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Medicine is generally not needed for
Tourette's disorder (TD). Usually doctors first work
with parents and other caregivers (such as teachers) to educate them about the
condition. Behavioral training, such as habit reversal training, creating an appropriate home and school
environment, and helping build your child's self-esteem are often tried first.
Sometimes medicines are added to a treatment program when tics are
severe or are causing your child a lot of physical, mental, or emotional
problems. The goal of using medicine for tics is to improve a child's overall
functioning, not to make the tics go away completely.
An overall program that includes medicine may ease a child's general
frustration and make him or her more comfortable around other people. Medicine
sometimes helps a child with TD feel better mentally and function better at
school and at home.
It is important to find out whether a child with TD also has
symptoms of other conditions, such as behavior problems or mood disorders.
Often problems such as
anxiety need to be treated first.
In the United States, treating
tics with medicine is often an
unlabeled use. This means that the U.S. Food and Drug
Administration (FDA) has not approved the medicine specifically for treating tics or
has not approved it for use in children. If a doctor suggests that your child
take medicine to control tics, ask for an explanation of the benefits and
risks. Ask how the medicine works, how long your child can take it, and whether
there are any short-term or long-term side effects.
It is sometimes difficult to know whether medicine is helping to
control tics. This is because the tics in Tourette's disorder can come and go.
Also, tics may return or seem worse when medicine is stopped. Always work with
a doctor when you want your child to start or stop taking medicine.
Medicines may target tics or symptoms of associated disorders, such
Medicines to treat tics include:
For safety, it is important that your child's doctor know about all
the medicines your child is taking.
Botulinum toxin (Botox) is sometimes used as a short-term treatment
for severe tics. The medicine is given as an injection (shot) into the area
where tics occur frequently, such as the vocal cords, neck, face, arms, or
legs. The medicine's effects typically last about 3 or 6 months.3
In rare cases, serious side effects can occur. Talk to your child's doctor
about the risks and benefits of this medicine.
Other medicines are being studied as possible treatments for
Medicines commonly used to treat symptoms of other disorders that are
frequently associated with TD include:
Many doctors consider it safe to give medicines to treat attention
deficit hyperactivity disorder (ADHD), with a few exceptions, to children who
also have TD. Although high doses of stimulant medicines have been reported
to increase tics in some children, controlled research suggests that most
children's tics do not get worse with these medicines. And some stimulant medicines have been shown to improve tic symptoms.4
Bloch MH, Leckman JF (2007). Tic disorders. In A Martin, FR Volkmar,
eds., Lewis's Child and Adolescent Psychiatry, 4th ed., pp.
569–583. Philadelphia: Lippincott Williams and Wilkins.
Sadock BJ, Sadock VA, eds. (2007). Tic disorders. In
Kaplan and Sadock's Synopsis of Psychiatry: Behavioral Sciences/Clinical Psychiatry, 10th ed., pp. 1235–1243. Philadelphia:
Lippincott Williams and Wilkins.
Kurlan R (2010). Tourette's syndrome. New England Journal of Medicine, 363(24): 2332–2338.
Bloch MH, et al. (2009). Meta-analysis: Treatment of attention-deficit/hyperactivity disorder in children with comorbid tic disorders. Journal of American Academy of Child and Adolescent Psychiatry, 48(9): 884–893.
July 22, 2013
John Pope, MD - Pediatrics & Karin M. Lindholm, DO - Neurology
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