Stimulant Selection for Patients with Tic Disorders

Introduction to Stimulant Therapy

• The American Academy of Child and Adolescent Psychiatry recommends using methylphenidate rather than any amphetamine-based stimulant for patients with tic disorders or family history of tics, as it offers the greatest ADHD symptom improvement without worsening tics 1, 2
• Methylphenidate does not worsen motor tics in Tourette's syndrome or increase tics in ADHD patients without Tourette's, according to controlled studies 1, 2

Key Evidence on Amphetamines and Tics

• Tic severity was worse with amphetamine (AMP) than with methylphenidate (MPH) in a controlled study directly comparing amphetamine formulations 1, 2
• No published studies specifically examine tic risk with lisdexamfetamine compared to other amphetamine formulations, but it is a prodrug converted to dextroamphetamine after ingestion 1, 3

Clinical Considerations

• Individual patients may experience tic exacerbation with any stimulant, and monitoring for dose-dependent increases in tic frequency is crucial 1, 2
• The relationship between stimulant dose and tic severity is critical, with supratherapeutic dosing increasing the risk of tic exacerbation 1, 2