By Emily Reid, MOT, OTR/L | Three23 Therapy

If you’ve ever started a new medication and thought, “Why are my tics suddenly worse?” you’re not imagining things.

One of the most common questions I hear from families and adults with tic disorders is:

“Could this medication be making my tics worse?”

The answer is…

Sometimes, yes.

But it’s also complicated.

Tics naturally wax and wane, meaning they increase and decrease over time—even without any medication changes. That makes it difficult to know whether a medication is truly responsible or if the timing is simply coincidental.

Still, there are certain medications that have been associated with new tics or temporary increases in tic frequency or severity in some individuals.

Let’s walk through what the research says, what families commonly report, and how to have a productive conversation with your physician.

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First: Don’t Stop Any Prescription Medication on Your Own

Before we dive in, one important reminder:

Never stop a prescription medication without talking to the healthcare provider who prescribed it.

Some medications require gradual tapering, while others are treating conditions that are equally (or more) important than the tics themselves.

Instead of stopping a medication, start by gathering information:

• When did the tic increase begin?
• Did it happen after starting a new medication?
• Was there a recent dosage increase?
• Have there been other changes like illness, poor sleep, stress, or anxiety?

Your physician can help determine whether the medication is the likely cause or whether something else may be contributing.

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1. ADHD Stimulant Medications

This is by far the most talked-about medication class when it comes to tic disorders.

Examples include:

• Adderall®
• Vyvanse®
• Dexedrine®
• Concerta®
• Ritalin®
• Focalin®

What does the research say?

For many years, stimulants were thought to directly worsen tics.

Newer research tells a more nuanced story.

Large studies have found that most children with ADHD and tic disorders do not experience significant tic worsening from stimulant medications, and many actually tolerate them well. Some studies even found that treating ADHD effectively can reduce stress, which may indirectly improve tics.

However…

Not everyone responds the same.

Clinically, some children and adults clearly notice an increase in tic frequency after beginning a stimulant or increasing the dose. This appears to happen more often with amphetamine-based medications (Adderall®, Vyvanse®) than with methylphenidate-based medications (Ritalin®, Concerta®), although individual responses vary.

So what does that mean?

A stimulant is not automatically “off limits” if someone has Tourette syndrome or a chronic tic disorder—but it should be monitored carefully with your prescribing provider.

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2. Zyrtec (Cetirizine) and Other Antihistamines

This one surprises many families.

While there isn’t strong research showing that Zyrtec (cetirizine) directly causes tics, it’s one of the medications I hear about most often from families who notice a sudden increase in tic frequency. Similar reports have also been shared with Xyzal (levocetirizine) and, less commonly, Claritin (loratadine) and Allegra (fexofenadine).

Why might this happen?

Histamine does much more than regulate allergies—it also plays an important role in brain function. Researchers have found that histamine helps regulate dopamine, a neurotransmitter heavily involved in tic disorders. While the exact relationship is still being studied, changes in histamine signaling may influence tic activity in some individuals.

It’s also important to remember that seasonal allergies themselves can increase tics, making it difficult to know whether the medication, the allergies, or a combination of both is responsible.

If you notice a consistent pattern, discuss it with your physician before making any medication changes. abruptly.

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3. Some Antidepressants (SSRIs)

Examples include:

• Prozac® (fluoxetine)
• Zoloft® (sertraline)
• Lexapro® (escitalopram)
• Paxil® (paroxetine)

SSRIs are commonly prescribed for:

• anxiety
• OCD
• depression

For many people with Tourette syndrome, these medications are incredibly helpful because reducing anxiety or OCD symptoms can indirectly reduce tic severity.

However, there are published case reports describing new or worsening tics in some individuals taking SSRIs, although this appears to be uncommon.

Again, this is not a reason to avoid these medications altogether.

It simply highlights the importance of individualized care and close monitoring.

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4. Certain Asthma and Allergy Medications

Montelukast (Singulair®) is commonly prescribed for asthma and allergies by reducing inflammation caused by leukotrienes, which are chemicals involved in the body’s immune response.

Although uncommon, there have been case reports and safety surveillance studies describing new or worsening movement symptoms, including tics, in some individuals after starting montelukast. The exact reason isn’t fully understood, but researchers believe it may be related to montelukast’s effects on the brain and nervous system. The FDA has also issued a boxed warning for montelukast because of potential neuropsychiatric side effects, including mood and behavior changes.

It’s important to remember that most people who take montelukast do not experience an increase in tics. However, if you notice that your tics began or significantly worsened soon after starting the medication, bring it to the attention of your prescribing provider. They can help determine whether the medication may be playing a role and discuss whether an alternative treatment would be appropriate.

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5. Some Anti-Seizure Medications

Although several anti-seizure medications are sometimes used to help movement disorders, others have been reported to trigger or worsen tics in rare cases.

Examples include:

• Lamictal® (lamotrigine)
• Tegretol® (carbamazepine)

These reactions appear to be uncommon but have been documented in medical literature.

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Remember: Correlation Doesn’t Always Mean Causation

One of the biggest challenges with tic disorders is that tics naturally fluctuate.

A medication may appear to cause worsening when the person was actually entering a natural “high tic” period.

Other factors often play a much larger role, including:

• stress
• anxiety
• excitement
• illness
• allergies
• poor sleep
• growth spurts
• hormonal changes
• fatigue

This is why keeping a simple symptom journal can be incredibly helpful.

Instead of assuming a medication is responsible, look for patterns over several weeks.

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Questions to Ask Your Doctor

If you’ve noticed an increase in tics after starting a medication, consider asking:

• Could this medication be contributing to the increase in tics?
• Is this a known side effect or simply a coincidence?
• Would adjusting the dose make sense?
• Are there alternative medications that may be less likely to affect tics?
• Should we monitor symptoms for a few more weeks before making changes?
• What are the risks and benefits of changing this medication?
• Are there non-medication strategies that could also help reduce tic severity?

Working together allows you and your provider to make decisions based on your overall health—not just your tics.

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Looking Beyond Medication: An Integrative Approach

Medication is only one piece of the puzzle.

Many individuals with tic disorders benefit from taking a broader look at factors that influence the nervous system.

Depending on your situation, it may be helpful to add an integrative or functional medicine provider to your healthcare team. They can help evaluate underlying contributors such as:

• iron deficiency (especially low ferritin)
• vitamin and mineral deficiencies
• sleep quality
• gut health
• inflammation
• nutrition
• hormonal changes
• environmental triggers

While these factors don’t necessarily always “cause” Tourette syndrome, optimizing overall health may help reduce the body’s overall stress load and improve resilience.

The goal isn’t replacing conventional medicine—it’s creating a team that looks at the whole person.

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So, What Should You Do?

Some medications can contribute to increased tic frequency in certain individuals—but there is rarely a one-size-fits-all answer.

For many people, the benefits of treating ADHD, anxiety, allergies, or other medical conditions outweigh the possibility of temporary tic changes.

The most important steps are:

• Never stop prescription medications without talking to your prescribing provider.
• Track patterns rather than isolated bad days.
• Remember that tics naturally wax and wane.
• Consider both conventional and integrative approaches when appropriate.
• If tics are interfering with daily life, seek evidence-based treatment such as Comprehensive Behavioral Intervention for Tics (CBIT), the first-line behavioral therapy recommended for children and adults with chronic tic disorders and Tourette syndrome.

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About Three23 Therapy

At Three23 Therapy, I specialize in helping children, teens, and adults better understand and manage tic disorders through virtual CBIT therapy. My approach combines evidence-based treatment with education about the many factors that can influence the nervous system—including sleep, stress, nutrition, movement, and lifestyle.

If you’re wondering whether CBIT is right for you or your child, I’d love to help.

Schedule a Discovery Call to learn more about your options.