Alert: Asthma and Allergy Meds Can Trigger Tics
We all know that people react differently to medications. What causes negative side effects for one person may be safer for someone else. We are grateful to a mother who contacted us to share her discovery that the allergy/asthma medicine fluticasone caused tics in her son. She also found a journal article to back up her observations—turns out her son was not alone. (Have you had this experience or noticed it for different medications? We hope you’ll add a comment at the end of this article.)
My son developed tics while taking his allergy medication fluticasone, a corticosteroid. When he was taken off the drug and switched to ciclesonide, his tics resolved.
When I first told his respiratory specialist that I suspected fluticasone had triggered tics in my son, he didn’t believe that it could cause tics. I searched the internet and found a 2013 report in Neurology, see below, and emailed it to him. The doctor said he was unaware of the link.
He prescribed ciclesonide for my boy, and said that he shared the research with his colleagues.
In Australia, Flixotide was the name of the puffer that he was on initially (with the active ingredient Fluticasone) and Alvesco is the one he currently takes that contains the active ingredient ciclesonide. I believe that puffer brands may be different in other countries so it’s important that those concerned identify the active ingredient.Hopefully, this information may assist others.”
In a Meeting Abstract article published in Neurology, researchers Drs Melanie Steele and Jodi Rosner of Ontario, Canada conducted a review of the literature to analyze the association between fluticasone and motor tic development in young asthmatic patients. They report on cases where new tics were triggered by the drug, and where existing tics were made worse.
The drug-cortisol-tic relationship
The researchers point out that fluticasone causes “greater dose-related adrenal suppression compared to other inhaled corticosteroids, such as beclomethasone, triamcinolone, and budesonide. This is significant because there is evidence that children with Tourette’s syndrome have significantly lower evening cortisol levels compared with healthy age-matched controls, and moreover, that evening cortisol values are negatively correlated with the number, intensity, or interference of motor tics, and overall tic severity.”
They add that the medication ciclesonide has been shown to reverse adrenal suppression, and this can explain why tics subsided after switching from fluticasone to ciclesonide.
The authors suggest that a link between tics and fluticasone “should be considered in the differential diagnosis of transient motor tic development or exacerbation in the pediatric asthmatic population.”
See the abstract: A Possible Association between Fluticasone Propionate and Tics in Pediatric Asthmatic Patients: Two Case Reports and a Literature Review here.
If you suspect that tics could be related to a medication, talk to your doctor about it and see if a change in treatment can help.
My son developed motor tics while taking the asthma/allergy drug SINGULAIR (montelukast). When we stopped giving it to him, the tics resolved. Then we tried Claritin and the tics returned. After stopping Claritin the tics once again resolved. He was virtually tic free for several years, but once he hit puberty the tics returned (at that time he was not taking any medications on a regular basis). After founding Parents United for Pharmaceutical Safety and Accountability, I received reports from parents that their children developed tics while taking Singulair. Tics and Tourette Syndrome have also been reported to FDA as suspected side effects of Singulair.
Hi Jenna, thank you for letting us know this, and about your organization. I looked at your site parentsforsafety.org Singulair is your primary focus? We’re very glad to have this information from you. If you have enough information related to Singulair side-effects for the conditions we look at like ADHD, depression, anxiety, and tics/Tourette’s we could do a feature article. Please keep in touch on this. Sheila
Jenna,
My son is currently taking Singular and has developed a tic on and off for a year. Constant throat clearing. I’m thinking that the singular is the culprit. He is also taking a flovent inhaled medication. Why do you feel your sons tic returned in puberty since he was not reg taking meds then
This comment was received in Spanish and has been translated by our team. The translation is:
Hi Jenna. My son’s neurologist told us that the increase in histamine due to spring allergy could increase tics. That’s how it went. All nonsteroidal anti-inflammatories (such as Singulair) influence the increase in histamine in the body, so tics can increase. In fact, any increase in histamine increases your tics, either by eating foods with a lot of histamine, or by some reaction such as that produced by your body when you put the vaccine to fight spring allergy.
Hola Jenna. El neurólogo de mi hijo nos dijo que el aumento de histamina debido a la alergia primaveral, podría aumentar los tics. Así fue. Todos los antiinflamatorios no esteroideos (como Singulair) influyen en el aumento de histamina en el cuerpo, por tanto pueden aumentar los tics. De hecho, cualquier aumento de histamina le aumentan los tics, bien por comer alimentos con mucha histamina, o por alguna reacción como la que produce su cuerpo al ponerle la vacuna para combatir alergia primaveral.
I recently used Flixotide for about 6 weeks. It exacerbated my tics and comorbid symptoms such as impulsiveness and anxiety. It’s been 4 weeks since I stopped and the tics are just starting to settle.
I was taking Flixotide for about 2 months because asthma relievers were making me hyperactive. My tics exacerbated significantly, along with impulsivity and mood swings. I thought it was the medication and did some research. I discovered many others had similar reactions. I stopped taking it about a month ago and my tics are still off.
My 10 year old son has asthma and has been on Seritide (contains Fluticasone) and Singulair for the last 4 years. During this time he has suffered from worsening motor tics and now vocal tics plus more lately OCD. He has also had regular migraine headaches and restless leg. Until now, I never realised there could be a link.
It has become all consuming for him and he is extremely distressed by it becoming more and more anxious and down. UK Doctors and counsellors have told me just to ignore them, they will wax and wane and there’s no cure, that when his anxiety reduces his tics will go, but don’t they get it, it’s a vicious circle! The tics are to some degree the cause of the anxiety!
I had no idea asthma meds,diet or magnesium deficiency could contribute or even cause tics, the wider medical profession simply don’t tell parents this, making you feel helpless to do anything for your tormented child. Am I at last on the right track? I feel so bad for not finding this out sooner. what are the main things I can eliminate or do to help my son?
Hi Julia,
First, I’m so very sorry you are dealing with all this. I know how hard it is to cope with health issues in your child and to feel helpless. I really hope the changes you make in medicine make a difference, please let us know how you make out with that. Meanwhile, there are lots of other things you can do that may help reduce tics and OCD.
This is an example http://latitudes.org/finding-help-last-diet-environment-causing-tourettes-ocd-child/
Everyone is different, and so what helps one may not help another. But in any event, it is usually important for everyone to avoid all scented products and chemicals (like in standard cleansers.) This includes personal and household products. Go green—all natural. Since he has asthma you have already probably been keeping the home as free of dust etc as you can.
Also strive to have him eat a diet free of artificial colors/flavors/sweeteners, caffeine, and preservatives–and keep sugars to a minimum. You’ll need to read lots of labels! He can still have snack foods, but pick ones without these additives.
At some point you can start to find out if he is reacting to different foods, like dairy. (Have you ever noticed if he was worse after eating something?) But it can seem overwhelming to try to do everything at once. So start with what you can, and write down what you are doing and if you see any changes.
Please read these stories if you have not already http://latitudes.org/category/conditions/tics/tourettes/families-speak-out-tics-tourettes/ for ideas. Do any of them ring a bell with your situation?
Almost all parents dealing with the symptoms you mention are in the same boat as you, having to find this information on the Internet, so please don’t beat yourself up that you didn’t know there could be a connection with diet and the environment, foods, meds, an infection, etc. Doctors generally aren’t aware of it, and worse than that, it’s not unusual for a parent to go to their doctor about these ideas and be told that it’s ridiculous and to forget it. So you should be patting yourself on the back for looking for help outside conventional treatment, period!
We don’t claim to have the answers for everyone, but the main thing is that you are going to try to find out WHY your son has the problems he does. And you sound like the type of parent who can make some real progress in this area. Wishing you the best and hoping to hear back!
Hi Sheila, thank you so much for replying!
The 1st thing I’m going to do is ask my GP to switch Asthma meds. I will be showing him the Canadian paper re Fluticasone. I’m not aware of a similar study for Singulair but have read of tic reactions to this as well.
We are already quite green but lots of improvements can be made plus air purifiers and filtering our water.
Diet is next, I am already suspicious of Dairy as he often has tummy ache after consuming larger quantities of it. Then Gluten is the other one I will try plus diminishing additives and sugars etc.
I would very much like some advice on Magnesium and B6 supplements please, what would be a good dose for a 10 year old? ( he’s 32kgs ). My local pharmacy was unwilling to help me with this pointing me towards my GP and I’m unsure of how receptive he will be but we will see.
Finally, do you know of any like minded medical practitioners in the UK who I could get my son referred to?
I will let you know how we get on when the meds have been eliminated. Thank you for your support, I am very grateful for your input!
HI: we recently moved to a new area and my almost-12 year old son has experienced awful allergies and asthma (2 attacks needing prednisone).
3 months ago his allergist put him on SInguIair, Flonase, and Qvar. But after another bad asthma attack last month she switched him to Flonase and Duvera. This is in addition to the Zyrtec he has taken for a few years.
He has recently developed motor tics (clucking) and I am not sure what to do!?!?! I don’t know if it because he is reaching puberty or if it is the medication. And if it IS the medication, then which one? He has been through so many in just a few months.
Hello! My son developed tics after using asthmanex. He also cried excessively. The crying stopped after he was off the medication for a week, but his vocal tic continued for a couple of months before subsiding. This happened when he was 5 years old. I truly wish that more doctors were aware of this as my physician basically brushed my concerns aside. Thank you all for your comments!!
My son was taking albuterol inhaler and machine meds, he now has vocal and physical tics….took him off, and from then….till now….two years later, he still has them.
Yes my 6 year old has developed tics which came and went when we used and took her off of Flonase.
Thank you for your feedback, Donna. That’s so helpful. I hope your daughter is doing well now!
My son is 5. The minute his asthma flared, we upped his dose during allergy season–Flovent and Flonase as per his doctor at CHOP. Since then he has developed severe motor tics we are stopping the medication today!
Hi Tara, I’m sorry to read about the tics your son has, which I know are distressing for the whole family. I hope they resolve soon. If you get a chance, please drop a note to let us know how things go after you stop the asthma medication as you plan to do. Hopefully, other interventions or less medication can help address the asthma.
My son is 8 yrs old and I feel he may have had a “blinking tic” a few months ago that came and went. We didn’t think it was a tic. However recently, he was prescribed Claritin, augmentin, and Flonase for allergies. On day 10 he developed a strange head/neck tic out of no where, wondering if the allergy meds and or Flonase could have been the cause . We see a neurologist Tuesday.
Hi TF, please let us know what you learn from the neurologist. Most are not aware that allergies can trigger tics, and also about Flonase or other meds causing tics. Is he still on the meds and have you made any more observations?
My son experienced severe abdominal tics while taking Flonase. The tic stopped two days after stopping Flonase. He also gets tics with other allergy meds as well.
Hi,
My 5 year old has developed tics after having singulair but as soon as I suspected that it was the culprit, I stopped immediately. How long does it take for the effects of singulair to ease out? It’s been 5 days and I see no improvement of the tics. Also, he’s on Fluticasone. Thank you
Hi Su, Thank you for writing, and we hope your son’s tics are eliminated soon.
You say you stopped Singulair and the tics remain but he is also on Fluticasone (Flonase). Both Singulair and Flonase have been linked to tics in a small number of cases.
There is no way to know if Flonase or Singulair is connected with your son’s case unless they were both stopped.
Regarding your question, I’m not sure how long the Singulair could be an issue after stopping it although it has a short . Typically it would not be an issue after 24 hours or less.
Have you had a chance to explore additional efforts to help reduce allergic/asthma reactions and consider any role that food may be playing?
My son 4 began having vocal tics after taking Flovent. The pediatrician blew it off. Had for months. When his asthma was bad and we were told to increase Flovent to twice a day, the tics got more prominent. We took him off and put back on budesonide. As soon as we stopped Flo Vent the tics stopped
Thank you for sharing that negative reaction to Flovent, Dk. It’s so good you discovered the culprit for you boy’s increase in tics. It’s amazing that doctors don’t look for a connection to see what might be aggravating tics. They aren’t trained that way, but hopefully they will listen to their patients and learn. I hope everything is is going along well for you and your little son now.
Hi, I’m really struggling with my little girl and have just found this feed. She has been on a brown preventer inhaler (beclomethasone) daily for asthma and taking a fluticasone nasal spray daily for around two years now, her allergies were terrible and these two had seemed to completely keep it all at bay. I thought she might be improving with age and might not need the nasal spray anymore so slowly gave less and now she’s off it but still using preventer inhaler. She developed a throat clearing tic that then developed into an eyebrow raising tic and now has a vocal tic (sort of whimper) the tic is at its worse now and she’s been off fluticisone for three weeks. Could the brown inhaler be the culprit? I’ve taken her off that as off last night. Fingers crossed she improves now she’s off both as she’s so anxious and of an age where she’s aware and embarrassed by the tic in school. Have you ever heard of fluticisone suppressing a tic or is that ridiculous?
Hi Ellie, I’m sorry your daughter has a serious problem with allergies and she’s been having some tics lately.
As you may know from our website, many families and practitioners note a connection between asthma/allergies and tics. And, per the article you are responding to, some find that asthma meds can trigger tics. Because reactions to medications can differ from person to person. it’s often difficult to konw what is taking place and why. (Along those lines, nothing is ridiculous about your observation that fluticasone may be preventing tics in your daughter. Anything is possible!) Tics can begin for a number of reasons separate from medications, so it can take time to tease it out.
What are you seeing now that you are withholding the inhaler?
IF you see a connection with the inhaler to tics, do you think your doctor might offer a different asthma medication?
Two years ago my son had severe asthma flare up. He was on albuterol and then budesonide. Eventually was put on a daily Flovent inhaler. he started strange eye tics and excessive chewing on clothes/blankets at this time and it seemed to be linked to the meds, although the doctors did not have any information about these types of side effects. We thought it was an overload of albuterol in his system. Phased out meds and tics gradually subsided. This spring he had another asthma flare up. We did not see side effects from the albuterol, or even the Flovent at first, other than hyperactivity, but after He had already been on the Flovent for a few months, he was put on a week long round of prednisone. (A month ago) This is when he developed a strange throat tic among others that would come and go. Also lots of anxiety. We took him off Flovent a week ago, and the tics increased at first. Now they are gradually tapering down. Playing computer or video games seems to trigger them the most. Hopefully they will completely resolve with time.
My daughter has taken Flonase off and on for years with no issue. She had an asthma flare recently and was started on Alvesco and she developed severe motor tics. We’ve discontinued all meds and with in a few days the tics are lessening. I’m not sure if it was the addition of the Alvesco or randomly the Flonase that caused this.
My son has dealt with turrets for years. I read early on that some allergy medications could exacerbate tics. He has allergies and is often fighting a cough. Do you have a suggestion for allergy medication that doesn’t affect the histamine levels? My son is 19 and hasn’t outgrown his allergies. They seem to be worse. Any suggestions will be appreciated.
Thanks