The objectives of this study were to identify trends in the use of medications for tic disorders in Canadian children and to gauge how they align with evidence-based guidelines.

Canadian guidelines on the treatment of tic disorders were published in 2012, providing evidence-based recommendations on treatment for tics. 

This study used data from IQVIA’s Canadian Disease and Therapeutic Index (CDTI), a survey-based dataset that collects data from a sample of office-based physicians and identifies pharmacoepidemiologic patterns by drug, indication, and demographics. Physicians comprise a representative Canadian sample, both geographically and by specialty. Statistical weighting adjustments are made to the sample-based estimates to extrapolate drug recommendations to national totals. Physicians complete an anonymized record of all patient visits during a 48-hour period in each quarter of the year, including patient age, gender, drug recommendation (prescribed drug), and therapeutic indication.  We focused on drug recommendations for alpha agonists and antipsychotic medications for children and adolescents with tic disorders from 2012 to 2016. 

Risperidone and clonidine were the most commonly recommended medications for tic disorders over the study period, with 36,868 and 35,500 recommendations in 2016 respectively.  Recommendations for both drugs increased over the study period. Guanfacine (approved in Canada in 2013), was used less frequently than clonidine. Clonidine was more frequently recommended than antipsychotics in children younger than six, in whom antipsychotic recommendations were uncommon. Aripiprazole was the second most commonly recommended antipsychotic, with 22,892 recommendations in 2016. Of the first-generation antipsychotics, pimozide was most commonly recommended (11,334 recommendations in 2016); haloperidol was infrequently recommended.