Are medication-induced tics (Tourette's-like symptoms caused by pharmacological agents) a dangerous condition?

From the Guidelines

Medication-induced tics are generally not dangerous to physical health, though they can be distressing and impact quality of life. These tics typically occur as side effects of certain medications, most commonly stimulants (like methylphenidate and amphetamines used for ADHD), antipsychotics (particularly first-generation drugs like haloperidol), and occasionally antidepressants. While the tics themselves rarely pose physical harm, they can cause social embarrassment and psychological distress, as noted in a study on the treatment of ADHD with comorbidities 1. If you experience medication-induced tics, don't stop your medication abruptly, but consult your healthcare provider promptly. They may adjust your dosage, switch to an alternative medication, or add a medication to manage the tics. For example, with stimulant-induced tics, reducing the dose or switching to non-stimulant options like atomoxetine might help, as atomoxetine has been shown not to worsen tics in clinical trials 1. Additionally, guanfacine may reduce tics, but evidence regarding its beneficial effects on tics remains inconclusive 1. These tics occur because certain medications affect dopamine pathways in the brain that regulate movement control. Most medication-induced tics are reversible once the medication is adjusted or discontinued, though this should always be done under medical supervision, as supported by guidelines for the treatment of ADHD and comorbid tic disorders 1. It's essential to weigh the benefits of medication against the potential for inducing tics, especially in patients with pre-existing tic disorders, and to consider alternative treatments or combinations of medications that can mitigate these side effects, as discussed in the context of treating ADHD with comorbidities 1.

From the FDA Drug Label

CNS stimulants, including methylphenidate, have been associated with the onset or exacerbation of motor and verbal tics. Worsening of Tourette’s syndrome has also been reported Before initiating methylphenidate hydrochloride oral solution, assess the family history and clinically evaluate patients for tics or Tourette’s syndrome. Regularly monitor methylphenidate hydrochloride-treated patients for the emergence or worsening of tics or Tourette’s syndrome, and discontinue treatment if clinically appropriate.

Medication-induced tics can be dangerous if they worsen or lead to the development of Tourette's syndrome. The emergence or worsening of tics or Tourette's syndrome may require discontinuation of treatment.

• Key considerations:
  • Assess family history and clinically evaluate patients for tics or Tourette's syndrome before initiating treatment.
  • Regularly monitor patients for the emergence or worsening of tics or Tourette's syndrome.
  • Discontinue treatment if clinically appropriate 2.

From the Research

Medication-Induced Tics: Safety and Efficacy

• Medications commonly used to treat Attention Deficit Hyperactivity Disorder (ADHD) symptoms, such as methylphenidate and atomoxetine, have been shown to be efficacious in treating ADHD symptoms in children with comorbid tic disorders 3, 4.
• However, there is a concern that these medications may worsen tic symptoms, although the evidence suggests that this is not the case for most people with tic disorders 3, 4.
• In fact, some studies have found that methylphenidate and atomoxetine can improve tic symptoms in children with ADHD and comorbid tic disorders 3, 4.
• Other medications, such as alpha-2 agonists (clonidine and guanfacine), desipramine, and deprenyl, have also been shown to be effective in treating ADHD symptoms and tic symptoms in children with comorbid tic disorders 3, 4.

Risks and Side Effects

• High doses of dextroamphetamine have been shown to worsen tic symptoms in some studies 3, 4.
• Antipsychotics, such as risperidone and tiapride, can also induce tardive syndromes, including tardive tics, after chronic exposure 5, 6.
• Antiepileptic drugs, such as carbamazepine and lamotrigine, can also induce tics in some cases 6.
• However, other antiepileptic drugs, such as levetiracetam and topiramate, have been proposed as potential treatments for tic disorders due to their positive effect on tics 6.

Treatment Considerations

• The choice of medication for treating ADHD symptoms in children with comorbid tic disorders should be based on individual needs and the potential risks and benefits of each medication 3, 5, 4.
• Clinicians should carefully monitor patients for any changes in tic symptoms and adjust treatment accordingly 3, 4.
• Further studies are needed to fully understand the safety and efficacy of different medications for treating ADHD symptoms and tic symptoms in children with comorbid tic disorders 5, 4.