The following information on medications has been reviewed by Rodger Elble, MD, Southern Illinois University School of Medicine, Springfield, IL, IETF Medical Advisory Board Member.
This information is not intended to be medical advice. Please discuss your medications with your treating physician.
Commonly Prescribed Medications
Propranolol is the only medication approved by the Food and Drug Administration (FDA) for the treatment of limb and head ET, and is available in immediate and long-acting formulations. Propranolol is a beta-blocker, which is a drug used primarily for treating high blood pressure. Side effects of propranolol are usually mild and are more frequent at higher doses. The main side effects are decreased pulse rate and blood pressure. If you have heart failure, diabetes, or asthma, talk with your doctor before taking propranolol. Other beta-blockers such as atenolol, metoprolol, and nadolol can also be beneficial for treating ET. For more detailed information visit https://www.drugs.com/propranolol.html
Primidone, an anti-seizure medicine, can reduce tremor with a daily dosage. Although it might have initial side effects, such as nausea, poor balance, dizziness, fatigue, drowsiness, and flu-like symptoms, there are few long-term problems. To reduce the possibility of side effects, it is recommended to start with a small dose at bedtime (12.5 mg or one-quarter of one tablet) and gradually increase the dose until tremor is suppressed. Please consult with your physician regarding medication and dosage. For more detailed information visit https://www.drugs.com/mtm/primidone.html
Clonazepam (Klonopin®), diazepam (Valium®), lorazepam (Ativan®), and alprazolam (Xanax®)
These anti-anxiety medications may be useful in patients who do not respond to other medications or who have associated anxiety. Side effects include sleepiness, dizziness, depression, fatigue, loss of coordination, memory loss, and confusion. These drugs are usually less effective than propranolol and primidone, and they can be addictive. There is also risk of withdrawal symptoms if the drugs are suddenly stopped. For more detailed information visit https://www.drugs.com/clonazepam.html
Gabapentin is a generally well tolerated anticonvulsant that has a modest benefit in ET. It is tried by patients whose tremor is unmanageable by other medications. Side effects include fatigue, slurred speech, drowsiness, impaired balance, and nausea especially when beginning drug therapy. Gabapentin requires multiple doses a day. For more detailed information visit https://www.drugs.com/gabapentin.html
Topiramate is an anticonvulsant that has been shown to be effective in controlling tremor in some patients. Side effects include numbness or tingling, memory loss, and weight loss. For more detailed information visit https://www.drugs.com/mtm/topiramate.html
Mirtazapine is an antidepressant. Due to its lack of effectiveness for the majority of patients and its significant side effects, mirtazapine is not recommended for the routine treatment of ET. Adverse effects include confusion, dry mouth, weight gain, frequent urination, balance and gait difficulty, nausea, and blurred vision. For more detailed information visit https://www.drugs.com/mirtazapine.html
Adults with ET often notice that responsibly drinking alcohol – having one or two drinks before social events for example – reduces tremor for one to two hours. One must consider, though, that a more severe rebound tremor can occur after the effects of alcohol have worn off, especially with excessive alcohol use.
The impact of cannabis on essential tremor has been debated for years. For every person who says CBD helps calm essential tremor, there is someone who says CBD has no impact on essential tremor. The IETF awarded grant funding to study the impact of CBD on essential tremor in 2017 and research is ongoing. Read more here
The cannabis plant has more than 100 compounds (such as THC, which is the psychoactive component, and cannabidiol, known as CBD that has not psychoactive components). The website, Cannabinoid Clinical
gives a comprehensive overview of science behind the plant and the history of medications.