Tourettes Syndrome

Mild tics:

Clonidine  

0.05 mg per day starting dose in children , increase gradually to 0.3 mg per day in three divided doses

May need to wait upto 3 months to see an effect

Adults 0.1 mg po bid

May use 0.1mg per day weekly transdermal patches

Hold if BP <90/60

Guanfacine

Start at 1mg at bedtime

After a month, may increase to 2 mg at bedtime.

Hold if BP <90/60

Moderate / severe tics

Pimozide

Pimozide start at 0.5 mg every other day.

Then gradually increase to 0.5-1 mg daily. May increased weekly to 1-4 mg per day if needed.

Pimozide is suitable if Tourette + ADHD, it improves cognition also.

Keep an eye on the QT interval

QT < 440 is normal

Prolonged QT poses risk of TdP