Doses and Side Effects of Medications for Tremor

(a common condition called “essential tremor”, different from Parkinson tremor).

Propranolol (non-selective beta-1, beta-2 blocker): has a spasmolytic action on skeletal muscle. This is the drug of choice. The doses range from 160-320mg. At higher doses, the pt will get hypotension, bradycardia, depression, fatigue, impotence, headache, breathlessness.

Primidone: metabolized to a barbiturate, causes relaxation. Side effects: sedation, nausea, vomiting.

Gabapentin (Neurontin): approved for epilepsy, approved for neuralgias, also effective in skeletal muscle tremor. Never to be used as a first line agent, probably always as an adjunct because of its side effects: drowsiness, fatique, slurred speech, imbalance, nausea, dizziness.

Alprazolam (Xanex): a benzodiazepine. Not first line therapy, but because of the tremor perhaps there is an anxiety component and the neurologist may consider this an underlying cause. Side effects include sedation, fatigue, tolerance.

Nimodipine: a calcium antagonist developed for HTN, with some effects on tremor. Because it’s a vasodilator, causes orthostatic hypotension.

Theophylline: a peculiar drug, it’s a caffeine derivative. Almost always taken for COPD.


The moral of the story is that there are a variety of drugs out there that physicians can prescribe. The one most important to you is low-dose Diazepam for night bruxism.

Category: Pharmacology Notes