Is Adderall (amphetamine and dextroamphetamine) prescribed for Tourette's syndrome?

Adderall is Not Recommended for Tourette's Syndrome

Adderall (amphetamine and dextroamphetamine) is not prescribed for Tourette's syndrome and may actually worsen tics in patients with this condition. 1

FDA Warnings and Contraindications

• The FDA drug label specifically warns that "amphetamines have been reported to exacerbate motor and phonic tics and Tourette's syndrome" 1
• Clinical evaluation for tics and Tourette's syndrome should precede the use of stimulant medications in any patient 1
• Adverse reactions associated with amphetamine use include "exacerbation of motor and phonic tics and Tourette's syndrome" 1

First-Line Treatments for Tourette's Syndrome

• Antipsychotics are the most effective medications for treating tics in Tourette's syndrome 2
• Only three medications have FDA approval specifically for Tourette's syndrome: pimozide, haloperidol (typical antipsychotics), and aripiprazole (atypical antipsychotic) 2
• Common first-line approaches often include alpha-agonists (like clonidine and guanfacine), followed by atypical antipsychotics, followed by typical antipsychotics 2

When ADHD Co-occurs with Tourette's

Tourette's syndrome frequently co-occurs with ADHD (50-75% of cases) 3, creating treatment challenges:

• Alpha-2 agonists (clonidine and guanfacine) are recommended as first-line treatment for patients with both Tourette's and ADHD 4, 5
• Atomoxetine (a selective norepinephrine reuptake inhibitor) is generally recommended as a third-line treatment option 4, 5
• While stimulants like methylphenidate may be considered as a second-line option in some cases, amphetamine-based medications like Adderall may cause worse tic severity than methylphenidate 6, 4

Important Clinical Considerations

• Treatment should be "symptom targeted" and personalized based on which symptoms are most troublesome 4, 7
• Non-pharmacological interventions, including psychotherapy, should be tried before considering medication for ADHD symptoms in patients with Tourette's 5
• If stimulants are used in patients with comorbid ADHD and Tourette's, careful monitoring for emergence or worsening of tics is essential 5

Treatment Algorithm for Tourette's with Comorbid ADHD

1. Begin with alpha-2 agonists (clonidine or guanfacine) 4, 5
2. If inadequate response, consider methylphenidate (not Adderall) with careful monitoring 4
3. If still inadequate response or worsening tics, switch to atomoxetine 4, 5
4. For severe tics requiring separate treatment, consider FDA-approved antipsychotics (aripiprazole, pimozide, or haloperidol) 2

While historical practice considered all stimulants absolutely contraindicated in Tourette's syndrome, more recent evidence suggests some patients with both ADHD and Tourette's may tolerate certain stimulants. However, Adderall specifically appears more likely to exacerbate tics than other options and is not recommended for this population 6, 1.