Remoxipride in Adolescents with Tourette's Syndrome: An Open Pilot Study

Remoxipride is a dopamine antagonist with more selective affinity for the mesolimbic dopaminergic system than conventional neuroleptic agents. The possible therapeutic and adverse effects of remoxipride were investigated in 7 adolescents with Tourette's syndrome in an open-label pilot study. The design included a 3-week baseline placebo washin period, an 8-week active treatment period, and a 3-week placebo washout period. Active treatment with remoxipride was administered in the dose range of 50–250 mg daily. Remoxipride treatment improved severity of illness ratings in 6 patients and diminished tic ratings in all 7 patients. During the placebo washout period, all patients deteriorated both on the severity of illness and on the tic ratings. In a sustained attention task, a slight reduction of workpace was observed, but accuracy and stability of performance were not affected. Verbal and visual memory functioning also remained intact. Adverse effects were few and mild in severity. Treatment-emergent nonspecific ST-T changes on the electrocardiogram were found in 3 patients and bradycardia in 2 patients. Although remoxipride has been withdrawn from the market in 1994 because of aplastic anemia, these preliminary findings suggest that Tourette's syndrome in adolescents might be improved by a dopamine antagonist with high specificity for D2 receptors in the mesolimbic system.