Medication for Tourette syndrome

This is an introductory guide only. If you have questions about medication for Tourette syndrome (TS), you should discuss them with a specialist who can take into account individual factors. Information about side effects given here is not intended to be comprehensive.

Medication can reduce symptoms of TS and improve quality of life. Unfortunately their effectiveness varies from person to person, and side effects of the treatments can happen, so they are not beneficial for everyone. In an ideal world, behavioural and psychological treatments, which are first-line, would be more accessible. Unfortunately, specialised therapists are often not available, which increases the likelihood of medication being offered. Medications are sometimes used when behavioural interventions are not available, if they have not worked, or in some cases, alongside side them. In some patients, medication can be a highly effective option.

Finding the right medication

Selecting treatment for TS is an individual process due to the wide range and severity of symptoms and the occurrence of associated conditions such as attention deficit hyperactivity disorder (ADHD), obsessive compulsive disorder (OCD) and depression. Clinicians need to work closely with patients and their families when deciding on the most appropriate medication, in order to balance the potential risks and benefits of treatment with medication. The decisions that need to be made include:

• Whether or not to treat with medication.
• Which symptoms to treat - tics or the other conditions such as ADHD or OCD.
• Whether a combination of medications is necessary to treat the different symptoms.

Assessing the effectiveness of treatment is complicated by the fact that tics naturally ‘wax and wane’, meaning that periodically they get better and worse over time. Sometimes therapies appear to be working well but this may be a period in which tics are naturally less severe.

General rules for using medication to treat TS and related symptoms

Sometimes there can be different views about which symptoms are causing the most problems, for example, a child with TS may think the tics are the biggest problem, whilst the parents may be more concerned about behaviour in school. This requires discussion and agreement before treatment is started.

Treatments in TS usually follow the ‘start low, go slow’ rule (i.e. start at a low dose and increase the dose slowly). This means that side-effects, if they do occur, can be more easily recognised and controlled. It is also advisable to make just one change at a time. If too many changes are made quickly and the TS improves or gets worse, it is hard to know why or what caused the change.

Stopping treatments suddenly is usually not a good idea, however, sometimes, this has to be done (e.g. if a person gets an acute reaction to a treatment). This should only be done in consultation with your doctor, so if you think you are having a reaction or side effects, discuss it with your doctor as soon as possible.

It can be useful to keep a diary of how you feel on each dose of medication or medication type. This means that you can look back and work out which treatment or combination worked best for you with the fewest side-effects. When you go and see your doctor about TS, always bring your medication or prescription with you so that the doctor knows what you are taking.

Types of medication

There are no medications that are licensed for TS, licensing is what allows medications to be advertised for a certain use. There are, however, mediations that research tells us can be effective in treating the symptoms of TS. There is no single medication that is clearly best for all patients. As the available medications vary in how effective they are for each person with TS, it can be necessary to try more than one option. As we usually start medications low and slow, each trial of a new medication can take weeks or months to see if it is working, and so it is important to be patient - it can take a while to find the right medication, at the right dose that is best for you. There is no evidence that any of the medications commonly used are addictive. 

Medications used to treat tics

Dopamine medications

The most commonly used medications for the treatment of tics are dopamine modulating mediations, referred to as antipsychotics. This is because they are primarily marketed for treating psychotic conditions such as schizophrenia. However, as these medications are increasingly being used for the management of non-psychotic conditions, this label is no longer appropriate and is likely to be changed in the future. There is no clinical link between psychosis and TS.

All antipsychotic medications work by altering the effect of dopamine (a chemical messenger) on the brain, specifically by blocking dopamine receptors, mainly the D2 receptor. Dopamine has been strongly linked with TS and some of these medications are the most useful for reducing tics.

Antipsychotic medications can be further divided into first, second and third generation. Although they all work by modifying dopamine effects, they differ in their side effect profile.

 

Third Generation medication for tics

Aripiprazole medication is one of the best researched and most commonly used medications for TS. This is because there is clinical trial evidence that it can be effective and it tends to be better tolerated than other options. Aripiprazole has a unique mechanism of action in that it can both block and stimulate dopamine receptors, depending on how much naturally occurring dopamine there is around. It has the advantage of being less likely to cause weight gain, neurological and cardiac side-effects. The side effects from this medication are usually mild to moderate and temporary and can include insomnia, drowsiness, fatigue, nausea and headache. Aripiprazole can also cause restlessness, which can be very uncomfortable. If this happens, the medication and dose should be reviewed and may be stopped. 

 

Second Generation medication for tics

These include risperidone, olanzapine, sulpiride and quetiapine. There is evidence from clinical trials that risperidone can be effective in controlling tics, and it is widely used. Olanzapine, sulpiride and quetiapine are similar medications but are used less often because there is less research evidence. Second-generation medications are often preferred to the older first-generation medications because they are less likely to produce neurological side effects. However, they can produce a different set of side effects because of their influence on other brain chemicals in addition to dopamine. Importantly, they can cause the ‘metabolic syndrome’, which is weight gain and abnormal glucose (sugar) and lipid (fat) processing. If not monitored, this can lead to high blood pressure, diabetes and effects on the liver. Patients should have their weight and blood pressure monitored and their blood tested before and soon after starting medication, and then at least once a year. Olanzapine is the medication that is most likely to cause this problem.

 

First Generation medication for tics

These include haloperidol and pimozide. Their main side effects are neurological and can include sudden stiffness, or tremors (shaking), and more rarely prolonged muscle contraction (known as acute dystonia), and restlessness. These neurological effects are reversible when the medication is stopped. Long-term treatment can very occasionally cause another movement disorder called tardive dyskinesia (involuntary repetitive movements, different to tics). This risk is very small, but the movements may occasionally persist after treatment is stopped.

Haloperidol was the first medication used to treat tics, but is now less often prescribed than second and third-generation medications because of the risk of side effects. However, by keeping to a low dose, these side effects can usually be avoided and haloperidol can be an effective and well-tolerated treatment for tics in some people.  

Pimozide was widely used in Europe for the treatment of tics as studies showed that it is an effective treatment and causes fewer neurological side effects than haloperidol. Unfortunately it can cause problems in heart rhythm and its use has declined. In fact, it is now known that many antipsychotic medications in the first and second generation groups can potentially cause this effect on the heart. Patients should have a heart trace (ECG) before starting, shortly after starting and then at least every year.  Some common medications (such as antibiotics) can make the effect of pimozide on the heart stronger, so care needs to be taken when other medications are prescribed at the same time. You should always make sure that your doctor or pharmacist knows what other medications you are taking.

 

Noradrenergic medications

Medications like clonidine and Guanfacine work by acting on a different chemical system to dopamine by stimulating adrenaline receptors in the brain. Both have been used for many years in the treatment of tics, particularly in children and young people, and can also improve ADHD symtopms. It is also a way to avoid the side effects of antipsychotics,which is why, especially in children, it may be used first line. . Most specialists feel it is not very effective in adults. Side effects may include drowsiness, sedation, headache, depression and dizziness. Clonidine was originally a blood pressure treatment. This means that people taking clonidine should have their blood pressure taken before they start and during treatment. Clonidine should not be stopped suddenly and must be reduced slowly in order to avoid a potentially dangerous increase in blood pressure. The newer medication guanfacine, which works in a similar way to clonidine, is reported to have fewer side effects than clonidine and is now also available in the UK for people under 18 years old.

Other medications for tics

Tetrabenazine reduces the effect of dopamine on the brain by a different mechanism than antipsychotics. This medication has been linked to side effects of fatigue, nausea, depression and insomnia. A newer version is now available and is being tested in TS in a clinical trial.

Finally, Topiramate is a medication for epilepsy and migraine that can reduce tics in some patients and does not act on the dopamine pathway. A clinical trial has shown it can be effective on its own or in addition to other anti-tic medication. However, the evidence on Topiramate is considered weak because of the small number of patients that took part in the clinical trial. Possible side effects include tingling, weight loss and depression. It should be avoided in women who may become pregnant.

Tiapride is a medication more widely used in Europe than in the UK, it also affects dopamine signalling in the brain. There is less evidence of its efficacy from trials for TS. Known side effects include dizziness, nausea, and dry mouth, and more rarely, some of the neurological side effects similar to antipsychotics.  

New and emerging treatments for tics

There is a new medicine, called Ecopipam, that works on dopamine, but at a messenger site (the D1 receptor) rather than current medicines (which mostly act on D2 receptors). A recent big international trial has shown that it can help reduce tics, and the benefits may last long-term. It is not yet available in the UK, but it may be in the future if approved by regulators.

Cannabis-based medicines are often in the news for the treatment of various neurological and other conditions, including certain forms of epilepsy. You may have seen news stories about cannabis and Tourette’s. Illegal cannabis contains hundreds of different chemicals, but medical versions contain just two important components in different ratios: CBD and THC. Some small studies in adults suggest that medicines made from THC (the part of cannabis that causes a “high”) can help tics, but side effects are common, and we don’t know enough about long-term safety. CBD-only products (such as oils sold in health food shops) have not been shown to help with tics. Importantly, there is no evidence that smoking cannabis helps with tics. In fact, using cannabis recreationally, especially in adolescence and young adulthood, can have negative effects on mental health, memory and motivation.

Our brains naturally make their own “cannabinoids” that help control movement. New medicines are being developed to boost these natural systems, but they are still at an early research stage and not yet available.

Medications used to treat ADHD

There are a number of medications used to treat ADHD including stimulants such as Ritalin, Concerta and Equasym. These are different forms of the same active medication, methylphenidate, which differ only in how and when the active medication is released. Methylphenidate is the most effective treatment for ADHD.

A commonly asked question about the treatment of ADHD in people who also have TS is whether or not the treatment for ADHD makes the tics worse. Tics vary over time and so it can be difficult to find out whether a change in treatment (such as adding a stimulant) was responsible for making tics worse or whether it was just a natural change in the severity of the TS, which would have happened anyway. ADHD is often apparent at a younger age than tics, so tics may appear to start after ADHD medication has already been used. More recent studies and opinions suggest that medications for ADHD do not generally lead to worsening of tics, so stimulants for ADHD can be used safely in children with tics.

Atomoxetine is a well-established but newer medication in the treatment of ADHD. A large trial showed that it is effective in children with TS and may even improve tics as well as ADHD.

Medications used to treat OCD

The group of medications used to treat depression known as SSRIs (Selective Serotonin Reuptake Inhibitors) are also effective for OCD, sometimes requiring high doses. Cognitive behavioural treatment used in combination with SSRIs is most effective. 

As Tourette syndrome often occurs alongside other conditions, it is important that each condition is assessed and managed appropriately. Your doctor may choose to start with one medication first and monitor all symptoms. Sometimes, when medication is prescribed for another condition - such as anxiety or OCD - TS symptoms may also improve, although the reasons for this are not always clear. For example, there is no evidence that SSRIs used to treat anxiety or OCD directly improve tics. However, by reducing anxiety (a known trigger for tics), some people may notice that their TS symptoms improve indirectly. This is why it is usually best to introduce one medication at a time and to ensure that treatment is tailored to the individual.

 

For more information about medications and side-effects, please refer to our factsheet.

For further information about TS and co-occurring conditions visit our web page

Further Information about medication for TS

In November 2017, Nottingham University held an open lecture with three speakers from the United States, all of whom are specialists in Tourette syndrome. In this video, James T McCracken  M. D., Professor of Child Psychiatry Director, Division of Child & Adolescent Psychiatry, Dept of Psychiatry & Bio-Behavioural Sciences at UCLA, gives an overview of the role of medical treatments in the treatment of TS and co-occurring conditions.

Please note that the information about medication on the Tourettes Action’s website is for guidance only. You should seek advice from a medical professional if you have any questions or concerns regarding medication.

The original version of this information was written by Professor Hugh Rickards, Dr Jeremy Stern, Dr Helen Simmons, Professor Eileen Joyce and Professor Andrea Cavanna in December 2018, and updated by Dr Edward Palmer in August 2025.