Drug Treatments for Essential Tremor
When essential tremor (ET) significantly interferes with daily activities, long-term drug treatment is needed. Drugs most commonly used to treat ET include beta-blockers and an epilepsy drug called Mysoline.
With the use of medication, people with ET may see improvement in their ability to control tremor, improving functions like drinking from a cup or using food utensils. More specialized motor functions, such as being able to thread a needle, may not improve.
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Your health care provider will determine which treatment is best for you based on your medical history. The goal of treatment is to provide maximum improvement in function while minimizing the side effects of drugs.
For people with mild ET, drug therapy may not be necessary. Tremors may be lessened by minimizing exposure to emotional stress and avoiding substances, such as caffeine and nicotine, which may increase tremor. In social situations, a person with mild tremor can take a beta-blocker or drink a small amount of alcohol, if such treatments are approved by a doctor.
Beta-Blockers for Essential Tremor
The beta-blocker Inderal has been used to treat essential tremor for more than 40 years. Other beta-blockers such as Lopressor also may be effective.
It is not clear how Inderal reduces tremors, but the drug may work by blocking nerve impulses to the muscles. Approximately 50%-60% of people taking Inderal experience some improvement in function, but total tremor suppression usually is not achieved. The greatest improvement is in hand tremors and voice tremor. The drugs may be taken once a day (for longer-acting formulation) or twice a day depending upon the formulation used.
Side Effects of Beta-Blockers
Beta-blockers are not right for everyone with ET. Side effects of beta-blockers may include:
- Slowing heart rate
- Fainting
- Fatigue
- Erectile dysfunction
- Depression
Some of these side effects may require that the treatment be stopped.
Be sure to tell your doctor if you:
- Have asthma or other bronchial conditions (beta-blockers may cause asthma symptoms)
- Have coronary artery disease or certain heart arrhythmias
- Have kidney disease
- Have liver disease
- Have diabetes
- Are pregnant or nursing
While you are taking Inderal, your health care provider will monitor your heart rate and blood pressure regularly. In general, Inderal works over a long period of time to suppress tremors; however, about 10% of people will develop tolerance to the drug after a year. This means that the drug stops being effective when given in the same dose as when you began treatment.
Mysoline for Essential Tremor
Mysoline is an anti-seizure drug that is also effective for treating essential tremor. It is most useful for people with hand tremor. Although it is not clear how it works, Mysoline appears to be as effective as Inderal, with significant suppression of tremor in most patients. However, as with Inderal, a percentage of people may develop tolerance to the treatment after about a year.
In most cases, Mysoline is given to people who do not tolerate Inderal. Mysoline also can be given in addition to Inderal to improve symptoms.
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