shift in medical thinking, many neurologists and psychiatrists now prefer prescribing typical over atypical neuroleptics because weight gain and associated metabolic syndrome cause such severe short and long term health problems.