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Tick - Treatment
Last reviewed: 06.07.2025
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Although the neurochemical substrate underlying tics remains unknown, it has been noted for some time that low doses of dopamine D2 receptor antagonists or drugs that block the accumulation of dopamine in vesicles (for example, reserpine and tetrabenazine) can effectively suppress tics. Alpha2-adrenergic receptor agonists clonidine and guanfacine, as well as the benzodiazepine clonazepam, can also be used to reduce tics. In any case, treatment is symptomatic and does not significantly affect the course of the disease. Many patients do not need to take any medications. Tic treatment should be carried out when tics significantly interfere with learning, establishing social relationships, and finding a job. Medications rarely completely eliminate tics, and their side effects can be quite significant. Explaining the nature of the disease to family members, teachers, and employers can sometimes solve many problems. Only if non-drug measures are insufficient are medications prescribed.
Because of the risk of long-term side effects with dopamine receptor antagonists, it is reasonable to start treatment with other drugs, although their effectiveness is not as high. For this reason, clonidine is often the drug of first choice. Although there are conflicting reports on the effectiveness of this drug, it does not cause long-term side effects. Treatment should be started with a low dose (0.05 mg twice daily), then gradually increased over several weeks until a therapeutic effect is achieved or side effects occur. It is important to warn the patient against abruptly stopping the drug, which may result in headache and increased blood pressure.
If clonidine is ineffective, a trial treatment with tetrabenazine may be tried, as this drug is quite effective in many patients, but, unlike neuroleptics, it probably does not cause tardive dyskinesia. The initial dose is 25 mg once daily, then it is increased to 25 mg 3 times daily. Reserpine is rarely used due to the risk of arterial hypotension and depression. Almost all dopamine receptor antagonists are effective in tics, but pimozide, haloperidol, and fluphenazine are the most popular. Pimozide has a lesser adverse effect on cognitive function than haloperidol and neuroleptics with pronounced anticholinergic action. Clozapine does not appear to be effective in tics. In recent years, risperidone has been used to treat tics, which is quite effective in some patients, but experience with its use is still insufficient. The general strategy is to start treatment with a minimum dose, which the patient takes for 2-3 weeks, then gradually increase the dose until a therapeutic effect is achieved or side effects occur. When treating with neuroleptics, the possibility of developing tardive dyskinesia should always be kept in mind. In this regard, the patient should be informed of this possibility and monitored regularly.
Treatment for obsessive-compulsive disorder, which often accompanies Tourette syndrome, includes fluoxetine, clomipramine, or other serotonin reuptake inhibitors. This class of drugs is effective for behavioral disorders associated with Tourette syndrome.