Table 7

Indications, efficacy and monitoring requirements of medications used for treatment of chronic tic disorders and TS

Medication	Indication	Investigations and monitoring	Frequent adverse reactions	Level of evidence	Dose
Alpha adrenergic agonists
Clonidine	ADHD/TS	BP, ECG	Orthostatic hypotension, sedation	A	0.05 mg/day up to maximum 0.3 mg/day ÷ three times a day
Guanfacine	ADHD/TS	BP, ECG	Orthostatic hypotension, sedation	A	0.5 mg/day up to 4 mg/day
Noradrenaline reuptake inhibitor
Atomoxetine	ADHD/TS	BP, ECG, transaminases	Nausea, dry mouth, anorexia, insomnia, fatigue, headache	A	40–60 mg/day
Typical neuroleptics
Haloperidol	TS	Blood count, ECG, weight, transaminases, neurologic status, prolactin	EPS, sedation, increased appetite	A	0.25 mg/day up to maximum 6 mg/day ÷ three times a day
Pimozide	TS	Blood count, ECG, weight, transaminases, neurologic status, prolactin	EPS, sedation, increased appetite	A	0.5 mg/day up to maximum 10 mg/day
Atypical neuroleptics
Risperidone	TS/DBD	Blood count, BP, ECG, weight, electrolytes, transaminases, prolactin, blood lipids, glucose	EPS, sedation, increased appetite, orthostatic hypotension	A	0.5 mg/day up to maximum of 6 mg/day
Olanzepine	TS/OCB	Blood count, BP, ECG, weight, electrolytes, transaminases, prolactin, blood lipids, glucose	Sedation, increased appetite, akathisia	B	5–10 mg /day
Benzamides
Sulpiride	TS/OCB	Blood count, ECG, weight, transaminases, prolactin, electrolytes	Problems with sleep, agitation, increased appetite	B	100 mg/day up to 800 mg/day ÷ twice a day

Evidence level: A (more than two controlled randomised trials), B (one controlled, randomised trial), C (case studies, open trials).
ADHD, attention-deficit hyperactivity disorder; BP, blood pressure; DBD, disruptive behaviour disorder; EPS, extrapyramidal symptoms; OCB, obsessive-compulsive behaviour; TS, Tourette syndrome.