'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.
