Medication

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Medication for Tourette Syndrome, 
ADHD, ADD and OCD
[Complete Drug Listing Below] [ Alternative Medicine - Holistic ]

Is There Medication That Can Help Tourette Syndrome Patients?
The good news for many TS patients is that their tics can often be controlled or minimized by medication. It's important to find a physician that has experience in treating Tourette Syndrome patients when considering any treatment for the disorder, because caution must be taken in determining the proper dosage levels. 

To date, no one medicine has been initially invented specifically for TS. One recent anomaly occurred in 2000 when Layton Biosciences received FDA approval for a nicotine patch used to treat Tourette Syndrome in combination with traditional drugs used to treat tics (e.g. Haldol).  

The primary pharmaceuticals that have been found to minimize tics are normally used to treat other serious illnesses (i.e., high blood pressure). Hence, these drugs can often cause side effects or present risks serious enough to cause some TS patients to opt for living with the tics rather than take medication.

Medication Information for
Tourette Syndrome, ADHD, ADD and OCD 

Drug or Medication: Haloperidol (Haldol)

Drug Class: Neuroleptic

Action: Alters the effects of dopamine in the CNS. Also has anticholinergic and alpha-adrenergic blocking activity.

Expected Therapeutic Effect: decrease in motor and phonic tics.

Dosage:  Initial dose 0.25mg at bedtime, increase by 0.25 to 0.50mg increments every 4-7 days.  Average dose 3mg-4mg per day

Comments: 

• Most side effects are dose relatedand can be resolved by decreasing dosage.
• Anti-parkinsonian medication (e.g.0.5mg/day of benztropine) can sometimes be used to alleviate side effects.
• Additive hypotension with antihypertensives, nitrates, or alcohol.
• Additive CNS depression with other CNS depressants.
• Concurrent use with epinephrine may result in severe hypotension and tachycardia.
• Acute encephalopathic syndrome may occur when used with lithium.

Adverse Effects:  Motor drug-induced parkinsonism, akinesia, akathisia, acute dystonia, tardive dyskinesia, oculogyric crisis, extrapyramidal reactions, restlessness CNS sedation, drowsiness, decrease in cognitive function, anxiety Autonomic dry eyes/ mouth, urinary retention, diaphoresis, hypersalivation GI increase appetite, weight gain, anorexia, constipation, hepatitis  Other dysphoria, social and school phobias, heat stroke, polydipsia, impotence, photosensitivity, rashes, galactorrhea, hyperpyrexia, anemia, leukopenia

Drug or Medication:   Pimozide (Orap)

Drug Class: Neuroleptic

Action:  Alters the effects of dopamine in the CNS. Possesses anticholinergic and alpha-adrenergic blocking activity.

Expected Therapeutic Effect: decrease in motor and phonic tics.

Dosage: Initial dose 1mg/day graduallyincreasing to a maximum of 6-10mg/day for children and 20mg/day for adults.Because of its long half-life (55hrs), a single daily dose may be feasible.

Comments: 

• Better tolerated than haloperidol and probably is of equal efficacy.
• EKG routinely ordered to monitor rhythm abnormalities. (U waves, invertedT waves, and Q-T prolongation.) Not generally a problem.

Adverse Effects:  In general, side effects are similar to haloperidol, but may be less severe and appear in fewer patients.

Drug or Medication: Fluphenazine (Prolixin)

Drug Class: Neuroleptic

Action:  Alters the effects of dopamine in the CNS. Possesses anticholinergic and alpha-adrenergic blocking activity.

Expected Therapeutic Effect:  decrease in motor and phonic tics.

Dosage: Initial adult dose 2.5mg 10.0 mg given in 6 to 8 hour doses.  Dose may titrated upwards to a maximum of 40mg/day.

Comments: 

• May cause false positive pregnancy test.
• May turn urine pink or reddish brown.

Adverse Effects:  In general side effects are the same as those listed for haloperidol, but, like Orap, some patients tolerate it better.

Drug or Medication: Thiothixene (Navane)

Drug Class: Neuroleptic

Action:  Alters the effect of dopamine in the CNS.

Expected Therapeutic Effect:  decrease in motor and phonic tics.

Dosage:  Initial dose in children over 12 is 2mg tid. Dose may be titrated up slowly to a maximum of 15mg/day  Adults may start at 5mg bid. Usual dose 20mg-30mg/day, to a maximum of 60mg/day.  Use in children under age of 12 is not recommended as no safe levels have been established.

Comments:

• In event hypotension occurs, epinephrine should not be usedas a pressor agent since a paradoxical further lowering of BP may result.
• EKG changes usually reverse and frequently disappear on continued therapy.
• May cause false positive pregnancy test.

Adverse Effects:  Adverse affects similar to those for haloperidol. In addition, may have tachycardia, hypotension, non specific EKG changes, amenorrhea.

Drug or Medication:  Chlorpromazine (Thorazine)

Drug Class: Neuroleptic

Action:  Alters the effect of dopamine in the CNS. Possesses significant anticholinergic and alpha adrenergic blocking activity.

Expected Therapeutic Effect: decrease in motor and phonic tics.

Dosage:  Initial dose for very young children 1/4mg/lb body weight. Older children doses up to 50mg.   100mg/daymaximum dose possible 500mg/d.

Comments: 

• Sudden death, apparentlydue to cardiac arrest, has been reported.
• Skin pigmentation may occur following prolonged usage.
• Ocular changes characterized by deposition of fine particulate matter inthe lens and cornea.

Adverse Effects:  In general, side effects same as forhaloperidol with an addition of two or three further symptoms. Noted EKG changes involving Q-T wave distortion, skin pigmentation changes, and eyechanges.

Drug or Medication:  Trifluoperazine (Stelazine)

Drug Class: Neuroleptic

Action:  Alters the effect of dopamine in the CNS. Possesses significant anticholinergic and alpha adrenergic blocking action.

Expected Therapeutic Effect:  decrease in motor and phonic tics.

Dosage: Adult doses start at 1-2mg bid up to 40mg/day.    Children 6-12 yrs. 1-2 mg daily or bid up to 6mg/day.

Comments:

• May cause falsepositive pregnancy test.
• May cause false positive liver bilirubin test.
• CBC and liver function tests should be monitored .

Adverse Effects:  In general, side effects similar to haloperidol. Additionally may cause Q wave and Twave changes, blood dyscrasia.

Drug or Medication: Thioridazine (Mellaril)

Drug Class: Neuroleptic 

Action:  Alters the effects of dopamine in the CNS.  Possesses significant anticholinergic and alpha adrenergic blocking activity.

Expected Therapeutic Effect:  decrease in motor and phonic tics. Improvement in behavior.

Dosage:  Adultdose of 25 mg 3 times daily. (Range of 20 200mg/day).  Initial dose for children over 2 yrs. 0.5-3mg/kg/day in 2-3 divided doses (10mg 2-3 times daily).

Comments: 

• Additive hypotension with other antihypertensive agent, nitrates, and acute ingestion of alcohol.
• Additive CNS depression with other CNS agents including antihistamines,narcotic analgesics, sedative/hypnotics.
• Lithium decreases blood level.
• May mask early signs of lithium toxicity and increases the risk of extra pyramidal reactions.
• Concurrent use with epinephrine may result in severe hypotension and tachycardia.
• Increased risk of agranulopcytosis with antithyroid agents.

Adverse Effects: In general, side effects similar to haloperidol.  Additionally may cause hepatic toxicity.

Drug or Medication: Risperidone (Risperdal)

Drug Class: Neuroleptic

Action: Dopamine and serotonin receptor antagonist.

Expected Therapeutic Effect:  decrease in motor and phonic tics. Improvement in behavior.

Dosage:  Adult dose of 4-8mg daily

Comments:    May be tolerated better than other neuroleptics,with fewer side effects.

Adverse Effects:  In general sdie effects similar to haloperidol.

Drug or Medication:  Clomipramine (Anafranil)

Drug Class: Anti-depressant Anti-obsessive

Action:  Potentiates the effect of serotonin (antiobsessionaleffect) and norepinephrine in the CNS. Also has moderate anticholinergicproperties.

Expected Therapeutic Effect:  decrease in obsessing, decrease in compulsions,possible decrease in tics, decrease in depression.

Dosage:  Adult dose of 25mg/day initially increasing over 2 wk period to 100mg/day to a maximum of 250mg/day in divided doses. In children dose begins at 25mg/day initially increased over 2 wks to 3mg/kg/day or 100 mg/day or (whicheveris smaller). May further be increased to 200mg/day (whichever is smaller) in divided doses until stabilizing dose is reached, entire daily dose maybe given at bedtime.

Comments: 

• May block therapeutic response to antihypertensives.
• Use with clonidine may cause hypertensive crisis.
• Additive CNS depression with other CNS depressants including alcohol, antihistamines,narcotic, analgesics, and sedative/hypnotics.
• Adrenergic and anticholinergic side effects may be additive with other agentsthat have the same properties.
• Nicotine or cigarette smoke may increase metabolism and decrease effectiveness.

Adverse Effects:  Motor muscle weakness, extra pyramidal reactions  CNS Seizures, sedation, drowsiness, lethargy, aggressive behavior. Autonomic dry eyes and mouth, blurred vision, vestibular disturbances, urinary retention GI constipation, weight gain,  Other impotence, photosensitivity, gynecomastia, hyperthermia

Drug or Medication: Fluoxetine (Prozac)

Drug Class: Antidepressant

Action:  Inhibits the uptake of serotonin in the CNS.

Expected Therapeutic Effect:  decrease in obsessing, decrease in compulsions,possible decrease in tics, decrease in depression.

Dosage:  Adult dose of 20mg/day in the morning. May increase by 20mg/day. Doses of 20mg/day should be given in 2 divided doses, 1 in the am and 1 at noon to a maximum of 80mg/day.  Initial dose in children starts at 5mg/day and increases slowly.

Comments: 

• Additive hypotension with antihypertensive agents. 
• Additive CNS depression with other CNS depressants including alcohol, antidepressants,antihistamines, MAO inhibitors, narcotic analgesics, sedative/hypnotics.
• Phenobarbital may increase metabolism and decrease effectiveness.
• Concurrent use with lithium may produce acute encephalopathy, decreased chlorpromazine absorption, increased excretion of lithium, increased risk of extra pyramidal reactions.
• Decreases vasopressor response to epinephrine and norepinephrine.
• Concurrent use with beta blockers may result in inhibition of metabolismof one or both drugs producing an increased response.
• Increased risk of anticholinergic effects with other agents having anticholinergicproperties.

Adverse Effects:   Motor extrapyramidal reactions, tardive dyskinesia, weakness, CNS seizures,  sedation, anxiety, insomnia, headache, tremor, dizziness, fatigue, mania,abnormal dreams Autonomic dry eyes and mouth, urinary retention, blurred vision, excessive sweating GI Constipation, ileus, anorexia, diarrhea  Other hypotension, tachycardia, photosensitivity, hyperthermia, rare suicidalideation, cough, flu-like syndrome, impotence

Drug or Medication: Sertraline HCL (Zoloft)

Drug Class: Antidepressant

Action: Potent selective inhibitor of neuronal serotoninreuptake and has only very weak effects on norepinephrine and dopamine neuronalreuptake. Does not inhibit MAO.

Expected Therapeutic Effect:  decrease in depression, decrease in aggressive behavior, possible decrease in obsessions and compulsions.

Dosage:  Initialadult dose of 50mg in once daily dose. May titrate up at 1 week intervalsto a maximum of 200mg/day.

Comments: 

• Reports of fatal reactions withgiven with MAO inhibitors.
• Recommended that at least 14 days should elapse between usage.
• 32% decrease in valium clearance.
• 8% increase in prothrombin time. Should monitor upon initiation or discontinuation of use with Warfarin.

Adverse Effects:  Motor ataxia, abnormal coordination, abnormal gait, tremor, dizziness CNS confusion, hyperesthesia, migraine, nystagmus, vertigo, twitching, insomnia Autonomic dry mouth, sweating, hypersalivation, urinary retention GI dysphagia, fecal incontinence, anorexia, weight gain, diarrhea  Other aggressive reaction, amnesia, abnormal dreams, depersonalization, emotionallability, hallucination, gynecomastia, male sexual dysfunction, skin discoloration,skin odor, myalgia

Drug or Medication: Bupropion (Wellbutrin)

Drug Class: Antidepressant

Action:  Decreases neuronal reuptake of dopamine inthe CNS. Diminished neuronal uptake of serotonin and norepinephrine (lessthan tricyclic antidepressants).

Expected Therapeutic Effect:  decrease in depression, increased ability to concentrate. Possible decreasein obsessions and compulsions.

Dosage:  Adult dose of 100mg twicedaily (morning and evening) initially; after 3 days may be increased to 100mg 3 times daily depending on response. If no response after 4 wks of therapy, may increase to a maximum daily dose of 450mg/day in divided doses.  No single dose to exceed 150mg, wait at least 6hrs. between doses at the 300 mg/day dose or at least 4 hrs between doses at the 450mg/day dose.  Safety not established in children.

Comments: 

• Increased risk of adversereactions when used with levodopa or MAO inhibitors.
• Increased risk of seizures with phenothiazines, antidepressants, cessationof benzodiazepines, or cessation of alcohol.
• If dose is missed, omit dose and return to regular dosing schedule. Do notdouble dose. Increased risk of seizure.

Adverse Effects: Motor tremor, ataxia/incoordination, seizure, dyskinesia, vertigo CNS seizures, agitation, insomnia, psychoses, mania, headache, mania/hypomania,hallucinations, depression, memory impairment, depersonalization, mood instability  Autonomic  dry mouth GI nausea, change in appetite, weight gain or loss,  constipation,dysphagia, stomatitis Other edema, EKG abnormalities, rashes, alopecia, gynecomastia, nocturia, vaginalirritation, sexual dysfunction, enuresis, urinary incontinence, menopause,shortness of breath, visual disturbance, flu-like syndrome.

Drug or Medication: Paroxetine HCL (Paxil)

Drug Class: Antidepressant

Action: Potentiation of serotonergic activity in the CNS resulting from inhibition of neural reuptake of serotonin. Very weak effects on norepinephrine and dopamine neuronal reuptake.

Expected Therapeutic Effect: decrease in depression, decrease in aggressive behavior.

Dosage: Initialadult dose should begin at 20mg/day. May titrate up in increments of 10mg/dayto a maximum of 50mg/day in a single morning dose.

Comments: 

• Phenobarbitolmay decrease effectiveness.
• Cimetidine may increase concentrations in plasma by 50%.
• Co-administration of certain antidepressants (e.g., nortriptyline, amitriptyline,imipramine, desipramine and fluoxetine) should be approached with caution.

Adverse Effects: Motor myoclonus CNS insomnia, agitation, anxiety, headache, parethesia, CNS stimulation, asthenia, somnolence, dizziness Autonomic dry mouth, sweating, blurred vision GI constipation, increased or decreased appetite, dyspepsia, diarrhea  Other fever, taste perversion, male sexual disturbance, urinary frequency, myalgia

Drug or Medication: Venlafaxine hydrochloride (Effexor)

Drug Class: Antidepressant

Action: Potent inhibitor of neuronal serotonin andnorepinephrine reuptake and weak inhibitors of dopamine reuptake.

Expected Therapeutic Effect: decrease in depression, possible decrease in obsessions and compulsions.

Dosage: Adult dose of 75mg/day, in 2-3 divided doses, taken with food. Dose may be increased to maximum of 225 mg/day in increments of up to 75 mg/day at intervals of no less than 4 days. Safety in children has not been established.

Comments: 

• When discontinued dose should be tapered slowly over a 2 week period.
• At least 14 days should elapse between discontinuation of an MAOI and initiation of therapy with Effexor.
• In addition, at least 7 days should be alloweda fter stopping Effexor before starting an MAOI.
• Dose may need to be reduced by 50% for patients with hepatic impairment.

Adverse Effects: Motor tremor, hypertonia, ataxia, hyperkinesia, rare dystonia CNS Migraine, asthenia, somnolence, dizziness, nervousness, anxiety, insomnia Autonomic Dry mouth and eyes, blurred vision sweating GI Nausea, constipation, anorexia, diarrhea Other abnormal ejaculation/orgasm, impotence

Drug or Medication: Fluvoxamine (Luvox)

Drug Class: Antidepressant

Action: Potent inhibitor of presynaptic neuronal reuptake of serotonin

Expected Therapeutic Effect: decrease in depression, decrease in obsessions and compulsions.

Dosage: Adult dose of 50 mg to 300 mg/day in a single or divided dose.

Comments:  The coadministration of fluvoxamine 100 mg/day and propranolol (Inderol) resulted in a five-fold increase in propranolol plasma concentration and a slightdecrease in heart rate.

Adverse Effects: Motor tremor, hypodinesia CNS somnolence, headache, agitation, dizziness, asthenia Autonomic dry mouth GI nausea/vomiting, constipation, anorexia. Other: insomnia, syncope

Drug or Medication: Desipramine HCL (Norpramin)

Drug Class: Tricyclic Antidepressant

Action: Blocks re-uptake of norepinephrine.Has significant anticholinergic properties.

Expected Therapeutic Effect: decrease in depression, increased ability toconcentrate, decrease in emotionally labile behavior.

Dosage: Usual adult dose is 100 200mg/day. May be further increased to a maximum of 300mg/day in a once daily dose. Lower dosages recommended for elderly and adolescent patients.

Comments: 

• Should not be given in conjunction with, or within2 weeks of, treatment with MAO inhibitor; hyperpyretic crisis and deathhave occurred.
• Not recommended for children.
• Sudden death resulting from cardiac arrest has been reported in childrenusing this medication.
• Prolongation of QRS or QT wave intervals on EKG are significant for toxicity.

Adverse Effects: Motor incoordination, ataxia, extrapyramidal symptoms, seizures CNS disorientation, anxiety, insomnia, nightmares, hypomania, drowsiness,  Autonomic dry mouth, blurred vision, urinary retention, sweating, urinary frequency GI anorexia, constipation, weight gain Other itching, photosensitivity, gynecomastia, galactorrhea, decreased libido,alopecia, EKG changes

Drug or Medication: Imipramine (Tofranil)

Drug Class: Tricyclic Antidepressant

Action: Potentiates the effect of serotoninand norepinephrine. Has significant anticholinergic properties.

Expected Therapeutic Effect: decrease in depression, increased ability toconcentrate, decrease in emotionally labile behavior.

Dosage: Adultdose 25-50mg 3-4 times daily to a maximum of 300mg/day. Total dose may begiven at bedtime.  Children below age 6 years, 25mg once daily before bedtime, may increase by 25mg at weekly intervals to 50mg in children. Children over age 12 mayincrease does to 75mg/day.

Comments: 

• May cause hypotension and tachycardiawhen used with MAO inhibitors. Avoid concurrent use-discontinue 2 weeksprior to start of imipramine.
• May prevent therapeutic response to most antihypertensive.
• May cause severe hypertension when used with clonidine. Avoid concurrentuse.

Adverse Effects: CNS drowsiness, sedation, confusion, agitation, hallucination, insomnia Autonomic dry mouth and eyes, blurred vision, urinary retention GI constipation  Other photosensitivity, hypotension, EKG changes, arrhythmias

Drug or Medication: Buspirone HCL (Buspar)

Drug Class: Antianxiety

Action: Binds to serotonin and dopamine receptors inthe brain (enhances serotonin transmission while blocking dopamine transmission).  Increases norepinephrine metabolism in the brain.

Expected Therapeutic Effect: decrease in emotionally labile behavior.

Dosage: Adult dose 15mg/day in 3 divided doses, may be increased by 5mg/day at 23 day intervals, to a maximum of 60mg/day. Usual dose is 20 30mg/day.

Comments: 

• Usewith MAO inhibitors may result in hypertension.
• Avoid use with alcohol

Adverse Effects: Motor incoordination, tremor, fatigue CNS dizziness, insomnia, nervousness, drowsiness, excitement, personality changes,paresthesia, numbness Autonomic blurred vision, nasal congestion, altered taste or smell, dry mouth andeyes, sweating, urinary hesitancy GI diarrhea, constipation, nausea. Other: myalgia, chest pain, palpitations, tachycardia, hypo or hypertension

Drug or Medication: Diazepam (Valium)

Drug Class: Antianxiety Sedative-Hypnotic

Action: Depresses the CNS, probably by potentiatinggamma-aminobutyric acid (GABA), an inhibitory neurotransmitter.
Produces skeletal muscle relaxation by inhibiting spinal polysynaptic afferentpathways.

Expected Therapeutic Effect: decrease in anxiety.

Dosage: Adult 2-10mg2-4 times daily. Children older than 6 months 1-2.5mg 3-4 times daily.

Comments: 

• Concurrent use with alcohol, antidepressants, antihistamines, and narcotic analgesicsresults in additive CNS depression.
• Cimetidine, oral contraceptives, disulfiram, fluoxetine, ionized, propranolol, ketoconazole, metoprolol, propoxphene, or valproic acid may enhance its actions.
• Sedative effects may be decreased by theophylline.

Adverse Effects: CNS dizziness, drowsiness, lethargy, hangover, paradoxical excitation, mental depression, headache Autonomic blurred vision GI nausea, constipation. Other: respiratory depression, tolerance, psychological dependence, physical dependence.

Drug or Medication: Clorazepate (Tranxene)

Drug Class: Antianxiety Sedative-Hypnotic Benzodiazepine

Action: Acts at many levels in the CNS to produceanxiolytic effect and CNS depression (by stimulating inhibitory GABA receptors).Produces skeletal muscle relaxation (by inhibiting spinal polysynaptic afferentpathways).

Expected Therapeutic Effect: decrease in anxiety.

Dosage: Adult dose 7.5-15mg 2-4 times daily.May be given in a single dose of up to 22.5mg at bedtime. Children 9-12 yr. 7.5mg twice a day. May increase no more than 7.5mg/dayat weekly intervals, not to exceed 60mg/day.

Comments:  May decreaseefficacy of levodopa. Other drug interactions similar to diazepam.

Adverse Effects: Side effects similar to those of diazapam.

Drug or Medication: Alprazolam (Xanax)

Drug Class: Sedative-Hypnotic Benzodiazepine

Action: Acts at many levels in the CNS to produceanxiolytic effect. Depresses the CNS, probably by potentiating gamma aminobutyricacid (GABA), an inhibitory neurotransmitter.

Expected Therapeutic Effect: decrease in anxiety.

Dosage: Adult dose 0.25-0.5mg 2-3 times dailynot to exceed 4mg/day.

Comments:  Drug interactions same as Tranxene.

Adverse Effects: Side effects similar to those of diazapam.

Drug or Medication: Carbamazepine (Tegretol)

Drug Class: Anticonvulsant

Action: Decreases synaptic transmission in the CNS.

Expected Therapeutic Effect: Decrease in aggressive behavior, decrease in emotionally labile behavior.

Dosage: Initial adult dose of 200mg 2 times daily or 100mg 4 times daily. May titrate upto therapeutic levels in the range of 800-1200mg/day in divided doses every 6 to 8 hrs. to a maximum of 1g/day. Children 6-12 yrs. 200mg/day in 2-4 divided doses. May increase until therapeutic levels in the range of 400-800mg/day to a maximum of 1g/day.

Comments: 

• May decrease effectiveness of oral contraceptives, benzodiazepines, and other anticonvulsants.
• Concurrent use (within 14 days) of MAO inhibitors may result in hyperpyrexia,hypertension, seizure and death.
• Verapamil, diltiazem, propoxphene, or erythromycin increases carbamazepine levels and may cause toxicity.

Adverse Effects: Motor ataxia CNS vertigo, drowsiness, psychosis, visual hallucinations Autonomic blurred vision, urinary retention or hesitancy GI hepatitis. Other: Congestive heart failure, syncope, hypo- or hypertension, photosensitivity,aplastic anemia, agranulocytosis, thrombocytopenia, leukopenia, leukocytosis, eosinophilia

Drug or Medication: Clonazepam (Klonipin)

Drug Class: Anticonvulsant

Action: Produces anticonvulsant and sedative effects in the CNS. Mechanism is unknown but is probably similar to that of benzodiazepines, has a high affinity for the y- gamma aminobutyric acid (GABA) receptor,increasing synaptic serotonin.

Expected Therapeutic Effect: decrease in aggressive behavior, decrease in emotionally labile behavior,decrease in tics.

Dosage: Initial adult dose not to exceed 1.5mg given in 3 divided doses, may increase by 0.5-1mg every 3 days. Total maximum dose of 20mg/day. Children up to 10 yr or 30kg 0.01-0.03mg/kg not to exceed 0.05mg/kg given in 2-3 daily doses; increase by no more than 0.5mg every 3 days until therapeutic blood levels are reached. Maximum dose of 0.2mg/kg/day.

Comments: 

• Longterm effects on growth and maturation in children not known.
• Concurrent use of alcohol, antidepressants, antihistamines, and narcotic analgesics will result in additive CNS depression.
• Cimetidine, oral contraceptives, disulfiram, fluoxetine, ionized, propranolol, ketoconazole, metoprolol, propoxphene, or valproic acid may enhance its actions.
• Sedative effects may be decreased by theophylline.

Adverse Effects: Motor Ataxia, choreiform movements CNS drowsiness, behavioral changes, abnormal eye movements, nystagmus Autonomic increased respiratory secretions, urinary retention, hypersalivation GI constipation, hepatitis Other: palpitations, anemia, leukopenia, thrombocytopenia, eosinophilia, fever,increase in libido

Drug or Medication: Clonidine (Catapres)

Drug Class: Antihypertensive Alpha blocker

Action: Stimulates alpha adrenergic receptors in the CNS. Result is inhibition of cardioacceleration and vasoconstriction center. Adrenergic agonist, but stimulates inhibitory neurons in the CNS. In higher doses ceases inhibitory effects and causes an increase in sympathetic arousal.

Expected Therapeutic Effect: decrease in tics, increased attention, decrease in emotionally labile behavior.

Dosage: Initial adult PO dose 0.1mg twice a day. Usual dose is 0.2-1.2mg/day in 2-3 divided doses. Adult transdermal patch is 1-3mg applied weekly. Initial dose in children starts at 0.15-0.4mg/day in divided doses (startwith 0.05mg at bedtime for a few days); also available in transdermal patch.

Comments: 

• Additive sedation with CNS depressants including alcohol, antihistamines, narcoticanalgesics, and sedative/hypnotics.
• Withdrawal phenomenon may be exaggerated by concurrent tricyclic antidepressants.
• Do not discontinue abruptly.

Adverse Effects: CNS: drowsiness, nightmares, nervousness, depression. Autonomic: dry mouth and eyes GI: constipation Other: hypotension, bradycardia, palpitations, impotence, weight gain, withdrawal phenomenon

Drug or Medication: Guanfacine (Tenex)

Drug Class: Antihypertensive Alpha blocker

Action: Stimulates CNS alpha adrenergicreceptors, resulting in decreased sympathetic outflow.

Expected Therapeutic Effect: decrease in motor tics, improvement in mood.

Dosage: Adult dose of1 mg daily given at bedtime, may be increased if necessary at 3 4wk intervalsup to 3 mg/day.

Comments: 

• Additive hypotension with other antihypertensiveagents, nitrates, and acute ingestion of alcohol.
• Additive CNS depression may occur with other CNS depressants, including alcohol, antihistamines, narcotic analgesics, tricyclic antidepressants,and sedative/hypnotics.

Adverse Effects: CNS drowsiness, weakness, fatigue, dizziness, headache, insomnia, depression Autonomic dry mouth GI constipation, abdominal pain, nausea Other Tinnitus, dyspnea, impotence

Drug or Medication: Propranolol (Inderol)

Drug Class: Antihypertensive Beta blocker

Action: Blocks stimulation of beta1 and beta 2 receptorsites.

Expected Therapeutic Effect: decrease in emotionally labile behavior, decrease in rage attacks, decrease in obsessive symptoms, possible improvement in tics.

Dosage: Adult dose of 60mgSR 2 times daily. Safety not established in children.

Comments: 

• Concurrent use with amphetamines,cocaine, ephedrine, epinephrine, norepinephrine, phenylephrine, or pseudoephedrinemay result in excess alpha-adrenergic stimulation, hypertension, and bradycardia.
• May produce hypertension within 14 days of MAO inhibitor.
• Cimetidine may decrease metabolism and increase the effects of propranolol.
• Do not withdraw abruptly.

Adverse Effects: CNS fatigue, weakness, depression, insomnia, dizziness Autonomic dry eyes, blurred vision, nasal stuffiness GI constipation, diarrhea, nausea, vomiting Other bronchospasm, bradycardia, pulmonary edema, hypo or hyperglycemia, impotence, Raynaud's phenomenon

Drug or Medication: Nifedipine (ProcardiaXL)

Drug Class: Antihypertensive Calcium channel blocker

Action:  Acts on slow calcium channels invascular smooth muscle and myocardium, producing vasodilation.

Expected Therapeutic Effect:  decrease in tic symptoms.

Dosage:  Adult dose of 10mg 3 times daily  Safety not established in children.

Comments: 

• Additive hypotensionwith antihypertensives.
• May increase blood levels and risk of toxicity with digoxin.
• Cimetidine may slow metabolism and lead to toxicity

Adverse Effects: CNS dizziness, giddiness, headache Autonomic flushing, warmth, sweating, nasal congestion, sore throat GI nausea, constipation, flatulence Other dyspnea, cough, hypotension, wheezing, tachycardia, arrhythmias, fever,heart failure, muscle cramping

Drug or Medication:  Verapamil (Isoptin)

Drug Class:  Antihypertensive Calcium channel blocker

Action: Inhibits calcium transport into myocardialand vascular smooth muscle cells, resulting in inhibition of excitationcontraction coupling and subsequent contraction.

Expected Therapeutic Effect: decrease in motor tics, improvement in mood.

Dosage:  Adult dose of 20mg 3 times daily. Children should not initiate therapy in a dose greater than 5mg.

Comments: 

• Mayincrease or decrease lithium levels. 
• Increase risk of toxicity from theophylline.
• Increased risk of bradycardia, congestive heart failure, and arrhythmiaswhen used with beta-adrenergic blocking agents or disopyramide.
• Additive hypotension with antihypertensive agents, acute ingestion of alcohol,nitrates, or quinidine.

Adverse Effects: CNS dizziness, headache, fatigue GI constipation,abdominal discomfort Other bradycardia, hypotension, edema, heart block, sinus arrest, pulmonary edema

Drug or Medication: Methylphenidate HCL (Ritalin )

Drug Class: CNS stimulant

Action: Produces CNS and respiratory stimulation withweak sympathomimetic activity.

Expected Therapeutic Effect:  increased attention span in attention deficit disorder.

Caution: May cause increase in motor tics. May cause onset of TS.

Dosage: Adultdose to be given 30 40 minutes prior meals 2 times daily of 20-30mg/dayto a maximum of 60mg/day. Sustained release tablets may be substituted ifthe equivalent dose over 8 hrs. is the same. Children older than 6 years of age should initiate therapy at 5mg beforebreakfast and before lunch, may increase by 5-10mg at weekly intervals toa maximum of 60mg/day.  Safety has not be established in children under 6 yrs.

Comments: 

• Adversereactions can usually be reduced by decreasing dosage or omitting dose inafternoon or evening.
• Toxic psychosis has been reported.
• Long term therapy may stunt growth.
• Treatment should be assessed periodically. Improvement may be sustainedwhen the drug is either temporarily or permanently discontinued.
• Drug treatment usually may be discontinued after puberty.

Adverse Effects: Motor increase in motor tics, restlessness, tremor, hyperactivity, akathisia,dyskinesia CNS insomnia, irritability, dizziness, headache, nervousness Autonomic blurred vision, dry mouth  GI nausea, anorexia, cramps, constipation, weight loss Other leukopenia, fever, tachycardia, palpitation, hyper or hypotension, metallictaste

Drug or Medication: Dextro amphetamine (Dexedrine)

Drug Class: CNS stimulant

Action: Produces CNS stimulation by releasing norephinephrinefrom nerve endings.

Expected Therapeutic Effect: increased attention span in attention deficit disorder. 

Caution: May cause increase in motor tics. May cause onset of TS.

Dosage: Children3-5 yrs. 2.5mg/day, may increase by 2.5mg at weekly intervals. Children over 6 yrs. 5 10mg/day in 1-2 doses, increase by 5mg at weeklyintervals.

Comments: 

• Additive adrenergic effects with other adrenergicagents.
• Use with MAO inhibitors can result in hypertensive crisis.
• Large doses of ascorbic acid decreases effect.
• Phenothiazines may decrease effect.
• May antagonize the response to antihypertensive.
• Increased risk of cardiovascular side effects with beta blockers or tricyclicantidepressants.

Adverse Effects: Side effects similar to those of Ritalinwith an addition of psychological dependence, physical dependence, increasedlibido, decrease in seizure threshold

Drug or Medication: Pemoline (Cylert)

Drug Class: CNS stimulant

Action: Produces CNS stimulation, which may be mediatedby dopamine.

Expected Therapeutic Effect: increase in attention span in attention deficit disorder. 

Caution: May cause increase in motor tics. May cause onset of TS.

Dosage: Childrenover 6 yrs. 37.5mg initially as single morning dose, may be increased 18.75mg at weekly intervals until optimum response is achieved. Usual maintenance dose is 56.25 75mg/day

Comments: 

• Long term therapy may stunt growth.
• Additive CNS stimulation with other CNS stimulants or adrenergics, including decongestants
• Take medication in a.m. to avoid sleep disturbances.

Adverse Effects: Side effects similar to those of Ritalin with the addition of dyskinetic movements, sweating, decrease in seizure threshold.

Drug or Medication: Lithium (Lithobid)

Drug Class: Antimanic Antidepressant

Action: Alters cation transport in nerve and muscle.May also influence re-uptake of neurotransmitters.

Expected Therapeutic Effect: given concurrently with antidepressant may enhance response to serotonergic agents

Dosage: Adult dose of 9001200mg/day in 3 or 4 divided doses (usual dose 300mg 3-4 times daily). Extended-release dosage may be given twice daily.

Comments: 

• May prolong the action ofneuromuscular blocking agents.
• Encephalopathic syndrome may occur with haloperidol.
• Diuretics, methyldopa, probenecid, indomethacin, and other nonsteroidal anti-inflammatory agents may increase the risk of toxicity.
• Lithium may decrease the effects of chlorpromazine.
• Chlorpromazine may mask early signs of lithium toxicity.
• Large changes in sodium intake (medication or food) may alter the renalelimination of lithium. Increasing sodium intake will increase renal excretion.

Adverse Effects: Motor muscle weakness, rigidity, hyperirritability, ataxia, tremors, psychomotorretardation CNS headache, impaired memory, lethargy, drowsiness, confusion, seizure, restlessness,aphasia, hyperirritability Autonomic tinnitus, blurred vision, dry mouth GI nausea, anorexia, epigastric bloating, abdominal pain, diarrhea, metallictaste, weight gain Other EKG changes, hypotension, arrhythmias, polyuria, nephrogenic diabetes insipidus,renal toxicity, acneiform erruption, folliculitis, pruritis, diminishedsensation, alopecia, hyper- or hypothyroidism, goiter, hyperglycemia, leukocytosis

References: Physicians' Desk Reference 1992, 46th edition.
Davis's Drug Guide For Nurses, third edition 1993, Judith Hopfer Deglin,PharmD, April Hazard Vallerand,
MSN, RN, F.A. Davis Company, Philadelphia

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