4.9.3 Essential tremor

Essential tremor

ChoiceDrugDosage
1st choicePropranolol tablets 10mg, 40mg, 80mg, 160mg; capsules m/r 80mg, 160mgDose:
Essential tremor: initially 40mg 2-3 times daily, increased if necessary; maintenance 80-160mg daily

'As required' use may be appropriate (see notes below)

Prescribing Notes

  • Propranolol may be used on an ‘as required’ basis e.g. where tremor is troublesome in stressful situations e.g. social events or work engagements.
  • The continued benefit of treatment with a beta blocker should be reviewed.
  • Primidone may be useful for essential tremor in patients unable to take beta-blockers due to, for example, asthma, bradycardia or peripheral vascular disease, although primidone can be poorly tolerated e.g. due to somnolence.

Cautions

  • Beta-blockers should usually be avoided in patients with a history of asthma, bronchospasm or a history of obstructive airways disease.