Return To Main Menu| Medication | Action | Dosage | Comments | Adverseeffects |
| Haloperidol (Haldol) Neuroleptic | Alters the effects of dopamine in the CNS. Alsohas anticholinergic and alpha-adrenergic blocking activity. Expected therapeutic effect: decrease in motor and phonic tics. | Initial dose 0.25mg atbedtime, increase by 0.25 0.50mg increments every 4-7 days. Average dose 3mg-4mg per day | Most side effects are dose relatedand can be resolved by decreasing dosage. Anti-parkinsonian medication (e.g.0.5mg/day of benztropine) can sometimesbe used to alleviate side effects. Additive hypotension with antihypertensives, nitrates, or alcohol. Additive CNS depression with other CNS depressants. Concurrent use with epinephrine may result in severe hypotension and tachycardia. Acute encephalopathic syndrome may occur when used with lithium. | Motor drug-induced parkinsonism, akinesia, akathisia, acute dystonia, tardivedyskinesia, oculogyric crisis, extrapyramidal reactions, restlessness CNS sedation, drowsiness, decrease in cognitive function, anxiety Autonomic dry eyes/ mouth, urinary retention, diaphoresis, hypersalivation GI increase appetite, weight gain, anorexia, constipation, hepatitis Other dysphoria, social and school phobias, heat stroke, polydipsia, impotence,photosensitivity, rashes, galactorrhea, hyperpyrexia, anemia, leukopenia |
| Pimozide (Orap) Neuroleptic | Alters the effects of dopamine in the CNS. Possessesanticholinergic and alpha-adrenergic blocking activity. Expected therapeutic effect: decrease in motor and phonic tics. | Initial dose 1mg/day graduallyincreasing to a maximum of 6-10mg/day for children and 20mg/day for adults.Because of its long half-life (55hrs), a single daily dose may be feasible. | Bettertolerated than haloperidol and probably is of equal efficacy. EKG routinely ordered to monitor rhythm abnormalities. (U waves, invertedT waves, and Q-T prolongation.) Not generally a problem. | Ingeneral, side effects are similar to haloperidol, but may be less severeand appear in fewer patients. |
| Fluphenazine(Prolixin) Neuroleptic | Alters the effects of dopamine in the CNS. Possessesanticholinergic and alpha-adrenergic blocking activity. Expected therapeutic effect: decrease in motor and phonic tics. | Initial adult dose 2.5mg 10.0mg given in 6 to 8 hour doses.Dose may titrated upwards to a maximum of 40mg/day. | May causefalse positive pregnancy test. May turn urine pink or reddish brown. | In general side effectsare the same as those listed for haloperidol, but, like Orap, some patientstolerate it better. |
| Thiothixene (Navane) Neuroleptic | Alters the effect of dopamine in the CNS. Expected therapeutic effect: decrease in motor and phonic tics. | Initial dose in childrenover 12 is 2mg tid. Dose may be titrated up slowly to a maximum of 15mg/dayAdults may start at 5mg bid. Usual dose 20mg-30mg/day, to a maximum of 60mg/day. Use in children under age of 12 is not recommended as no safe levels havebeen established. | In event hypotension occurs, epinephrine should not be usedas a pressor agent since a paradoxical further lowering of BP may result. EKG changes usually reverse and frequently disappear on continued therapy. May cause false positive pregnancy test. | Adverse affectssimilar to those for haloperidol. In addition, may have tachycardia, hypotension,non specific EKG changes, amenorrhea. |
| Chlorpromazine (Thorazine) Neuroleptic | Alters the effect of dopamine in the CNS. Possessessignificant anticholinergic and alpha adrenergic blocking activity. Expected therapeutic effect: decrease in motor and phonic tics. | Initial dose for veryyoung children 1/4mg/lb body weight. Older children doses up to 50mg 100mg/daymaximum dose possible 500mg/d. | Sudden death, apparentlydue to cardiac arrest, has been reported. Skin pigmentation may occur following prolonged usage. Ocular changes characterized by deposition of fine particulate matter inthe lens and cornea. | In general, side effects same as forhaloperidol with an addition of two or three further symptoms. Noted EKGchanges involving Q-T wave distortion, skin pigmentation changes, and eyechanges. |
| Trifluoperazine (Stelazine) Neuroleptic | Alters the effect of dopamine in the CNS. Possessessignificant anticholinergic and alpha adrenergic blocking action. Expected therapeutic effect: decrease in motor and phonic tics. | Adult doses start at 1-2mg bid up to 40mg/day. Children6-12 yrs. 1-2mg daily or bid up to 6mg/day. | May cause falsepositive pregnancy test. May cause false positive liver bilirubin test. CBC and liver function tests should be monitored . | In general,side effects similar to haloperidol. Additionally may cause Q wave and Twave changes, blood dyscrasia. |
| Thioridazine (Mellaril) Neuroleptic | Alters the effects of dopamine in the CNS. Possessessignificant anticholinergic and alpha adrenergic blocking activity. Expected therapeutic effect: decrease in motor and phonic tics. Improvement in behavior. | Adultdose of 25mg 3 times daily. (Range of 20 200mg/day). Initial dose for children over 2yrs. 0.5-3mg/kg/day in 2-3 divided doses(10mg 2-3 times daily). | Additive hypotension with other antihypertensiveagent, nitrates, and acute ingestion of alcohol. Additive CNS depression with other CNS agents including antihistamines,narcotic analgesics, sedative/hypnotics. Lithium decreases blood level. May mask early signs of lithium toxicity and increases the risk of extrapyramidalreactions. Concurrent use with epinephrine may result in severe hypotension and tachycardia. Increased risk of agranulopcytosis with antithyroid agents. | Ingeneral, side effects similar to haloperidol. Additionally may cause hepatictoxicity. |
| Risperidone (Risperdal) Neuroleptic | Dopamine and serotonin receptor antagonist. Expected therapeutic effect: decrease in motor and phonic tics. Improvement in behavior. | Adultdose of 4-8mg daily | May be tolerated better than other neuroleptics,with fewer side effects. | In general sdie effects similarto haloperidol. |
| Clomipramine (Anafranil) Antidepressant Antiobsessive | Potentiates the effect of serotonin (antiobsessionaleffect) and norepinephrine in the CNS. Also has moderate anticholinergicproperties. Expected therapeutic effect: decrease in obsessing, decrease in compulsions,possible decrease in tics, decrease in depression. | Adultdose of 25mg/day initially increasing over 2 wk period to 100mg/day to amaximum of 250mg/day in divided doses. In children dose begins at 25mg/dayinitially increased over 2 wks to 3mg/kg/day or 100 mg/day or (whicheveris smaller). May further be increased to 200mg/day (whichever is smaller)in divided doses until stabilizing dose is reached, entire daily dose maybe given at bedtime. | May block therapeutic response to antihypertensives. Use with clonidine may cause hypertensive crisis. Additive CNS depression with other CNS depressants including alcohol, antihistamines,narcotic, analgesics, and sedative/hypnotics. Adrenergic and anticholinergic side effects may be additive with other agentsthat have the same properties. Nicotine or cigarette smoke may increase metabolism and decrease effectiveness. | Motor muscle weakness, extrapyramidal reactions CNS Seizures, sedation, drowsiness, lethargy, aggressive behavior. Autonomic dry eyes and mouth, blurred vision, vestibular disturbances, urinary retention GI constipation, weight gain, Other impotence, photosensitivity, gynecomastia, hyperthermia |
| Fluoxetine(Prozac) Antidepressant | Inhibits the uptake of serotonin in the CNS. Expected therapeutic effect: decrease in obsessing, decrease in compulsions,possible decrease in tics, decrease in depression. | Adultdose of 20mg/day in the morning. May increase by 20mg/day. Doses of 20mg/dayshould be given in 2 divided doses, 1 in the am and 1 at noon to a maximumof 80mg/day. Initial dose in children starts at 5mg/day and increases slowly. | Additive hypotension with antihypertensive agents. Additive CNS depression with other CNS depressants including alcohol, antidepressants,antihistamines, MAO inhibitors, narcotic analgesics, sedative/hypnotics. Phenobarbital may increase metabolism and decrease effectiveness. Concurrent use with lithium may produce acute encephalopathy, decreasedchlorpromazine absorption, increased excretion of lithium, increased riskof extrapyramidal reactions. Decreases vasopressor response to epinephrine and norepinephrine. Concurrent use with beta blockers may result in inhibition of metabolismof one or both drugs producing an increased response. Increased risk of anticholinergic effects with other agents having anticholinergicproperties. | Motor extrapyramidal reactions, tardive dyskinesia, weakness, seizures CNS sedation, anxiety, insomnia, headache, tremor, dizziness, fatigue, mania,abnormal dreams Autonomic dry eyes and mouth, urinary retention, blurred vision, excessive sweating GI Constipation, ileus, anorexia, diarrhea Other hypotension, tachycardia, photosensitivity, hyperthermia, rare suicidalideation, cough, flu-like syndrome, impotence |
| Sertraline HCL (Zoloft) Antidepressant | Potent selective inhibitor of neuronal serotoninreuptake and has only very weak effects on norepinephrine and dopamine neuronalreuptake. Does not inhibit MAO. Expected therapeutic effect: decrease in depression, decrease in aggressivebehavior, possible decrease in obsessions and compulsions. | Initialadult dose of 50mg in once daily dose. May titrate up at 1 week intervalsto a maximum of 200mg/day. | Reports of fatal reactions withgiven with MAO inhibitors. Recommended that at least 14 days should elapsebetween usage. 32% decrease in valium clearance. 8% increase in prothrombin time. Should monitor upon initiation or discontinuationof use with warfarin. | Motor ataxia, abnormal coordination, abnormal gait, tremor, dizziness CNS confusion, hyperesthesia, migraine, nystagmus, vertigo, twitching, insomnia Autonomic dry mouth, sweating, hypersalivation, urinary retention GI dysphagia, fecal incontinence, anorexia, weight gain, diarrhea Other aggressive reaction, amnesia, abnormal dreams, depersonalization, emotionallability, hallucination, gynecomastia, male sexual dysfunction, skin discoloration,skin odor, myalgia |
| Bupropion (Wellbutrin) Antidepressant | Decreases neuronal reuptake of dopamine inthe CNS. Diminished neuronal uptake of serotonin and norepinephrine (lessthan tricyclic antidepressants). Expected therapeutic effect: decrease in depression, increased ability to concentrate. Possible decreasein obsessions and compulsions. | Adult dose of 100mg twicedaily (morning and evening) initially; after 3 days may be increased to100mg 3 times daily depending on response. If no response after 4 wks oftherapy, may increase to a maximum daily dose of 450mg/day in divided doses.No single dose to exceed 150mg, wait at least 6hrs. between doses at the300 mg/day dose or at least 4 hrs between doses at the 450mg/day dose. Safety not established in children. | Increased risk of adversereactions when used with levodopa or MAO inhibitors. Increased risk of seizures with phenothiazines, antidepressants, cessationof benzodiazepines, or cessation of alcohol. If dose is missed, omit dose and return to regular dosing schedule. Do notdouble dose. Increased risk of seizure. | Motor tremor, ataxia/incoordination, seizure, dyskinesia, vertigo CNS seizures, agitation, insomnia, psychoses, mania, headache, mania/hypomania,hallucinations, depression, memory impairment, depersonalization, mood instability GI dry mouth, nausea, change in appetite, weight gain or loss, constipation,dysphagia, stomatitis Other edema, EKG abnormalities, rashes, alopecia, gynecomastia, nocturia, vaginalirritation, sexual dysfunction, enuresis, urinary incontinence, menopause,shortness of breath, visual disturbance, flu-like syndrome |
| Paroxetine HCL (Paxil) Antidepressant | Potentiation of serotonergic activity in the CNS resultingfrom inhibition of neural reuptake of serotonin. Very weak effects on norepinephrineand dopamine neuronal reuptake. Expected therapeutic effect: decrease in depression, decrease in aggressive behavior. | Initialadult dose should begin at 20mg/day. May titrate up in increments of 10mg/dayto a maximum of 50mg/day in a single morning dose. | Phenobarbitolmay decrease effectiveness. Cimetidine may increase concentrations in plasma by 50%. Co-administration of certain antidepressants (e.g., nortriptyline, amitriptyline,imipramine, desipramine and fluoxetine) should be approached with caution. | Motor myoclonus CNS insomnia, agitation, anxiety, headache, parethesia, CNS stimulation, asthenia,somnolence, dizziness Autonomic dry mouth, sweating, blurred vision GI constipation, increased or decreased appetite, dyspepsia, diarrhea Other fever, taste perversion, male sexual disturbance, urinary frequency, myalgia |
| Venlafaxine hydrochloride (Effexor) Antidepressant | Potent inhibitor of neuronal serotonin andnorepinephrine reuptake and weak inhibitors of dopamine reuptake. Expected therapeutic effect: decrease in depression, possible decrease in obsessions and compulsions. | Adultdose of 75mg/day, in 2-3 divided doses, taken with food. Dose may be increasedto maximum of 225 mg/day in increments of up to 75 mg/day at intervals ofno less than 4 days. Safety in children has not been established. | When discontinueddose should be tapered slowely over a 2 week period. At least 14 days should elapse between discontinuation of an MAOI and initiationof therapy with Effexor. In addition, at least 7 days should be allowedafter stopping Effexor before starting an MAOI. Dose may need to be reduced by 50% for patients with hepatic impairment. | Motor tremor, hypertonia,ataxia, hyperkinesia, rare dystonia CNS Migraine, asthenia, somnolence, dizziness, nervousness, anxiety, insomnia Autonomic Dry mouth and eyes, blurred vision sweating GI Nausea, constipation, anorexia, diarrhea Other abnormal ejaculation/orgasm, impotence |
| Fluvoxamine (Luvox) Antidepressant | Potent inhibitor of presynaptic neuronal reuptakeof serotonin Expected therapeutic effect: decrease in depression, decrease in obsessions and compulsions. | Adultdose of 50 mg to 300 mg/day in a single or divided dose. | Thecoadministration of fluvoxamine 100 mg/day and propranolol (Inderol) resultedin a fivefold increase in propranolol plasma concentration and a slightdecrease in heart rate. | Motor tremor, hypodinesia CNS somnolence, headache, agitation, dizziness, asthenia Autonomic dry mouth GI nausea/vomiting, constipation, anorexia Other insomnia, syncope |
| Desipramine HCL (Norpramin) Tricyclic antidepressant | Blocks re-uptake of norepinephrine.Has significant anticholinergic properties. Expected therapeutic effect: decrease in depression, increased ability toconcentrate, decrease in emotionally labile behavior. | Usualadult dose is 100 200mg/day. May be further increased to a maximum of 300mg/dayin a once daily dose. Lower dosages recommended for elderly and adolescentpatients. | Should not be given in conjunction with, or within2 weeks of, treatment with MAO inhibitor; hyperpyretic crisis and deathhave occurred. Not recommended for children. Sudden death resulting from cardiac arrest has been reported in childrenusing this medication. Prolongation of QRS or QT wave intervals on EKG are significant for toxicity. | Motor incoordination, ataxia, extrapyramidal symptoms, seizures CNS disorientation, anxiety, insomnia, nightmares, hypomania, drowsiness, Autonomic dry mouth, blurred vision, urinary retention, sweating, urinary frequency GI anorexia, constipation, weight gain Other itching, photosensitivity, gynecomastia, galactorrhea, decreased libido,alopecia, EKG changes |
| Imipramine (Tofranil) Tricyclic antidepressant | Potentiates the effect of serotoninand norepinephrine. Has significant anticholinergic properties. Expected therapeutic effect: decrease in depression, increased ability toconcentrate, decrease in emotionally labile behavior. | Adultdose 25-50mg 3-4 times daily to a maximum of 300mg/day. Total dose may begiven at bedtime. Children below age 6 years, 25mg once daily before bedtime, may increaseby 25mg at weekly intervals to 50mg in children. Children over age 12 mayincrease does to 75mg/day. | May cause hypotension and tachycardiawhen used with MAO inhibitors. Avoid concurrent use-discontinue 2 weeksprior to start of imipramine. May prevent therapeutic response to most antihypertensive. May cause severe hypertension when used with clonidine. Avoid concurrentuse. | CNS drowsiness, sedation, confusion, agitation, hallucination, insomnia Autonomic dry mouth and eyes, blurred vision, urinary retention GI constipation Other photosensitivity, hypotension, EKG changes, arrhythmias |
| Buspirone HCL (Buspar) Antianxiety | Binds to serotonin and dopamine receptors inthe brain (enhances serotonin transmission while blocking dopamine transmission).Increases norepinephrine metabolism in the brain. Expected therapeutic effect: decrease in emotionally labile behavior. | Adult dose 15mg/day in 3 divided doses, may be increased by 5mg/day at 23 day intervals, to a maximum of 60mg/day. Usual dose is 20 30mg/day. | Usewith MAO inhibitors may result in hypertension. Avoid use with alcohol | Motor incoordination, tremor, fatigue CNS dizziness, insomnia, nervousness, drowsiness, excitement, personality changes,paresthesia, numbness Autonomic blurred vision, nasal congestion, altered taste or smell, dry mouth andeyes, sweating, urinary hesitancy GI diarrhea, constipation, nausea Other myalgia, chest pain, palpitations, tachycardia, hypo or hypertension |
| Diazepam (Valium) Antianxiety Sedative /hypnotic | Depresses the CNS, probably by potentiatinggamma-aminobutyric acid (GABA), an inhibitory neurotransmitter. Produces skeletal muscle relaxation by inhibiting spinal polysynaptic afferentpathways. Expected therapeutic effect: decrease in anxiety. | Adult 2-10mg2-4 times daily. Children older than 6 months 1-2.5mg 3-4 times daily. | Concurrentuse with alcohol, antidepressants, antihistamines, and narcotic analgesicsresults in additive CNS depression. Cimetidine, oral contraceptives, disulfiram, fluoxetine, ionized, propranolol,ketoconazole, metoprolol, propoxphene, or valproic acid may enhance itsactions. Sedative effects may be decreased by theophylline. | CNS dizziness, drowsiness, lethargy, hangover, paradoxical excitation, mentaldepression, headache Autonomic blurred vision GI nausea, constipation Other respiratory depression, tolerance, psychological dependence, physical dependence. |
| Clorazepate (Tranxene) Antianxiety Sedative /hypnotic Benzodiazepine | Acts at many levels in the CNS to produceanxiolytic effect and CNS depression (by stimulating inhibitory GABA receptors).Produces skeletal muscle relaxation (by inhibiting spinal polysynaptic afferentpathways). Expected therapeutic effect: decrease in anxiety. | Adult dose 7.5-15mg 2-4 times daily.May be given in a single dose of up to 22.5mg at bedtime. Children 9-12 yr. 7.5mg twice a day. May increase no more than 7.5mg/dayat weekly intervals, not to exceed 60mg/day. | May decreaseefficacy of levodopa. Other drug interactions similar to diazepam. | Side effects similar to those of diazapam. |
| Alprazolam (Xanax) Sedative /hypnotic Benzodiazepine | Acts at many levels in the CNS to produceanxiolytic effect. Depresses the CNS, probably by potentiating gamma aminobutyricacid (GABA), an inhibitory neurotransmitter. Expected therapeutic effect: decrease in anxiety. | Adult dose 0.25-0.5mg 2-3 times dailynot to exceed 4mg/day. | Drug interactions same as Tranxene. | Sideeffects similar to those of diazapam. |
| Carbamazepine (Tegretol) Anticonvulsant | Decreases synaptic transmission in the CNS. Expected therapeutic effect: decrease in aggressive behavior, decrease in emotionally labile behavior. | Initialadult dose of 200mg 2 times daily or 100mg 4 times daily. May titrate upto therapeutic levels in the range of 800-1200mg/day in divided doses every6 8hrs. to a maximum of 1g/day. Children 6-12 yrs. 200mg/day in 2-4 divided doses. May increase until therapeuticlevels in the range of 400-800mg/day to a maximum of 1g/day. | Maydecrease effectiveness of oral contraceptives, benzodiazepines, and otheranticonvulsants. Concurrent use (within 14 days) of MAO inhibitors may result in hyperpyrexia,hypertension, seizure and death. Verapamil, diltiazem, propoxphene, or erythromycin increases carbamazepinelevels and may cause toxicity. | Motor ataxia CNS vertigo, drowsiness, psychosis, visual hallucinations Autonomic blurred vision, urinary retention or hesitancy GI hepatitis Other Congestive heart failure, syncope, hypo- or hypertension, photosensitivity,aplastic anemia, agranulocytosis, thrombocytopenia, leukopenia, leukocytosis,eosinophilia |
| Clonazepam (Klonipin) Anticonvulsant | Produces anticonvulsant and sedative effectsin the CNS. Mechanism is unknown but is probably similar to that of benzodiazepines,has a high affinity for the y- gamma aminobutyric acid (GABA) receptor,increasing synaptic serotonin. Expected therapeutic effect: decrease in aggressive behavior, decrease in emotionally labile behavior,decrease in tics. | Initial adult dose not to exceed 1.5mggiven in 3 divided doses, may increase by 0.5-1mg every 3 days. Total maximumdose of 20mg/day. Children up to 10 yr or 30kg 0.01-0.03mg/kg not to exceed 0.05mg/kg givenin 2-3 daily doses; increase by no more than 0.5mg every 3 days until therapeuticblood levels are reached. Maximum dose of 0.2mg/kg/day. | Longterm effects on growth and maturation in children not known. Concurrent use of alcohol, antidepressants, antihistamines, and narcoticanalgesics will result in additive CNS depression. Cimetidine, oral contraceptives, disulfiram, fluoxetine, ionized, propranolol,ketoconazole, metoprolol, propoxphene, or valproic acid may enhance itsactions. Sedative effects may be decreased by theophylline. | Motor Ataxia, choreiform movements CNS drowsiness, behavioral changes, abnormal eye movements, nystagmus Autonomic increased respiratory secretions, urinary retention, hypersalivation GI constipation, hepatitis Other palpitations, anemia, leukopenia, thrombocytopenia, eosinophilia, fever,increase in libido |
| Clonidine (Catapres) Antihypertensive Alpha blocker | Stimulates alpha adrenergic receptors in theCNS. Result is inhibition of cardioacceleration and vasoconstriction center. Adrenergic agonist, but stimulates inhibitory neurons in the CNS. In higherdoses ceases inhibitory effects and causes an increase in sympathetic arousal. Expected therapeutic effect: decrease in tics, increased attention, decrease in emotionally labile behavior. | Initialadult PO dose 0.1mg twice a day. Usual dose is 0.2-1.2mg/day in 2-3 divideddoses. Adult transdermal patch is 1-3mg applied weekly. Initial dose in children starts at 0.15-0.4mg/day in divided doses (startwith 0.05mg at bedtime for a few days); also available in transdermal patch. | Additivesedation with CNS depressants including alcohol, antihistamines, narcoticanalgesics, and sedative/hypnotics. Withdrawal phenomenon may be exaggerated by concurrent tricyclic antidepressants. Do not discontinue abruptly. | CNS drowsiness, nightmares, nervousness, depression Autonomic dry mouth and eyes GI constipation Other hypotension, bradycardia, palpitations, impotence, weight gain, withdrawalphenomenon |
| Guanfacine (Tenex) Antihypertensiv eAlpha blocker | Stimulates CNS alpha adrenergicreceptors, resulting in decreased sympathetic outflow. Expected therapeutic effect: decrease in motor tics, improvement in mood. | Adult dose of1 mg daily given at bedtime, may be increased if necessary at 3 4wk intervalsup to 3 mg/day. | Additive hypotension with other antihypertensiveagents, nitrates, and acute ingestion of alcohol. Additive CNS depression may occur with other CNS depressants, includingalcohol, antihistamines, narcotic analgesics, tricyclic antidepressants,and sedative/hypnotics. | CNS drowsiness, weakness, fatigue, dizziness, headache, insomnia, depression Autonomic dry mouth GI constipation, abdominal pain, nausea Other Tinnitus, dyspnea, impotence |
| Propranolol(Inderol) Antihypertensive Beta blocker | Blocks stimulation of beta1 and beta 2 receptorsites. Expected therapeutic effect: decrease in emotionally labile behavior, decrease in rage attacks, decreasein obsessive symptoms, possible improvement in tics. | Adultdose of 60mgSR 2 times daily. Safety not established in children. | Concurrent use with amphetamines,cocaine, ephedrine, epinephrine, norepinephrine, phenylephrine, or pseudoephedrinemay result in excess alpha-adrenergic stimulation, hypertension, and bradycardia. May produce hypertension within 14 days of MAO inhibitor. Cimetidine may decrease metabolism and increase the effects of propranolol. Do not withdraw abruptly. | CNS fatigue, weakness, depression, insomnia, dizziness Autonomic dry eyes, blurred vision, nasal stuffiness GI constipation, diarrhea, nausea, vomiting Other bronchospasm, bradycardia, pulmonary edema, hypo or hyperglycemia, impotence,Raynaud's phenomenon |
| Nifedipine (ProcardiaXL) Antihypertensive Calcium channel blocker | Acts on slow calcium channels invascular smooth muscle and myocardium, producing vasodilation. Expected therapeutic effect: decrease in tic symptoms. | Adult dose of 10mg 3 times daily. Safety not established in children. | Additive hypotensionwith antihypertensives. May increase blood levels and risk of toxicity with digoxin. Cimetidine may slow metabolism and lead to toxicity. | CNS dizziness, giddiness, headache Autonomic flushing, warmth, sweating, nasal congestion, sore throat GI nausea, constipation, flatulence Other dyspnea, cough, hypotension, wheezing, tachycardia, arrhythmias, fever,heart failure, muscle cramping |
| Verapamil(Isoptin) Antihypertensive Calcium channel blocker | Inhibits calcium transport into myocardialand vascular smooth muscle cells, resulting in inhibition of excitationcontraction coupling and subsequent contraction. Expected therapeutic effect: decrease in motor tics, improvement in mood. | Adult dose of 20mg 3 times daily. Children should not initiate therapy in a dose greater than 5mg. | Mayincrease or decrease lithium levels. Increase risk of toxicity from theophylline. Increased risk of bradycardia, congestive heart failure, and arrhythmiaswhen used with beta-adrenergic blocking agents or disopyramide. Additive hypotension with antihypertensive agents, acute ingestion of alcohol,nitrates, or quinidine. | CNS dizziness, headache, fatigue GI constipation,abdominal discomfort Other bradycardia, hypotension, edema, heart block, sinus arrest, pulmonary edema |
| Methylphenidate HCL (Ritalin ) CNS stimulant | Produces CNS and respiratory stimulation withweak sympathomimetic activity. Expected therapeutic effect: increased attention span in attention deficit disorder. Caution: may cause increase in motor tics. May cause onset of TS. | Adultdose to be given 30 40 minutes prior meals 2 times daily of 20-30mg/dayto a maximum of 60mg/day. Sustained release tablets may be substituted ifthe equivalent dose over 8 hrs. is the same. Children older than 6 years of age should initiate therapy at 5mg beforebreakfast and before lunch, may increase by 5-10mg at weekly intervals toa maximum of 60mg/day. Safety has not be established in children under 6 yrs. | Adversereactions can usually be reduced by decreasing dosage or omitting dose inafternoon or evening. Toxic psychosis has been reported. Long term therapy may stunt growth. Treatment should be assessed periodically. Improvement may be sustainedwhen the drug is either temporarily or permanently discontinued. Drug treatment usually may be discontinued after puberty. | Motor increase in motor tics, restlessness, tremor, hyperactivity, akathisia,dyskinesia CNS insomnia, irritability, dizziness, headache, nervousness Autonomic blurred vision, dry mouth GI nausea, anorexia, cramps, constipation, weight loss Other leukopenia, fever, tachycardia, palpitation, hyper or hypotension, metallictaste |
| Dextro amphetamine (Dexedrine) CNS stimulant | Produces CNS stimulation by releasing norephinephrinefrom nerve endings. Expected therapeutic effect: increased attention span in attention deficit disorder. Caution: may cause increase in motor tics. May cause onset of TS. | Children3-5 yrs. 2.5mg/day, may increase by 2.5mg at weekly intervals. Children over 6 yrs. 5 10mg/day in 1-2 doses, increase by 5mg at weeklyintervals. | Additive adrenergic effects with other adrenergicagents. Use with MAO inhibitors can result in hypertensive crisis. Large doses of ascorbic acid decreases effect. Phenothiazines may decrease effect. May antagonize the response to antihypertensive. Increased risk of cardiovascular side effects with beta blockers or tricyclicantidepressants. | Side effects similar to those of Ritalinwith an addition of psychological dependence, physical dependence, increasedlibido, decrease in seizure threshold |
| Pemoline(Cylert) CNS stimulant | Produces CNS stimulation, which may be mediatedby dopamine. Expected therapeutic effect: increase in attention span in attention deficit disorder. Caution: may cause increase in motor tics. May cause onset of TS. | Childrenover 6 yrs. 37.5mg initially as single morning dose, may be increased 18.75mgat weekly intervals until optimum response is achieved. Usual maintenancedose is 56.25 75mg/day | Long term therapy may stunt growth. Additive CNS stimulation with other CNS stimulants or adrenergics, includingdecongestants Take medication in a.m. to avoid sleep disturbances. | Side effects similar to those of Ritalin with the additionof dyskinetic movements, sweating, decrease in seizure threshold. |
| Lithium (Lithobid) Antimanic Antidepressant | Alters cation transport in nerve and muscle.May also influence re-uptake of neurotransmitters. Expected therapeutic effect: given concurrently with antidepressant mayenhance response to serotonergic agents. | Adult dose of 9001200mg/day in 3 or 4 divided doses (usual dose 300mg 3-4 times daily). Extended-releasedosage may be given twice daily. | May prolong the action ofneuromuscular blocking agents. Encephalopathic syndrome may occur with haloperidol. Diuretics, methyldopa, probenecid, indomethacin, and other nonsteroidalanti inflammatory agents may increase the risk of toxicity. Lithium may decrease the effects of chlorpromazine. Chlorpromazine may mask early signs of lithium toxicity. Large changes in sodium intake (medication or food) may alter the renalelimination of lithium. Increasing sodium intake will increase renal excretion. | Motor muscle weakness, rigidity, hyperirritability, ataxia, tremors, psychomotorretardation CNS headache, impaired memory, lethargy, drowsiness, confusion, seizure, restlessness,aphasia, hyperirritability Autonomic tinnitus, blurred vision, dry mouth GI nausea, anorexia, epigastric bloating, abdominal pain, diarrhea, metallictaste, weight gain Other EKG changes, hypotension, arrhythmias, polyuria, nephrogenic diabetes insipidus,renal toxicity, acneiform erruption, folliculitis, pruritis, diminishedsensation, alopecia, hyper- or hypothyroidism, goiter, hyperglycemia, leukocytosis |
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