What is the effective medication and dosage for anxiety with tremors in an inpatient?

From the Guidelines

For an anxious inpatient experiencing tremors, a recommended medication is lorazepam (Ativan) at a dose of 0.5 to 1 mg orally every 6-8 hours as needed, as supported by recent guidelines 1. This recommendation is based on the most recent and highest quality study available, which suggests that lorazepam is a suitable option for managing anxiety and tremors in an inpatient setting.

Key Considerations

• Start with the lower dose of 0.5 mg and increase if necessary, as recommended by 1.
• The maximum daily dose should not exceed 4 mg in 24 hours for standard patients, and 2 mg in 24 hours for elderly or debilitated patients, as suggested by 1.
• For severe anxiety or tremors, the medication can be administered intravenously at 2 mg per mL, given slowly over 2-5 minutes, although this is not explicitly mentioned in the most recent guideline 1.

Mechanism of Action

Lorazepam is a benzodiazepine that works by enhancing the effects of GABA, a neurotransmitter that reduces brain activity, which helps to calm anxiety and reduce tremors.

Monitoring and Precautions

Monitor the patient closely for side effects such as drowsiness, dizziness, and potential respiratory depression, as cautioned by 1 and 1. Be cautious with long-term use due to the risk of dependence, and consider tapering the medication when discontinuing if used for more than a few days, as advised by 1 and 1.

Alternative Options

While other medications, such as propranolol, may be effective for essential tremor, as mentioned in 1, lorazepam is a more suitable option for managing anxiety and tremors in an inpatient setting, according to the most recent guideline 1.

From the FDA Drug Label

DOSAGE AND ADMINISTRATION Dosage should be individualized for maximum beneficial effect. Treatment for patients with anxiety should be initiated with a dose of 0.25 to 0.5 mg given three times daily. The dose may be increased to achieve a maximum therapeutic effect, at intervals of 3 to 4 days, to a maximum daily dose of 4 mg, given in divided doses.

The effective medication for anxiety with tremors in an inpatient is alprazolam (PO), with a recommended initial dose of 0.25 to 0.5 mg given three times daily, which may be increased to a maximum daily dose of 4 mg in divided doses. 2

From the Research

Effective Medication for Anxiety with Tremors in Inpatients

• The treatment of essential tremor includes medications, surgical options, and other forms of therapy 3.
• If the tremor is disabling only during periods of stress and anxiety, propranolol and benzodiazepines can be used during those periods when the tremor causes functional disability 3.
• The currently available medications can improve tremor in approximately 50% of the patients, with propranolol and primidone being the most commonly used medications 3, 4.

Dosage of Medication for Anxiety with Tremors in Inpatients

• The initial dose of propranolol can be 30 mg/day, which can be increased to 60 mg/day after 5 days, then to 90 mg/day on the 11th day, and continued thereafter for 20 days 5.
• Arotinolol can be used at a dose of 10 mg per day, 20 mg per day, or 30 mg per day, with each course of treatment lasting 6 weeks 6.
• Primidone can be used as an alternative to propranolol, with the dosage adjusted according to the patient's response 3, 4.

Comparison of Medications for Anxiety with Tremors in Inpatients

• Arotinolol was found to be as effective as propranolol at reducing tremor, with a more significant effect on motor-task performance scores 6.
• Low-frequency rTMS of the cerebellum significantly improved tremor severity, specific motor tasks, and functional disability, with no significant difference in efficacy compared to propranolol 5.
• Botulinum toxin injections into the muscles may provide relief from the tremor, especially in patients with disabling head or voice tremor 3, 4.