A possible link between fluticasone propionate and tics in pediatric asthmatics.

We report a six year-old asthmatic male who developed transient motor tics, possibly secondary to his use of fluticasone propionate (fluticasone). At this particular clinic visit, the mother reported that the patient had begun using fluticasone 50 mcg two puffs b.i.d. for the last four months. The motor tics began to appear about two months after he began the fluticasone, and continued throughout that time period. His fluticasone was replaced with ciclesonide (100 mcg one puff daily), and within eight weeks, his motor tics resolved. Furthermore, we report a ten year-old male with asthma and Tourette’s syndrome (TS) whose tics worsened five days after the introduction of fluticasone 125 mcg two puffs b.i.d. When fluticasone was discontinued, his tics returned to baseline. Due to asthma symptoms, he was prescribed fluticasone again, but at a dose of 50 mcg two puffs b.i.d. Once again a similar exacerbation of his tics was noted, which again resolved after discontinuation of fluticasone. The purpose of this letter is to speculate a link between fluticasone and tics in the pediatric asthmatic population based on these cases and a literature review.