Medications for Essential Tremor
Exploring Options Such as Beta-Blockers, Anti-Seizures Medications, Benzodiazepines, and More
Medically reviewed by Femi Aremu, PharmD
Essential tremor is a disorder that causes various parts of your body to shake involuntarily, such as the head, hands, legs, or even your voice. Essential tremor is a progressive disease, meaning it generally worsens over time, but it varies from person to person.
While there isn’t a medication that cures essential tremor, the following treatments are available to control symptoms:
Nondrug treatment approaches can also be helpful for those living with essential tremor.
A healthcare provider can help determine the best treatment options for you. Keep reading to learn more about essential tremor and different medications to treat it.
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Young male spilling multiple pills in his hand.What Medications Are Available for Essential Tremor?
Essential tremor can significantly affect your daily activities, such as feeding yourself or even signing your name.
However, there are several medication options that can help control and reduce the symptoms and improve quality of life.
The main medications prescribed for essential tremor include the following:
Beta-blockers: Beta-blockers are thought to work for essential tremor by blocking nerve impulses to muscles and, in turn, reducing rapid movements. Examples of beta-blockers used for essential tremor include propranolol and Tenormin (atenolol).
Anti-seizure medications: Anti-seizure medications may also be beneficial for people with essential tremor. Also known as antiepileptics or anticonvulsants, these medications alter electrical activity in the brain to reduce seizures. While essential tremor is not a type of seizure, this same mechanism is thought to help reduce rapid muscle movements. Some anti-seizure medications that may be used for essential tremor include primidone, Topamax (topiramate), or Neurontin (gabapentin).
Benzodiazepines: Benzodiazepines work best in people with muscle tension or anxiety that induces or worsens tremors. These drugs work by producing a calming effect on the brain and relaxing the muscles in your body. Benzodiazepines that may be used for essential tremor include Xanax (alprazolam) and Klonopin (clonazepam).
Botulinum toxins: Botulinum toxins work for essential tremor by weakening the muscles to reduce shaking. One such drug is Botox (onabotulinumtoxinA), which is an injectable medication.
Beta-Blockers
Beta-blockers work by blocking specific receptors in your body. They work by reducing smooth muscle contractions and easing essential tremor.
Experts recommend beta-blockers as a first-line option for treating essential tremor.
Propranolol
The most commonly recognized FDA-approved beta-blocker for essential tremor is propranolol. Brand names are Innopran XL and Inderal LA.
Taking propranolol can make symptoms of essential tremor less noticeable. Some studies show the drug reduces the severity of essential tremor by about half.
However, propranolol may not be effective for everyone with essential tremor. While propranolol is used as a first-line treatment option for essential tremor, a 2022 review states that it may only be effective in roughly 40% of patients.
Accordingly, providers may recommend switching to or adding a different medication.
Off-Label Beta-Blockers
To treat essential tumor, the following beta-blockers have been used off-label, meaning for a use or at a dosage for which it was not FDA-approved:
Tenormin (atenolol)
Lopressor or Toprol XL (metoprolol)
Beta-Blocker Safety
Some side effects of beta-blockers may include the following:
Drop in heart rate
Light-headedness or fainting
Beta-blockers may not be suitable for you if you have any of the following health conditions:
Low blood pressure
Asthma or lung disease
Kidney disease
Heart arrhythmias
A healthcare provider can determine an appropriate treatment based on your health history and needs.
Anti-Seizure Medications
If a beta-blocker isn’t working for your essential tremor or if you can’t take a beta-blocker, your healthcare provider may prescribe an anti-seizure medication.
Anti-seizure medications are thought to reduce essential tremor by altering chemical and electrical impulses in your body and brain. This may reduce rapid muscle contractions and involuntary movement.
Treatment guidelines recommend Mysoline (primidone) as a first-line anti-seizure medication for essential tremor. Other options may include topiramate or gabapentin.
Primidone
Similar to propranolol, primidone (sold under the brand name Mysoline) may reduce tremors by up to 50% in some people with essential tremor.
Primidone may also be prescribed in combination with propranolol if either medication is not effective enough alone.
However, unlike propranolol, primidone’s use for essential tremor is off-label; its FDA-approved indication is specific types of seizures.
Primidone is not safe for everyone. Primidone should be avoided if any of the following apply to you:
History of suicidal tendencies
Blood disorder
Anti-Seizure Medication Safety
Side effects of anti-seizure medications generally include the following:
Topiramate
Topiramate (sold as a generic and under the brand names Topamax and Topiragen) is FDA-approved to help treat migraines or epilepsy.
Topiramate is sometimes prescribed off-label for essential tremor if first-line medications like primidone or propranolol do not work well enough.
Avoid topiramate if you:
Have vision problems such as glaucoma
Are pregnant
Have kidney stones
Gabapentin
Like topiramate, gabapentin (sold as a generic and under the brand name Neurontin) is typically prescribed off-label if primidone and/or propranolol don’t work adequately for essential tremor.
Some evidence supports gabapentin for reducing hand tremors. However, more studies are needed to confirm its effectiveness.
People with the following should avoid taking gabapentin as it may increase risk:
Suicidal thoughts or behaviors
Myasthenia gravis (an autoimmune disease that causes weakness in voluntary muscles)
Benzodiazepines
A healthcare provider may prescribe alprazolam or clonazepam off-label for essential tremor.
These benzodiazepines are mainly used to relieve anxiety. However, they are also believed to help reduce essential tremor in individuals whose tremors are caused or worsened by anxiety.
Explainer
Benzodiazepines have a risk of abuse and dependence, so they should be taken with caution and are typically not first-line medications.
Alprazolam
Alprazolam (sold as a generic and under the brand name Xanax) may be particularly useful to reduce essential tremor affecting your arms or legs, but more studies are necessary to confirm this.
One study found a 69% to 76% reduction in tremor 40 to 80 minutes after taking a dose of alprazolam.
Clonazepam
Clonazepam (sold as a generic and under the brand name Klonopin) has limited evidence behind its effectiveness for essential tremor.
Two small studies in the 1980s had conflicting results, with one study showing significantly reduced tremor with clonazepam and the other showing no benefit with the drug.
Benzodiazepine Safety
Side effects of benzodiazepines include the following:
Drowsiness
Light-headedness
Confusion
Muscle weakness
Dizziness
Nausea
In rare cases, overdose, especially if combined with opioid medications like Oxycontin (oxycodone)
People with the following should avoid taking benzodiazepines:
Kidney disease
Lung disease
Liver disease
Myasthenia gravis
Sleep apnea
Botulinum Toxins
Botulinum toxins, such as Botox, are not FDA-approved for essential tremor. However, they are indicated for treating spasticity (stiff or rigid muscles).
Healthcare providers do not commonly prescribe botulinum toxin injections for essential tremor.
However, they may be an option when other medications aren’t helpful or for people who cannot take oral medications.
Current evidence suggests that botulinum toxins may help reduce hand, head, and voice tremors in people with essential tremor.
Botulinum Toxin Safety
Common side effects of botulinum toxin injections include:
Pain, swelling, redness, or bruising at the injection site
Botulinum toxin injections may interact with the following medications:
Jantoven (warfarin)
Antibiotics
Antiarrhythmics (heart rhythm medications)
People with current urinary tract infections should avoid botulinum toxin injections.
Surgery for Essential Tremor
Some people are eligible for surgery for essential tremor.
The following procedures may be options for people with severe essential tremor that doesn’t respond to medications:
Stereotactic thalamotomy (surgery to inactivate a certain area of the brain)
Nutrition
Little is known about the potential pros and cons of taking herbs or dietary supplements for essential tremor. Results from studies are somewhat limited or conflicting.
Examples include the following:
Cannabis: Cannabis did not reduce arm tremor in a small study with 19 patients taking a single oral dose of cannabis.
Caprylic acid: Preclinical studies show promising results from this medium-chain fatty acid. However, there is not enough human data to confirm caprylic acid's usefulness for managing essential tremor.
Thiamine: High-dose thiamine (vitamin B1) injections reduced tremor in a study. This effect has not been seen with standard oral doses of this vitamin.
Note that some herbs and supplements may interact with prescription drugs. Before starting a dietary supplement, consult a healthcare provider or pharmacist to check for any precautions or interactions with any over-the-counter (OTC) or prescription medications you take.
Other factors may also impact the risk of developing essential tremor. Nutrition or dietary factors that may be linked to developing essential tremor include the consumption of:
Beta-carboline alkaloids are found in meat and are thought to contribute to essential tremor.
Also, environmental exposure to lead or pesticides may put you at a greater risk of developing essential tremor.
More research is needed to confirm the connection between essential tremor and lifestyle factors, including diet and environmental exposure.
What Can Make Essential Tremor Worse?
Some factors can make essential tremor worse. Examples include the following:
Drinking alcohol
Taking medications known to cause tremor as a side effect, such as antidepressants, immunosuppressants, or cancer medications
A healthcare provider can advise you on what to do if you suspect a medication is causing or worsening your essential tremor.
You shouldn’t stop your medication without professional guidance. A healthcare provider can also support you in any lifestyle modifications that are challenging for you, such as quitting smoking and getting better sleep.
Summary
If essential tremor interferes with your daily activities, various medications can help manage it. The two most common are propranolol and primidone, though they may not work for everyone. Surgery may also be an option for some people.
More research is needed regarding the safety and effectiveness of dietary supplements for essential tremor. However, nutrition and lifestyle factors like diets high in vegetables may be preventive.
Speak with a healthcare provider to determine if trying a medication for essential tremor is an option for you.
Frequently Asked Questions
What is the best medication for essential tremor?
The two most commonly prescribed medications for essential tremor are propranolol, a beta-blocker, and primidone, an anticonvulsant. These medications can reduce tremor by about 50% in some people. In some cases, providers prescribe these medications in combination.
Keep in mind that beta-blockers and anticonvulsants can interact with other medications. For your safety, be sure to tell your pharmacist and healthcare providers about all prescription drugs, over-the-counter medications, and supplements you take.
What is essential tremor?
Essential tremor is a neurological condition causing involuntary movements and shaking of the body. Essential tremor can cause shaking of the head, hands, legs, abdomen, and even your voice. Essential tremor can be mild and may not require treatment, although the condition can get worsen over time.
What causes essential tremor?
The cause of essential tremor is unknown, though some factors can bring it about or make it worse. These include taking certain medications, exposure to heavy metals or toxins, caffeine, having a thyroid disorder, diabetes, liver or kidney failure, stress, anxiety, or fatigue.
Read the original article on Verywell Health.
