9 best medications for tic (tic hyperkinesis)

Review of the best according to the editorial board. On the selection criteria. This material is subjective and does not constitute advertising and does not serve as a purchase guide. Before buying, you need to consult with a specialist.

Before prescribing any treatment for a patient who has tics, he needs to be examined not only by a therapist, not only by a neurologist, but also by a specialist at the Center for Extrapyramidal Diseases. There are such centers in every major city, since tics belong to extrapyramidal hyperkinesis. To distinguish real tics from imaginary ones, for example, hysterical, sometimes lengthy examinations of the patient are necessary. First of all, the tick must be a truly involuntary movement that is unnecessary and redundant. The tic should be due to the defeat of the extrapyramidal nervous system, which controls unconscious movements.

About unconscious movements

Many people without medical and biological education do not quite correctly understand what an unconscious movement is. Some even say that this movement is impossible, because when a person lies unconscious, then he 'does not move'. In fact, this is not the case. Along with those movements that are subject to our will, there is a parallel nervous system, which we do not even suspect. It is called extrapyramidal because it lies outside the control of the pyramidal path through which all movements we control pass.

The extrapyramidal system is in charge of the same muscles – arms, legs, trunk. But she does it quickly, and, if necessary, seizes control over the muscles from the consciousness, from the cerebral cortex. Here's a simple example that everyone knows. You slipped on the ice but didn't fall. You suddenly and sharply waved your arms, bent over, 'danced' for a couple of seconds and restored your balance. Everything happened unexpectedly: you yourself cannot remember and reproduce that sequence of movements that came out completely unconsciously for you, but restored the position of the center of gravity.

Here is an example of the work of the extrapyramidal system, which allows you to restore balance in a critical situation. But sometimes it gets out of control, and tics, or tic hyperkinesis, are one example of disorders of this system. The common name for these hyperkinesias is dyskinesia, and tic is far from the only condition among them. Together with them, you can name: tremor, athetosis, chorea, myoclonus, and other rare disorders that are studied by neurologists – specialists in extrapyramidal diseases.

Each hyperkinesis has its own motor 'pattern', and it is difficult to confuse it with any other. For example, a tremor, which is known to everyone, is a small-sweeping tremor of the neck, head, fingers. Parkinson's tremors are rhythmic movements at the base of the thumbs, similar to 'counting coins'. Athetosis, which occurs quite rarely as a complication of encephalitis, is the slow, frilly, and worm-like movement of small muscles, such as the fingers. What is tic, or tic hyperkinesis?

What are tics?

A tick is one movement or group of movements that is abrupt, has no rhythm, and involves individual muscles or muscle groups in this activity. During tics, another, normal muscle activity is realized. Therefore, a tic can occur in a walking, writing, speaking person. Tic hyperkinesis is imposed, as it were, and then leaves the person.

In some cases, tics can also resemble purposeful movement, and the patient can even fight them, and very successfully. With an effort of will, he can suppress this violent movement for a few seconds, or even for a minute, but then the internal struggle gradually increases, and the tic breaks out again. Sometimes patients describe that they really want to make these movements, this need is simply irresistible.

Each patient's tics recur with a special frequency, and each patient's 'repertoire of tics' is his own, individual. It is extremely important that during sleep tics do not disappear, but continue to appear at their own rhythm. What are the types of tic hyperkinesis? Their classification is very complicated, and we will not dwell on it, let specialists do it.

Let's just say that ticks are simple and complex. Simple tics define any one type of movement, sensation, or exclamation (vocal tics). So, a motor, simple tic is closing your eyes, shrugging your shoulders. A complex motor tic is a repetition of a seen gesture, punching oneself in the chest, that is, making movements that already require the work of several groups of coordinated muscles. So, the same simple muscle tic can be sudden or very fast, then it is called classic. Their quick tics are often resolved quickly, and it is much easier to deal with them by volitional effort. But the slow tic, which is called dystonic, is practically not controlled by the patient. This is, for example, persistent shutting of the eyes, or blepharospasm.

There are sound or vocal tics. This is snorting, coughing and whistling, grunting, and even an irresistible need to utter obscene or other people's words (coprolalia or echolalia). There is also a sensory tic with a pronounced sensitive component. The patient begins to experience an unpleasant and alien sensation that simply requires some kind of movement.

About the causes of tic hyperkinesis

Why do tics occur? Quite often, they occur primarily, that is, outside of connection with any disease, and most often begin in childhood or in adolescents. Sometimes such tics then disappear without a trace, and this can be considered a variant of the maturation of connections between various parts of the central nervous system: the frontal cortex, the basal extrapyramidal ganglia and the limbic system. In this case, the boy suffers from tics twice as often as girls. One of the most famous diseases associated with various hyperkinesis and tics is Tourette's (de la Tourette's) syndrome, in which a combination of motor, that is, motor, and vocal, that is, vocal tics that can occur at different times occurs.

It is believed that the manifestation of Tourette's syndrome may be associated with a genetic defect. Tics change over time, in adolescence and young age they are already weaker than in adolescents. And in adulthood, tics very often stop and without any treatment. If they do not disappear, then they decrease significantly. Not only their intensity decreases, but also the patient gets used to them, therefore continuing tics worsen the quality of life to a lesser extent than fresh ones that have just begun. However, in one third of patients, tics continue to persist throughout their lives, but they rarely lead to permanent disability: people adapt well to obsessive movements. A stressful situation always provokes an increase in tics, and this determines one of the types of treatment – the appointment of antidepressants.

Doctors have noticed that patients with common tic hyperkinesis, and especially with Tourette's syndrome, have mental abnormalities. This is obsessive-compulsive syndrome, or obsessive-compulsive disorder, attention deficit hyperactivity disorder, and other disorders. Therefore, such patients are also prescribed medications from psychiatric practice, for example, antipsychotics and especially in severe cases. If we talk not about primary, but secondary tics, then their cause can be various diseases and injuries. This is postnatal trauma to the central nervous system, taking medications, such as psychostimulants, anticonvulsants or antipsychotics. Quite often, extrapyramidal hyperkinesis in general and tics in particular are caused by encephalitis and vascular pathology of the brain, acute and chronic poisoning.

Drug therapy

All of the above confirms the great ambiguity of the tick problem. Sometimes they do not need to be treated with drugs at all, it is enough just to eliminate overwork, and in adults – to stop smoking and drinking strong coffee. Although now there are frequent cases when teenagers not only smoke and abuse coffee, but also have severe addictions – from chemical-salt addiction to alcoholism.

If the treatment of tics is still necessary, then the treatment program should be long-term. And when a specialist undertakes to treat such a patient, he can never say in advance when the patient will get rid of his disease. In any case, the treatment of tics cannot be shorter than 3-4 months, and sometimes it lasts several years. Moderate tics are treated with benzodiazepines; in Russia, drugs are used that alter the metabolism of gamma-aminobutyric acid. Moderately expressed tic hyperkinesis requires prescriptions of mild antipsychotics, or even atypical drugs from this group.

Consider the most effective drugs that doctors prescribe for various types of hyperkinesis. Many of these drugs cannot be bought over the counter, such as antipsychotics or anticonvulsants. Each drug is first represented by its INN, or international non-proprietary name. Then, if any, the name of the original product is given, and then its generics, or copies. The price (or range) for one package is also given, which is valid for all pharmacies of all forms of ownership in the Russian Federation for the fall of 2019.

The Drug List does not in any way reflect rating, importance, or popularity. Their sequence is presented in no particular order. And let's start the review with drugs that are used in the mildest cases and often lead to success. These are drugs from the GABAergic group.

The best medicines for tic (tic hyperkinesis)

Nomination a place Name of product price
GABAergic drugs 1 Hopantenic acid (Pantogam, Gopantam) 456 r
2 Aminophenylbutyric acid (Noofen, Anvifen, Phenibut) RUB 1,150
Anticonvulsants 1 Clonazepam 148 RUB
2 Topiramate (Topamax, Maxitopyr, Topalepsin, Toreal) 772 RUB
3 Levetiracetam (Keppra, Levitinol, Epiterra) 316 RUB
4 Valproic acid (Depakine chrono, Konvulex, Konvulsofin) 214 r
Antipsychotics 1 Haloperidol 28 RUB
2 Risperidone (Rispolept, Risset, Torendo, Speridan) 244 RUB
3 Tiaprid (Tiapridal) RUB 1,309

GABAergic drugs

These drugs act mildly, and they are especially indicated at the onset stage of tic hyperkinesis, in preschool and primary school age. The drugs act on the same ion channels as gamma-aminobutyric acid, which is an inhibitory mediator in the central nervous system. The appointment of these drugs leads to the activation of intellectual functions, increases motivation, reduces the symptom of asthenia and irritability. In children, these remedies are used to correct delicate and mild tics and stuttering. However, for rubles, these funds are not used due to the lack of an evidence base. Therefore, it is possible that the positive effect is associated with the optimization of the regimen, rest, and improvement in the quality of sleep in a teenager. In the event that in the onset of tic disorder it was not possible to cope with the prescription of drugs, then after a month or two it is necessary to revise the treatment tactics, and, if necessary, select a drug from other groups of anticonvulsants or antipsychotics, but always after consulting a psychiatrist and a specialist in extrapyramidal disorders.

Hopantenic acid (Pantogam, Gopantam)

Popularity rating: 4.9

Hopantenic acid (Pantogam, Gopantam)

Russian children's neurologists and psychiatrists are very fond of prescribing Pantogam and its analogues. But widespread use does not mean that the drug is 'best'. The volume of indications is impressive: from physical overload and disorders of copper metabolism to mental retardation, stuttering, tics, epilepsy and cerebral palsy. The list of indications goes on and on. They are treated with the consequences of intracranial trauma, excessive activity and urinary incontinence, neurotic disorders and impaired attention. Pantogam is also used to treat various tics in children and adolescents; it can also be used in adults.

The drug is available both in the form of tablets and in the form of a syrup. One package of 50 tablets of 500 mg Pantogam will cost from 550 to 870 rubles lei. The cost of the syrup is about the same, a pack of 100 ml of syrup will cost from 330 to 600 rubles. A single dose for children is usually either one tablet or up to 5 ml of syrup. The daily adult dose for children should not exceed 30 ml, that is, 6 tablets, or 3 grams of the drug. The dose for adults is the same, the duration of the course is from 1 to 6 months.

Advantages and disadvantages

Pantogam has one big drawback, which can outweigh all the advantages: it is the lack of an evidence base, and the refusal to use it in Western countries and in Japan. In the latter, Pantogam has been banned since 1990. After taking it, there were a number of fatal complications, or a sharp deterioration in the condition of patients with Rett syndrome. In the world medical literature, only a small number of controversial works on the effectiveness of Pantogam are known. The World Health Organization does not recommend it (it is unknown), it is unknown in the USA. Accordingly, there is no proven efficacy of this drug and its analogues for tics. Therefore, if the doctor prescribes this remedy, then it is advisable to talk with the doctor and find out the reason for the recommendations.

Aminophenylbutyric acid (Noofen, Anvifen, Phenibut)

Popularity rating: 4.8

Aminophenylbutyric acid (Noofen, Anvifen, Phenibut)

Noofen and its analogues are classified as psychostimulants and nootropic drugs. In addition to tic hyperkinesis, it is prescribed by our doctors for profuse emotional disorders, anxiety and withdrawal symptoms, enuresis and neuroses, stuttering and sleep disorders. Some experts prescribe it for Meniere's disease, dizziness, and other disorders of the vestibular apparatus. Sometimes the remedy is even used as a cure for motion sickness and motion sickness. Noofen consists of aminophenylbutyric acid hydrochloride, and has a calming and at the same time stimulating effect.

The medicine is used orally after meals, for adults 1-2 tablets three times a day. The dosage for children is determined by the pediatrician, usually one tablet three times a day, and no more. Produced by Noofen, the Latvian company Olainfarm. It is the most expensive aminophenylbutyric acid product on the market. The cost of one package of Noofen, of 20 tablets, ranges from 900 to 1400 rubles lei. The domestic drug Anvifen has a cost of 300 to 500 rubles, and the domestic Phenibut is considered the cheapest analogue. It can be purchased for even less than 100 rubles for the same package.

Advantages and disadvantages

With Phenibut (Noofen), the international situation is the same as with hopantenic acid. We have this remedy is used extremely widely, not only for the treatment of tics, but for the relief of anxiety, for the treatment of insomnia, dizziness. Of course, there is some effect from it, since there is information that in Europe it is “addicted” as a drug. However, no randomized clinical trials performed according to all the rules have been conducted, and it is not found in any international recommendations. It is absent in Cocrane reviews and evidence-based medicine protocols, the US Federal Agency (FDA) does not have data on this drug, and the World Health Organization does not mention this drug for the treatment of tics in its recommendations.

Anticonvulsants

Anticonvulsants, or anticonvulsants, are the second stage in the treatment of tic hyperkinesis, and if we talk about international practice, then the first stage, since drugs acting on GABA are used only in the Russian Federation and the countries of the former CIS, they have no evidence base. Therefore, if the patient's non-drug methods of dealing with tics and other hyperkinesis have not been successful, then he is prescribed anticonvulsants, or anticonvulsants. Below are some of them.

Clonazepam

Popularity rating: 4.9

Clonazepam

The anticonvulsant drug Clonazepam has practically no commercial copy names, and it is inexpensive: from 90 to 120 rubles. for 2 mg tablets in the amount of 30 pieces. The drug is not often available in pharmacies, and is sold only by prescription. The drug is a benzodiazepine derivative, it also has a hypnotic and central muscle relaxant effect, also slightly affects the GABA mediator, slowing down the transmission of nerve impulses. All this allows him to reduce emotional stress, reduce anxiety and fear, induce sedation and an anticonvulsant effect. All this suppresses the spontaneous activity that occurs during tics. Naturally, the drug is most often used for epilepsy, but it is also prescribed for tic hyperkinesis. In addition, of the rare indications, one can name somnambulism, insomnia, and psychomotor agitation.

As for the dosage regimen of this drug, for adults, the initial dose should not exceed 1.5 mg per day, moreover, being divided into three doses. There are special regimens for the treatment of tics with Clonazepam, so we will not give the exact dosages here.

Advantages and disadvantages

Clonazepam has a number of serious contraindications for use. First of all, it is severe respiratory failure, severe depressive conditions. By the way, the latter is not at all uncommon in patients with severe tics, but taking clonazepam in such patients can increase suicidal tendencies. Also, Clonazepam should not be taken in pregnant and lactating women, and there are a number of conditions when it must be taken with caution. So, it is not recommended to take it against the background of acute bronchitis and pneumonia, because it suppresses the cough reflex and is able to deepen the infectious lesion of the bronchopulmonary system.

Topiramate (Topamax, Maxitopyr, Topalepsin, Toreal)

Popularity rating: 4.8

Topiramate (Topamax, Maxitopyr, Topalepsin, Toreal)

Topamax is a modern antiepileptic drug produced by Janssen cilag, and capsules in the amount of 60 pieces of 25 mg each can be bought in pharmacies from 600 to 1700 rubles. This drug is used as a monotherapy in patients with tic hyperkinesis, and is prescribed in certain dosages which may not be as large. Thus, the minimum effective dose of the drug for various forms in patients with epilepsy is 200 mg per day, but the initial dosage may be even less. This is one 25 mg tablet at bedtime for a week. If there is an effect, then you can stop at such a small dose. But in any case, the maximum daily dose should not exceed 500 mg, that is, 20 tablets. This is a very high dose, and it is used in patients with epilepsy, and in people with tics, there are special regimens for the administration of Topamax. Also, this medicine is used to prevent migraine attacks.

Advantages and disadvantages

Topiramate is well tolerated and has few side effects. Of these, the most common are decreased concentration, drowsiness, decreased appetite, emotional lability, and weight loss. However, these effects are dose-dependent, and most often occur in patients with severe epilepsy when topiramate is prescribed in rather high dosages. With extrapyramidal hyperkinesis, the doses are not so large, so its use is quite safe.

Levetiracetam (Keppra, Levitinol, Epiterra)

Popularity rating: 4.7

Levetiracetam (Keppra, Levitinol, Epiterra)

Many drugs from anticonvulsants in the official instructions do not have specific indications and dosages for tic hyperkinesis. So, the official instruction for levetiracetam, or Keppra's drug, indicates six different indications for use, but all these are some form of epilepsy. In the case of extrapyramidal pathology, doctors learn about the appointment of any drug 'through their own channels': symposia, materials of congresses, presentations, from special magazines. And after a few years, this indication is officially entered into the instructions for use.

Levetiracetam is a highly soluble drug, and when administered intravenously and taken in tablets, the doses have the same equivalence. But with tics, the doctor almost always prescribes only pills. The drug is used for extrapyramidal pathology at a dosage of 500 mg per day, which is divided into two doses when it comes to monotherapy. However, in order to take the minimum effective dose of the drug, it is necessary to follow the instructions of the neurologist in the office of extrapyramidal disorders.

Keppru is produced by the Belgian company USB-Pharma. One package of 30 tablets, designed for a month of use, will cost in October 2019 from 1,300 to 1,800 rubles. Perhaps the cheapest domestic levetiracetam is half the dosage, that is, 250 mg No. 30 can be purchased at a price of 310 rubles. For packaging, in the pharmacy service for ordering medicines. It will be the INN-generic Levitracetam produced by the domestic company Ozone LLC.

Advantages and disadvantages

Keppra's drug is a highly effective drug, but, like any other modern antiepileptic drug, it has serious contraindications. It can not be used in children under four years of age, as well as in old age; it is not recommended to take it in case of chronic progressive renal failure. If we are talking about the appointment of levetiracetam in pregnant and lactating women, then the drug in some cases can be used, but only under special medical supervision, and if the benefits of using the drug will exceed the potential harm of the drug for the child's development.

However, tics, with all their deterioration in the quality of life of patients, are not life-threatening conditions, and a pregnant woman with tics can be switched to other drugs during pregnancy. In addition, pregnancy, in some cases, has a beneficial effect, leads to a significant improvement in the course of the disease, and sometimes to complete recovery, since the etiology and pathogenesis of tic hyperkinesis has not yet been fully understood.

When using it, it should be remembered that Keppra causes the following side effects: headache, nasopharyngitis, drowsiness, dizziness and fatigue. Of course, other symptoms, such as eosinophilia, depression, double vision and dizziness, are rare, so treatment with levetiracetam should always be carried out under the supervision of a physician. And the last thing. Do not confuse the anticonvulsant drug Levitracetam with Levitra (vardenophil), a drug for the treatment of erectile dysfunction in men.

Valproic acid (Depakine chrono, Konvulex, Konvulsofin)

Popularity rating: 4.6

VALPROIC ACID (DEPAKIN CHRONO, KONVULEX, KONVULSOFIN)

Depakine chrono, like other valproates, penetrates well into the brain and cerebrospinal fluid, where it is 10% of the concentration in the blood serum. The drug is used for complex therapy for many tic hyperkinesis, and rather severe convulsive epileptic seizures, including in children. It is indicated for the treatment of adults and children over 6 years old, and in the treatment of tics, it can be prescribed both as monotherapy and together with other drugs. In addition to the anticonvulsant effect, Depakine has a sedative and central muscle relaxant effect, relaxing the striated muscles.

It must be used in the dosages indicated by the attending physician, but an initial dosage of 5 to 10 mg per kilogram of body weight is recommended first. After a week, it is increased by 5 mg, until a satisfactory effect appears. At the same time, for adult patients with a body weight of 60 kg and above, the average daily dose for long-term treatment is 20 mg per kilogram, that is, from one and a half to 2 g per day. Depakine Chrono is produced by the French company Sanofi, and a package of 30 500 mg tablets will cost from 200 to 650 rubles.

Advantages and disadvantages

Valproates, despite their clear clinical efficacy, have a fairly large list of contraindications and an impressive list of side effects. If you do not take the standard hypersensitivity to the drug, then the main contraindications to the use of Depakine will be chronic and acute hepatitis, severe liver diseases, poor tolerance of valproates in close relatives of patients, acute chronic pancreatitis, some hereditary mitochondrial diseases, hereditary changes in urea synthesis, pregnancy, children age up to 6 years.

Very carefully, Depakine Chrono should be prescribed for tic hyperkinesis in combination therapy with another anticonvulsant drug; it is better to carry out another method of treatment. The risk of liver damage is greatly increased. The drug can cause side effects such as anemia, a decrease in platelet concentration, it can even provoke tremors and the appearance of extrapyramidal disorders, in which case its use should be discontinued. On Depakine Chrono, reversible and even irreversible deafness can develop, pleural effusion and other rather severe side effects appear.

Antipsychotics

Drugs from the group of antipsychotics are often used in severe cases of various common types of complex tics, when non-drug methods, and drugs from other groups do not help well. The most commonly used Haloperidol, which is able to help 70% of patients, and achieve either remission, or a clear reduction in the frequency and duration of attacks. Drugs such as fluorophenazine and pimozide are also used in complex therapy, but unlike haloperidol, they are better tolerated, since they have incomparably less sedative effects, and this is especially important with a long period of treatment. Their disadvantage is that they are very rare in pharmacies, and we will not describe them here. Most often, treatment is carried out either during an exacerbation of the disease, or for a long time, regardless of the stage of the disease. With a steady improvement, the dose of the neuroleptic is gradually reduced, and then they are canceled altogether. Let's consider the most effective drugs from the group of antipsychotics for reducing the symptoms of tic hyperkinesis.

Haloperidol

Popularity rating: 4.9

Haloperidol

Haloperidol is one of the 'big neuroleptics' used to treat major and real mental illnesses such as schizophrenia, delusions, and various behavioral disorders. But one of the official indications for the appointment of haloperidol is multiple motor tics, which are combined with vocal speech stereotypes, that is, Tourette's syndrome, which is severe. This drug is a derivative of butyrophenone, available both in tablet form and in ampoules for injection. It affects dopamine receptors, which are blocked, causing an antipsychotic effect. By acting on the structures of the hypothalamus, it lowers body temperature, lowers the gag reflex, and the antipsychotic effect is manifested in the fact that the drug eliminates pronounced personality changes. The drug relieves delirium, mania, relieves hallucinations, increases the patient's interest in the environment. Along the way, Haloperidol affects the functions of the autonomic nervous system, eliminates vascular spasm, reduces motility and tone of the gastrointestinal tract. Haloperidol is very helpful in psychosis accompanied by severe fear of death and anxiety.

It is important to remember that it is undesirable to take Haloperidol for a long time, since it changes the secretion of hormones: the anterior lobe of the pituitary gland begins to synthesize excessively prolactin, and the production of gonadotropic hormones decreases. It can decrease sex drive and also cause galactorrhea. Haloperidol is used for tic hyperkinesis according to the combination prescribed by the doctor. You should not be guided by the dosages with which schizophrenia is treated. Haloperidol is always included in the list of vital drugs – essential medicines, and the drug is very, very cheap. Thus, a package of 50 haloperidol tablets will cost from 23 to 50 rubles, the drug is produced in Russia by many pharmaceutical companies.

Advantages and disadvantages

It should be remembered that Haloperidol, when taken in a high dose, itself causes and provokes extrapyramidal hyperkinesis in the form of persistent muscle contraction, a characteristic symptom of 'haloperidol' intoxication of drug addicts is a tonic contraction of the neck muscles, a painful spasm that turns the neck to one side. Therefore, the dosage of this drug, which cannot be bought in any pharmacy without a special prescription, for Tourette's disease is usually between 1 and 3 mg. Such a small dosage is also sold in tablets, and costs even less: from 36 to 48 rubles. per packing.

Haloperidol is contraindicated in cases of central nervous system depression and should not be used in Parkinson's disease and epilepsy, as well as in severe depression. The drug is categorically not combined with alcohol, it should not be used in pregnant women, nursing mothers. Also, the medicine has a large number of side effects. In addition to these neck spasms, on the contrary, tic-like movements may increase, blood pressure changes. With prolonged use, women may experience unusual milk secretion, menstrual irregularities, and men – impotence. Therefore, it is necessary to use Haloperidol very, very carefully, even for the treatment of severe disorders.

Risperidone (Rispolept, Risset, Torendo, Speridan)

Popularity rating: 4.8

Risperidone (Rispolept, Risset, Torendo, Speridan)

Rispolept also belongs to antipsychotics, which, with their activity against hyperkinesis, have a rather low level of sedation. He, like Haloperidol, is widely used in psychiatry for delusions, hallucinations and schizophrenia, for chronic delusional disorders and obsessive-compulsive episodes. At the same time, the drug also reduces the level of the gag reflex and lowers body temperature. To a lesser extent than the classic representative of neuroleptics, chlorpromazine, it inhibits spontaneous motor activity, and rarely causes side effects. Yes, it, like Haloperidol, can increase the level of prolactin and reduce the concentration of gonadotropic hormones in the blood plasma with prolonged use. The drug is used to treat severe tics and Tourette's syndrome at a dose of 2 to 4 mg per day. It is produced in tablets of 2 mg No. 20 at a price of 300 to 400 rubles. In a dosage twice as high, 4 mg, it can be bought at prices from 500 to 1200 rubles, but with a special prescription. Rispolept is produced as an original drug by Janssen cilag, an Italian division, so it can be considered a Johnson product.

Advantages and disadvantages

Plus Riperidone – a rather limited number of contraindications, of which only hypersensitivity is noted in the official instruction. However, there are quite a few restrictions on the use of the drug. These are gross violations of cardiac conduction, heart failure, impaired liver and kidney function, Parkinson's disease, age up to 15 years. Considering that tics and Tourette's syndrome are a disease of a young age, then, in general, these restrictions are not very relevant.

However, if we are talking about a lactating woman, then at the time of using risperidone, breastfeeding should be abandoned. The drug also has side effects. These are insomnia or drowsiness, decreased blood pressure, nausea and vomiting. In women, this is amenorrhea, in both sexes, a decrease in libido. In case of an overdose, it is possible to increase the sedative effect, develop drowsiness, the appearance of a rapid heart rate, arterial hypotension. In case of an overdose, there may be extrapyramidal disorders while taking risperidone, so it is necessary to carefully titrate the dose and apply it, preferably in short courses.

Tiaprid (Tiapridal)

Popularity rating: 4.7

TIAPRID (TIAPRIDAL)

Tiaprid is a rather expensive drug: one pack of 30 100 mg tablets will cost 1,750 rubles, despite the fact that it is a domestic manufacturer – Organika, which produces some of the cheapest drugs. There is also Tiapridal, which is produced by Sanofi-aventis. Its pack of 20 tablets will cost 1,300 rubles. This drug is not often prescribed for tics, but its main use, in addition to tic hyperkinesis, is various forms of trochee, behavioral disorders associated with opium addiction. It is used very effectively in patients with alcoholic psychosis, withdrawal symptoms and alcohol dependence syndrome.

Tiapridal is used for Tourette's syndrome and chorea in adults at a dosage of 300 to 800 mg per day, but dose titration is required for treatment. You need to start with a very low dose, which is only 25 mg per day, and gradually increase it. However, the maximum dosage for severe tic hyperkinesis should not exceed 300 mg per day. As a result, it turns out that the packaging of Tiaprid in an average dosage of 500 mg per day will end in a week, or rather, after 6 days, if the package contains 30 tablets. Accordingly, a monthly course of taking this drug will cost about 6,500 rubles, which is expensive in Russia.

Advantages and disadvantages

As in all other cases, antipsychotics are serious drugs for the treatment of severe disorders, and Tiapride can have side effects and contraindications. Contraindications, in addition to hypersensitivity, include pregnancy and breastfeeding, and side effects – drowsiness and fatigue; in case of an overdose, there may be acute neuroleptic or even malignant neuroleptic syndrome with a temperature rise of up to 40 degrees and above. On the part of the genitourinary system, as in previous cases in neuroleptics, with prolonged use, there may be changes in the concentration of hormones in the blood plasma, an increase in prolactin, galactorrhea, frigidity, gynecomastia and impotence.

Instead of a conclusion

It is extremely important in the case of antipsychotics to take the minimum dose, and slowly raise it to acceptable values. It is strictly forbidden to start treatment immediately with high dosages. In the event that the tic is severe, and treatment with neuroleptics alone does not bring an effect, then schemes with large doses are used, but still it is most preferable not to increase the dosage of one drug, but to connect a second antipsychotic to the treatment, which has another mechanism of action. For example, risperidone and tiapride are combined, or an antipsychotic drug with an anticonvulsant drug. In the event that there are painful and convulsive spasms, if the tic has a painful dystonic character with the involvement of the muscles of the neck and face, then botulinum toxin can be used. It is aimed at those muscles that take part in tic hyperkinesis.

Of course, the treatment of tics is not limited to the above drugs, and even their groups. If a teenager or young man has concomitant hyperactivity and attention deficit, then small doses of psychostimulants, tricyclic antidepressants may be prescribed. If, in addition, there is obsessive compulsive disorder, or obsessive-compulsive disorder, then antidepressants from the SSRI group, or selective serotonin reuptake inhibitors, are indicated. They were written about in other articles, so we will not talk about them here. In the treatment of tics, Gliatilin, nootropic drugs, vitamins are also used. It is very important to use, first of all, non-medicinal products. These are methods of psychotherapy, which, although they do not reduce the tics themselves, change the attitude of patients towards them. This is very important because, in the end, the quality of life improves, obsessive-compulsive disorder decreases and social adaptation increases. It is very important to reduce internal tension by teaching patients relaxation, as well as the ability to arbitrarily control the tic, using special techniques.

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