From the FDA Drug Label
The most commonly observed adverse events in placebo-controlled, parallel-group, add-on epilepsy trials associated with the use of tiagabine hydrochloride in combination with other antiepilepsy drugs not seen at an equivalent frequency among placebo-treated patients were dizziness/light-headedness, asthenia/lack of energy, somnolence, nausea, nervousness/irritability, tremor, abdominal pain, and thinking abnormal/difficulty with concentration or attention. Among these events, depression, tremor, nervousness, difficulty with concentration/attention, and perhaps asthenia exhibited a positive relationship to dose A higher percentage of patients above 65 years of age reported accidental injury, infection, pain, somnolence, and tremor.
Tremors can be a side effect of certain antiepileptic drugs (AEDs), including Tiagabine and Valproic acid. According to the drug labels, tremor is listed as an adverse event associated with the use of Tiagabine 1 and Valproic acid 2. Therefore, it is possible that Valproic acid and Tiagabine could cause tremors in a patient with epilepsy.
- Valproic acid and Tiagabine are the AEDs that could commonly cause tremors.
- The correct answer is D Valproic acid and Tiagabine. 1, 1, 2
From the Research
Yes, antiepileptic drugs (AEDs) such as Valproic acid and Tiagabine can cause tremors in patients with epilepsy. Tremor is one of the more common side effects of Valproic acid (also known as Depakote), typically presenting as a fine postural tremor similar to essential tremor that affects the hands. This side effect is often dose-dependent, meaning higher doses increase the risk of tremors. Tiagabine (Gabitril) can also cause tremors, though less frequently than Valproic acid. These medication-induced tremors typically develop gradually after starting the medication or increasing the dose. If a patient experiences troublesome tremors, dose reduction may help alleviate symptoms while maintaining seizure control. In some cases, adding a beta-blocker like propranolol (10-40 mg two to three times daily) can reduce tremor severity while continuing the necessary AED therapy. The mechanism behind these tremors involves the drugs' effects on neurotransmitter systems, particularly GABA pathways and possibly cerebellar function, as discussed in 3. Patients should be advised not to discontinue their AEDs without medical consultation, as sudden withdrawal could trigger seizures, but rather to report tremors to their healthcare provider for appropriate management. Key characteristics of valproate-induced tremor, such as high frequency and low amplitude, have been identified in studies like 4, which can help distinguish it from essential tremor. Moreover, distinguishing features between valproate-induced tremor and essential tremor have been explored in research, including differences in patient age and tremor evolution time, as noted in 5. Given the potential for AEDs to cause tremors, it is essential to monitor patients for this side effect and adjust treatment plans accordingly to minimize morbidity and maintain quality of life. The most recent and highest quality study, 3, supports the notion that valproate is among the drugs commonly associated with tremor, further emphasizing the need for careful consideration in the selection and management of AEDs. Therefore, Valproic acid and Tiagabine are indeed AEDs that could commonly cause tremors, as supported by the evidence from 6 and 3, highlighting the importance of vigilant monitoring and management of potential side effects in patients with epilepsy.