Essential Tremor Medications: Benefits & Side Effects

Medical Reviewer: Dhira Khosla D.O.

With approximately 10 million affected in the United States alone, essential tremor is one of the most common movement disorders. Impacting the nervous system, it can cause involuntary shaking in almost any part of the body, especially in the hands.

While essential tremor is not life threatening, it gradually worsens with time, negatively impacting one’s ability to perform necessary daily activities. As of yet, there is no definitive cure for essential tremor. However, there are a number of treatment options that can effectively manage essential tremor symptoms, decreasing the amplitude and frequency of tremors while improving muscle control.

Essential tremor medication is considered a first-line treatment. Beta-blockers like propranolol for tremor, epilepsy medication, tranquilizers, and migraine drugs are the most commonly prescribed.

In this article, we will take a closer look at each of these medications, focusing on their benefits and side effects. As we wrap up, we will also discuss some alternative options for benign essential tremor treatment.

Overall, for a customized treatment plan that best suits you, it’s important to consult your medical provider. Keep in mind that meds for tremors don’t work for everyone and can lose their effectiveness over time.

What is Essential Tremor Medication?

As essential tremor progresses, many patients may experience a decline in their quality of life. From eating and drinking to speaking and writing, this disorder can make everyday tasks challenging and troublesome. Getting an accurate diagnosis from your medical provider and ruling out any other possible conditions is a crucial first step in managing essential tremor.

Your medical provider may suggest using essential tremor medication to control your symptoms.

Beta-blockers, namely propranolol for tremor and metoprolol, are the most common type of tremor medication. However, other medications, including tranquilizers, anticonvulsants, and botox, are also prescribed, especially for patients who cannot tolerate the effect of beta-blockers.

Keep reading to learn more about the benefits and side effects of each type of essential tremor medication.

Beta-Blockers (Propranolol)

Most commonly used to reduce high blood pressure, beta-blockers have been used as a benign essential tremor treatment for over four decades. While their ability to reduce tremors is not fully understood, experts believe that beta-blockers help block the nerve impulses to the muscles responsible for tremors.

The two beta-blockers most conducive to managing essential tremor are:

• Propranolol: Propranolol for tremor, also known by its brand name Inderal, is the only FDA-approved essential tremor medication and provides a noticeable improvement in 50 to 60% of patients. It is also the most prescribed medication for essential tremor. While it does not eliminate tremors, it lessens their amplitude and frequency. For those taking propranolol for tremor, the greatest improvement is seen in the hands, while the least improvement occurs for head and voice tremors. Despite its efficacy, many patients develop a tolerance to propranolol after a year. In addition, 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: Found on the market as Lopressor or Toprol XL, metoprolol is a tremor medication often prescribed for patients who cannot tolerate propranolol, especially those who have severe asthma. In terms of efficacy, metoprolol is as effective as propranolol in reducing the magnitude of tremors.

Potential beta-blocker side effects

Like any other medication, beta-blockers can cause side effects in some patients. For propranolol and metoprolol, while most side effects are tame and go away as the body adjusts, certain serious side effects require immediate medical attention.

Some of the most common metoprolol and propranolol side effects are:

• Decrease in blood pressure
• Slowed heart rate
• Fatigue
• Fainting
• Erectile dysfunction
• Cold extremities
• Depression
• Anxiety
• Shortness of breath
• Dry mouth
• Dizziness
• Nausea

In addition to these common side effects, there are less common effects that require immediate medical attention:

• Lung issues: If your shortness of breath doesn’t subside and you start to wheeze or feel a tightness in your chest, contact your healthcare provider to screen for lung issues.
• Heart issues: If your shortness of breath is coupled with a cough that worsens during physical activity and you notice your legs and ankles swelling after taking beta-blockers, you may have heart issues. Additionally, check to see if you have an irregular heartbeat.
• Liver issues: The whites of your eyes turning yellow may be indicative of liver issues. Your skin may turn yellow as well, but that can be difficult to notice.
• Too much thyroid hormone in the blood: If your heart is beating rapidly and you feel yourself trembling or confused, there might be too much thyroid hormone in your blood.
• Low platelet numbers in your blood: Bruising easily or having bruises that appear all of a sudden may mean that the number of platelets in your blood is low.

Tranquilizers (Benzodiazepines)

Tranquilizers, also known as benzodiazepines or benzos, are another frequently prescribed tremor medication. As a depressant, they increase the levels of GABA in the brain to slow down nerve impulses, producing a calming effect. Tranquilizers are especially effective for patients whose tremors worsen with tension and anxiety.

Your medical provider will take your medical history, current health condition, lifestyle, mental health, and more into consideration when prescribing you meds for tremors. It is important to note that tranquilizers are not for everyone as they can be habit-forming.

Generally, the tranquilizers used as essential tremor medication include:

• Clonazepam (Klonopin): Clonazepam is especially useful for orthostatic tremor, a rare form of essential tremor. Patients with orthostatic tremor shake involuntarily while standing still, with severe trembling in their legs. Clonazepam is a long-acting benzodiazepine, which means it is processed more slowly by your body.
• Alprazolam (Xanax): Alprazolam is another benzodiazepine used as an essential tremor medication, and its efficacy has been discussed as far back as 1984. In general, it reduces tremor severity, especially in the case of frequent adverse events.
• Lorazepam (Ativan): Lorazepam is an intermediate-acting tranquilizer. It has a focus on treating anxiety disorders, so it is notably useful for patients who suffer from both essential tremor and anxiety.
• Diazepam (Valium): Like other tranquilizers, diazepam has proven to be effective as an essential tremor medication. However, more research is needed to confirm its efficacy.

Potential tranquilizer side effects

Benzodiazepines are commonly prescribed for anxiety, insomnia, and seizures, but they are also used as a tremor medication. They can be addictive and easily abused, so they should always be used with caution and under the supervision of your doctor.

Tranquilizers come with certain side effects, such as:

• Drowsiness
• Depression
• Slurred speech
• Sleep disturbances
• Weakness
• Loss of orientation
• Loss of coordination
• Decreased blood pressure

Botox Injections

Botox injections have proven to be successful as a benign essential tremor treatment as well. Most commonly used to reduce the appearance of wrinkles and other facial creases, botox injections utilize botulinum neurotoxin produced by Clostridium botulinum to temporarily paralyze muscles.

As an essential tremor medication, it is mainly utilized for head and voice tremors and can improve symptoms for up to three months. Although botox prevents the injected muscles from shaking for a certain period of time, it can be very costly and cause transient or even long-term muscle weakness.

Botox injections for essential tremor must be done by a trained and experienced professional. When used for voice tremors, it may cause difficulty swallowing or speaking. For hand tremors, botox may result in weakness of your fingers.

Potential side effects of botox injections

Before using botox injections as a treatment for essential tremor, consider its side effects. They include:

• Muscle weakness
• Difficulty swallowing or speaking
• Pain

Anticonvulsants (Primidone and Gabapentin)

Anticonvulsants are another class of meds for tremors. While scientists and researchers do not fully understand how they work to ease essential tremor symptoms, they are often prescribed for patients who beta-blockers are ineffective for.

• Primidone: The anticonvulsant primidone, also known as Mysoline, has proven to be especially effective as a tremor medication, even more so than propranolol. 1 to 7 hours after ingestion, a single oral dose of primidone can decrease tremors by up to 60%. Compared to head tremors, it is more successful in suppressing hand tremors. Despite its effectiveness, primidone is linked with considerable adverse drug reactions in 32% of patients with essential tremor. 13% of patients also developed a tolerance to this drug after a year of use.
• Gabapentin: Gabapentin, usually sold under the brand name Neurontin, is a short-term treatment for essential tremor. It can be combined with other drugs like propranolol or used alone. Studies on gabapentin’s efficacy as an essential tremor medication have had mixed results. One study reported a reduction in tremors on par with propranolol, while other studies revealed negative or modest results.

Potential primidone side effects

Compared to patients with epilepsy, primidone for tremors side effects seem to be much more prevalent. Some primidone for tremors side effects include:

• Restlessness
• Shakiness
• Unsteadiness
• Difficulty walking
• Nausea
• Chills
• Fainting spells
• Fever
• Irregular heartbeat

Potential gabapentin side effects

Gabapentin, unlike most meds for tremors, is relatively well tolerated by most patients with essential tremor. Gabapentin side effects include:

• Sedation
• Weight gain
• Irritability
• Difficulty walking
• Fatigue

Topiramate

Topiramate, known on the market as Topamax, is a carbonic anhydrase inhibitor medication used to treat seizures and migraines. It can also be a helpful medication for moderate to severe essential tremor, reducing tremor frequency while improving motor tasks, speaking, writing, and more.

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

Using topiramate as an essential tremor medication can come with the following side effects:

• Fatigue
• Weight loss
• Upper respiratory infection
• Nausea
• Nervousness

How Can You Reduce Your Tremor Naturally?

There is no cure for essential tremor, so patients dealing with this condition should work closely with a healthcare professional to closely observe and treat the progression of this nervous system disorder. Although many of the tremor 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.

Lifestyle Changes

Bettering your lifestyle, from changing your diet to fixing your sleep schedule, can also help keep your essential tremor symptoms at bay. For example, eating a Mediterranean diet that involves a foundation of plant-based foods and a moderate amount of dairy, seafood, and poultry can improve your condition. Tea, coffee, and other foods with caffeine, on the other hand, can exacerbate essential tremor as they can cause shaky hands on their own.

In addition to a well-balanced diet, physical therapy with a trained professional allows you to improve the strength and coordination of your muscle movements. Managing your stress is also imperative to improving your quality of life as someone with essential tremor. Concentrate on learning how to relax with deep breathing, meditation, and muscle relaxation when you feel stressed and frustrated.

Assistive Devices

Living with essential tremor does not have to be difficult and complicated. Assistive devices make the daily tasks impacted by essential tremor easier to complete. A weighted utensil or pen keeps the hand steady, while an ergonomic mouse or keyboard can make using the computer much more comfortable. These devices help you take back control of your life.

Cala TAPS Therapy

In addition to medications, lifestyle changes, and assistive devices, there is also a revolutionary alternative essential tremor therapy option available. The Cala device offers customized therapy in the form of a wearable that electrically stimulates specific 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.

The Cala device is calibrated to your unique tremor pattern. This non-invasive therapy is easy to use and effective. Cala TAPS therapy specifically targets the source of the tremor so you can accomplish your daily tasks more easily.

The Cala device is cleared by the FDA as a Class II Medical Device and only available with a prescription. Cala’s clinical studies demonstrated tremor improvement in 75% of patients after one 40-minute therapeutic session. Over 60% of patients report tremor relief for over an hour. 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 therapy are mild and may include discomfort due to the electrical stimulation, sensitivity to the electrodes, or slight skin irritation. You can still use your essential tremor medications alongside Cala therapy. You should not stop using your medications unless directed by your healthcare provider; it’s important to follow your doctor’s treatment plan and make adjustments.

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 therapy can be used in conjunction with essential tremor medications. Essential tremor symptoms may progress over time, but Cala’s revolutionary electrical stimulation can provide relief that allows you to live more independently. This non-invasive benign essential tremor treatment may help reduce the frequency and amplitude of tremors, so you can take on daily tasks more confidently.