Clinical recommendation	Evidence rating	References
Alpha2-adrenergic agonists are useful in treating patients with Tourette's syndrome, although they improve tics to a lesser degree than dopamine-receptor–blocking drugs. Clonidine (Catapres) also tends to improve sleep and attention. Guanfacine (Tenex) has the same pharmacologic mechanism as clonidine, but displays a more benign side-effect profile.	B	19
Dopamine-receptor–blocking drugs are the most effective treatment for tics. Haloperidol (Haldol) and pimozide (Orap) have been studied most extensively but are infrequently used because of potential side effects.	B	21–25,27–30
Fluphenazine (Prolixin; brand no longer available) displays a more benign safety profile than haloperidol or pimozide, but has been studied in controlled trials to a lesser degree.	B	25,26
Tetrabenazine (investigational) is a promising dopamine-depleting drug; controlled trials are ongoing.	B	31
Medically refractory motor and disabling phonic tics such as coprolalia can be ameliorated by botulinum toxin (Botox) injections.	B	32–34
Deep brain stimulation is being used at an increasing rate for medically refractory tics in Tourette's syndrome.	B	12