From the Guidelines
Medications that can cause tremors as a side effect include stimulants, psychiatric medications, seizure medications, asthma medications, immunosuppressants, and certain antibiotics, with the most recent evidence suggesting that beta-blockers like propranolol can also be effective in treating essential tremor 1.
Common Medications that Cause Tremors
- Stimulants like caffeine, amphetamines (Adderall), and methylphenidate (Ritalin)
- Psychiatric medications such as lithium, antipsychotics (haloperidol, risperidone), and certain antidepressants (SSRIs like fluoxetine)
- Seizure medications including valproic acid and carbamazepine
- Asthma medications like albuterol and theophylline, with increased sensitivity to side effects like tremor and tachycardia in older adults 1
- Immunosuppressants such as cyclosporine and tacrolimus
- Certain antibiotics
- Thyroid medications that lead to hyperthyroidism
- Corticosteroids like prednisone
Mechanism of Action
These medications typically cause tremors by affecting neurotransmitter systems in the brain, particularly dopamine, norepinephrine, and serotonin pathways, or by stimulating the sympathetic nervous system 1.
Management
The tremors are often dose-dependent and may improve with dose reduction or medication discontinuation. If you experience tremors while taking medication, consult your healthcare provider before making any changes to your regimen, as abrupt discontinuation of some medications can cause serious withdrawal effects. Additionally, beta-blockers like propranolol may be used to treat essential tremor, as they have been shown to be effective in reducing tremor symptoms 1.
From the FDA Drug Label
Most common adverse reactions are (incidence ≥5%; ≥2× placebo rate): ... tremor ... The medication bupropion can cause tremor as one of its adverse reactions, with an incidence of ≥5% and at least twice the placebo rate 2.
From the Research
Medications that Cause Tremor
- The most common drugs associated with tremor include:
- Amiodarone
- Selective serotonin (and norepinephrine) reuptake inhibitors (SSRIs/SNRIs)
- Amitriptyline
- Lithium
- Valproate
- β-adrenoceptor agonists
- Dopamine receptor antagonists
- VMAT2 inhibitors
- Drugs of abuse: ethanol, cocaine, etc. 3
- Other medications that can cause or exacerbate tremors include:
- Caffeine
- Beta-adrenergic agonists
- Selective serotonin reuptake inhibitors
- Tricyclic antidepressants 4
- Psychiatric drugs that do not block dopamine receptors can also induce movement disorders, including tremor, such as:
- Serotonin reuptake inhibiting (SSRI) drugs
- Valproic acid
- Lithium 5
- Combinations of newer antidepressants and second-generation antipsychotics can also lead to pharmacokinetic and pharmacodynamic interactions, potentially causing tremor 6
- Certain antidepressants, such as fluoxetine, paroxetine, duloxetine, and bupropion, can increase the risk of hemodynamic adverse events when combined with β-blockers, potentially leading to tremor 7
Risk Factors for Drug-Induced Tremor
- Polypharmacy
- Male gender
- Older age
- High doses
- Immediate-release preparations
- Reaching toxic levels of the offending drugs 3
Clinical Features of Drug-Induced Tremor
- Drug-induced tremor usually resembles essential or parkinsonian tremor, depending on the offending drug
- Features such as unilateral, task-specific, position-dependent tremor or sudden onset, distractibility, entrainment, and arrest with contralateral movements suggest etiologies such as dystonic or functional (psychogenic) tremor 3