From the Guidelines
For an anxious inpatient experiencing tremors, a recommended medication is lorazepam (Ativan), as it is a fast-acting benzodiazepine that can effectively reduce anxiety and tremors, as suggested by the 2006 Annals of Emergency Medicine study 1. Lorazepam works by enhancing the effects of GABA, a neurotransmitter that promotes relaxation in the brain and nervous system. This medication can provide quick relief, usually within 20-30 minutes of administration. When administering lorazepam:
- Monitor the patient closely for sedation and respiratory depression.
- Start with the lowest effective dose and titrate as needed.
- Use caution in elderly patients or those with liver impairment.
- Be aware of potential for dependence with prolonged use. For longer-term management, consider adding an SSRI antidepressant like sertraline (50-200 mg daily) or escitalopram (10-20 mg daily) to address underlying anxiety. These medications take several weeks to reach full effect but can provide more sustainable anxiety relief without the risk of dependence associated with benzodiazepines. It's also worth noting that beta-blockers like propranolol have been used to treat essential tremor for many years, as mentioned in the 2022 Hypertension study 2, but lorazepam is a more suitable option for anxiety with tremors in an inpatient setting due to its rapid onset of action and effectiveness in reducing anxiety symptoms. The dosage of lorazepam can be started with 0.5 to 1 mg orally every 6-8 hours as needed, with a maximum of 4 mg per day, as a general guideline. However, the specific dosage and treatment plan should be individualized based on the patient's response and medical history.
From the FDA Drug Label
Lorazepam Oral Concentrate USP is indicated for the management of anxiety disorders or for the short-term relief of the symptoms of anxiety or anxiety associated with depressive symptoms. Lorazepam Oral Concentrate is a prescription medicine used: to treat anxiety disorders for the short-term relief of the symptoms of anxiety or anxiety that can happen with symptoms of depression
Lorazepam is effective for anxiety. However, the provided drug labels do not directly address the issue of tremors.
- The labels mention that lorazepam can cause side effects such as weakness, unsteadiness, and muscle twitching, but they do not specifically discuss its effectiveness in treating tremors.
- Therefore, based on the provided information, lorazepam may be used to treat anxiety in an inpatient setting, but its effectiveness for tremors is unclear 3, 4.
From the Research
Medication Options for Anxiety with Tremors in Inpatients
- Propranolol, a nonselective beta-adrenergic blocker, has been used as a standard treatment for essential tremor (ET) 5, 6.
- Primidone, an antiepileptic drug, has also shown higher efficacy in the treatment of ET 7, 8.
- Topiramate and phenobarbital could be alternative drugs for ET treatment, according to certain evidence-based guidelines 7.
- Botulinum toxin A injections may be useful for patients with refractory ET, especially those with head tremor 7, 8.
- Other drugs, such as T calcium channel blockers, modulators of GABAA receptors, GABAB receptors, and glutamatergic neurotransmission, and drugs that decrease the expression of LINGO-1, could be interesting options for future treatment of ET 7, 8.
Comparison of Treatment Options
- A study compared the antitremor effect of 1-Hz cerebellar repetitive transcranial magnetic stimulation (rTMS) and propranolol in ET patients, and found that both treatments could be effective options, but it is not clear which method is more effective 5.
- Propranolol has been shown to potentially reduce upper limb action tremor, but has a poor effect on axial tremor symptoms, such as essential head tremor and voice tremor 6.