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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 essential tremor include beta-blockers (propranolol) and an epilepsy drug called Mysoline (primidone). Topamax (topiramate), another drug used to treat epilepsy and migraine, helps some people.

With the use of medication, people with essential tremor may see improvement in their ability to control their tremor and improvement in activities such as drinking from a cup or using food utensils. More specialized motor functions, such as being able to thread a needle, may still be too difficult. However, for most people, essential tremor is not disabling.

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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 help provide maximum improvement in function while minimizing the side effects of the medication you are taking.

For people with mild essential tremor, drug therapy is usually not 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. Although alcohol may lessen the tremor, there is the danger of slowly increasing your intake.

Beta-Blockers for Essential Tremor

The beta-blocker Inderal (propranolol) 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% to 60% of people taking Inderal experience some improvement in function, but total tremor suppression usually is not achieved. The greatest improvement is in hand and voice tremors. 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 essential tremor. Side effects of beta-blockers may include:

  • Slowing heart rate
  • Drop in blood pressure
  • Fainting
  • Apathy
  • 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 or worsen 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. In general, Inderal works over a long period of time to suppress tremors; however, nearly 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. In this case your doctor will suggest another medication or treatment.

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