From the Guidelines
Propranolol, a beta blocker, can be used to treat essential tremor, but its effectiveness varies for other types of tremors. When considering the use of beta blockers like propranolol for tremor treatment, it's crucial to understand that their efficacy is largely dependent on the type of tremor 1. For essential tremor, propranolol has been a viable treatment option for over 40 years, and other beta blockers such as metoprolol may also be effective 1. Key points to consider when using propranolol for tremor treatment include:
- The typical starting dose is 10-20mg taken 30-60 minutes before anticipated tremor-inducing situations, or 20-40mg twice daily for ongoing treatment.
- Doses can potentially increase up to 240mg daily if needed and tolerated.
- Propranolol is less effective for parkinsonian tremor, cerebellar tremor, or dystonic tremor.
- The medication works by blocking beta-adrenergic receptors, reducing the effects of adrenaline and related hormones that can worsen tremors.
- Patients should be aware that propranolol may cause side effects including fatigue, dizziness, and lowered blood pressure.
- It should be avoided by people with certain conditions like asthma, certain heart conditions, or diabetes. Given the potential benefits and risks, it is essential to consult with a healthcare provider before starting propranolol to determine if it's appropriate for the specific type of tremor and medical history 1.
From the Research
Types of Tremors
- Essential tremor: a common movement disorder that can be treated with propranolol, as shown in studies 2, 3, 4, 5, 6
- Limb tremor: propranolol is effective in reducing tremor severity, especially in the upper extremities 3, 4, 6
- Head tremor: propranolol has a poor effect on axial tremor symptoms, such as essential head tremor 6
- Voice tremor: propranolol has a poor effect on axial tremor symptoms, such as voice tremor 6
Efficacy of Propranolol
- Propranolol is classified as clinically useful for essential tremor, similar to primidone and topiramate (>200 mg/day) 2
- Propranolol reduces tremor severity by half in limb tremor 4
- Propranolol is effective in reducing upper limb action tremor, but has a poor effect on axial tremor symptoms 6
Alternative Treatments
- Primidone: an alternative treatment for essential tremor, similar to propranolol 2, 4
- Topiramate: an alternative treatment for essential tremor, especially at doses higher than 200 mg/day 2, 5
- Botulinum toxin injections: likely efficacious for limb, voice, and head tremor, but associated with side effects 4, 5
- Surgical interventions: deep brain stimulation, magnetic resonance-guided focused ultrasound, and thalamotomy for unilateral and bilateral procedures 2, 4