Medical Reviewer: Dhira Khosla D.O.
When essential tremor negatively impacts your ability to comfortably go about your day, your doctor might advise a treatment plan that involves long-term medication protocols. Beta-blockers, epilepsy medications, tranquilizers, and migraine drugs are often used to treat this condition. With medication usage, patients with essential tremor may see an improvement in the muscle control necessary for tasks like drinking out of a cup or using utensils. Unfortunately, essential tremor medications don’t work for everyone with ET and can lose their effectiveness over time. Plus, many of these medications may cause unpleasant side effects.
Ultimately, your doctor will choose a treatment plan customized for you and your medical history. Below, we’ll explore the medications used for essential tremor, their efficacy, and other options you can leverage that may improve essential tremor symptoms.
Essential Tremor Pharmaceutical Medications: Overview
Essential tremor is a neurological movement disorder that causes involuntary, rhythmic shaking. Although it can occur anywhere in the body, the shaking is often seen in the hands. ET begins gradually and worsens with certain movements like using utensils. It can be worsened by tiredness, extreme temperatures, stress, or stimulants like caffeine.
Although essential tremor medications aren’t the right course of treatment for everyone with ET, therapeutic pharmaceuticals may help reduce the symptoms of this condition. Besides the medications below, there are also lifestyle changes and non-invasive treatments that can make a positive impact on a patient’s tremors. For example, avoiding caffeine and nicotine may help reduce tremors. Keep reading to learn more about the benefits and drawbacks of essential tremor medications.
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Beta-blockers for tremors, such as propranolol (Inderal) and metoprolol (Lopressor or Toprol XL), have been used to treat essential tremor for over four decades. Experts believe that beta-blockers help block the nerve impulses to the muscles responsible for tremors, but the drug’s ability to reduce tremors is not fully understood.
Beta-blockers provide a noticeable improvement in 50% to 70% of patients. It’s important to note that beta-blockers won’t result in complete elimination of tremors, but may reduce their amplitude or frequency. The greatest positive improvement is usually seen in tremors of the voice or hands.
Potential beta-blocker side effects:
- Decrease in blood pressure
- Slowed heart rate
- Erectile dysfunction
- Cold extremities
- Shortness of breath
- Dry mouth
Propranolol for tremors
Propranolol is the only drug approved by the FDA for essential tremor. It’s been shown to reduce tremors by up to about 50%. Unfortunately, adverse effects are seen in up to 66% of patients who use propranolol. Because of potential respiratory side effects (shortness of breath), it’s not suitable for asthmatics.
Metoprolol for tremors
Another beta-blocker that has shown promise for reducing essential tremor symptoms is metoprolol. Metoprolol’s efficacy was found to be similar to propranolol in reducing the magnitude of tremors. Metoprolol is sometimes given to patients who can’t tolerate propranolol because of severe asthma.
Doctors may prescribe ET patients tranquilizers known as benzodiazepines. Tranquilizers can be helpful for those whose tremors worsen with tension and anxiety.
Benzodiazepines for tremors
While this essential tremor medication may reduce tremor, they can be habit-forming and come with potentially serious side effects. Medications prescribed might be clonazepam (Klonopin), alprazolam (Xanax), lorazepam (Ativan), or diazepam (Valium).
Potential side effects of benzodiazepines:
- Sleep disturbances
- Loss of orientation
Botox can be used to treat both head and voice tremors and can improve symptoms for up to three months. However, it has some significant drawbacks as it may cause difficulty swallowing when injected for voice tremors. If it’s used to treat hand tremors, it may result in weakness of your fingers.
Potential side effects of botox injections:
- Hand weakness
- Difficulty swallowing
Anti-seizure or anticonvulsants are another class of drugs that may help certain essential tremor patients. Scientists and researchers do not fully understand why they help. Anticonvulsants are sometimes prescribed if beta blockers are found ineffective for the patient.
Primidone for tremors
Primidone (Mysoline) is an anti-seizure drug that’s also used to treat essential tremor. It’s an effective drug for patients with hand tremors. However, some may experience tolerance to the treatment after about a year. Primidone is given to those who can’t tolerate propranolol. It can also be given in addition to propranolol to ameliorate symptoms.
Patients who use primidone start out on a low dose because negative side effects are more likely to start at the beginning of treatment. Adverse effects are common and found in 22% to 72% of patients.
As for primidone’s efficacy, the drug was found to reduce tremors by 60% in 1 to 7 hours after ingestion.
Potential primidone side effects:
- Difficulty walking
Gabapentin for tremors
Gabapentin (Neurontin) is a short-term treatment for essential tremor. It can be combined with other drugs like propranolol or used alone.
Potential gabapentin side effects:
- Weight gain
- Difficulty walking
Topiramate for tremors
Topiramate (Topamax) is typically used to treat migraines and seizure disorders. Patients are typically started on a low dose that’s slowly increased to avoid side effects like sleepiness. Some patients do not tolerate this drug well. Adverse effects were reported in about 32% of patients in a topiramate study.
Potential Topiramate side effects:
- Weight loss
- Upper respiratory infection
Non-Pharmaceutical Medication Therapy
There is no cure for essential tremor, so patients dealing with this condition should work closely with their healthcare provider to closely observe and treat the progression of this nervous system disorder. Although many of the medications listed in this article may provide relief from the severity of tremors, they don’t work for everyone. These drugs have the potential to cause unpleasant side effects that negatively impact or disrupt other aspects of a patient’s life. Plus, some patients may develop a tolerance to these drugs, rendering the therapeutic effects ineffective over time. Luckily, medications are just one option among many treatment plans.
In addition to medications, there is a revolutionary new treatment option available to help those suffering from essential tremor. Cala Trio offers customized therapy in the form of a wristband that sends electrical stimulation through nerves in the wrist. The targeted nerves reach the part of the brain network that generates hand tremors. By stimulating these nerves, the brain’s network is disrupted, which can result in tremor reduction for patients with essential tremor.
Wristbands are calibrated to your unique tremor pattern. This non-invasive therapy is easy to use and effective. Cala Trio wristbands specifically target the source of the tremor so you can accomplish your daily tasks more easily.
Cala Trio is cleared by the FDA as a Class II Medical Device and only available through a prescription. In Cala Trio’s clinical study, it provided tremor improvement in 75% of patients after one 40-minute therapeutic session. Sixty four percent of patients reported a tremor reduction of 94 minutes on average. Patients had a 49% reduction in tremor amplitude which meant activities like eating with a spoon or holding a cup became easier and more convenient. Some patients even experienced an 80% reduction of tremors.
Potential side effects of Cala Trio are mild and may include discomfort due to the electrical stimulation, an allergic reaction to the electrodes, or slight skin irritation. You can still use your essential tremor medications alongside Cala Trio therapy and you shouldn’t stop them unless directed by your healthcare provider; it’s important to follow your doctor’s treatment plan.
Besides using Cala Trio and medications, reducing your environmental stress and stimulants like caffeine can also offer potential relief for those with ET. Although there isn’t a cure, there are ways to mitigate the symptoms so you can continue to enjoy a high quality of life.
Takeaways: Essential Tremor Medications and Treatment Plans
Essential tremor symptoms can vary widely. Some ET patients experience tremors in their limbs or torso, while others might have a voice or head tremor. While eliminating essential tremor completely isn’t possible yet, your healthcare provider can prescribe a treatment plan alongside lifestyle changes that make the condition easier to manage. Because essential tremor medications may have side effects or lose their effectiveness over time, your treatment plan may need to adapt and change.
With that said, Cala Trio can be used in conjunction with essential tremor medications. Essential tremor symptoms may progress over time, but Cala Trio’s revolutionary electrical stimulation can provide relief that allows you to live more independently. This non-invasive therapy may help reduce the frequency and amplitude of tremors, so you can take on daily tasks more confidently.
MKG-1117 Rev A Nov 2020