Suggested drug treatment of Tourette’s syndrome
| Drug treatment | Starting dose | Gradual increase as needed to | ||
| Tics | ||||
| First line | Aripiprazole | 2.5 mg at night | 15–20 mg at night | |
| Alternative | Sulpiride | 100 mg | 300–400 mg twice daily | |
| Risperidone | 1 mg | 5 mg | (ECG monitoring) | |
| Second line | Clonidine (more often used first line in children) | 25 μg | 75 μg twice daily (ECG, taper withdrawal) | |
| Alternative | Guanfacine | 1 mg | 5–7 mg | |
| Third line | Topiramate | 25 mg | 100 mg twice daily | |
| Pimozide | 1 mg | 5 mg | (ECG monitoring) | |
| Tetrabenazine | 25 mg | 25 mg three times a day | ||
| Fourth Line | Clonazepam | 500 μg | 1.5 mg | |
| Haloperidol | 1 mg | 5 mg | ||
| Botulinum toxin injection for selected focal motor tics (neck, eyes), and severe vocal tics | ||||
| Obsessive-compulsive disorder | ||||
| SSRIs | Sertraline | |||
| Tricyclics | Clomipramine | |||
| Attention-deficit hyperactivity disorder | ||||
| Stimulants | Methylphenidate, dextroamphetamine | |||
| Non-stimulants | Atomoxetine, clonidine, guanfacine | |||
These recommendations reflect personal preference given the limitations of the evidence. If there is poor tolerability, it is worth trying alternative agents of the same class before those of different classes; responses vary between patients. See text for further details of monitoring of neuroleptic drugs.