From the Guidelines
Many medications can cause tremors as a side effect, with common culprits including stimulants, psychiatric medications, seizure medications, immunosuppressants, and certain antibiotics. The most recent and highest quality study 1 suggests that SSRIs, a type of antidepressant, can cause tremors as a side effect. Some specific medications that can cause tremors include:
- Stimulants like albuterol, methylphenidate (Ritalin), and caffeine, which can cause tremors by overstimulating the nervous system 1
- Psychiatric medications such as lithium, antipsychotics (haloperidol, risperidone), and certain antidepressants (SSRIs like fluoxetine) may produce tremors by affecting neurotransmitter balance 1
- Seizure medications including valproic acid and carbamazepine can cause tremors, as can immunosuppressants like tacrolimus and cyclosporine
- Other medications that commonly cause tremors include thyroid replacement hormones when dosed too high, certain antibiotics, chemotherapy drugs, and corticosteroids The mechanism typically involves effects on the central nervous system, disruption of neurotransmitter function, or stimulation of the sympathetic nervous system. Tremors often resolve when the medication is discontinued or the dose is reduced, but always consult with a healthcare provider before making any medication changes, as sudden discontinuation can be dangerous for many of these drugs. It's also important to note that the risk of tremors can be increased when certain medications are combined, such as SSRIs and MAOIs, which can cause serotonin syndrome, a potentially life-threatening condition 1.
From the FDA Drug Label
Most common adverse reactions are (incidence ≥5%; ≥2× placebo rate): ... tremor... Adverse reactions have included ... tremor, ataxia, gait disturbance, vertigo, and dizziness It is presumed that the toxicity results from cumulative dopamine agonist effects.
Medications that can cause tremors include:
- Bupropion
- Dopaminergic drugs (levodopa and amantadine) when used concomitantly with bupropion
- Other medications that lower the seizure threshold (e.g., other bupropion products, antipsychotics, antidepressants, theophylline, or systemic corticosteroids) when used concomitantly with bupropion
- MAOIs when used concomitantly with bupropion (contraindicated due to increased risk of hypertensive reactions) Some key points to consider:
- Tremor is a common adverse reaction associated with bupropion
- Dopaminergic drugs (levodopa and amantadine) can increase the risk of tremor when used concomitantly with bupropion
- Medications that lower the seizure threshold can increase the risk of tremor when used concomitantly with bupropion
- MAOIs are contraindicated with bupropion due to increased risk of hypertensive reactions 2, 2, 2
From the Research
Medications that Can Cause Tremors
- Amiodarone 3
- Selective serotonin (and norepinephrine) reuptake inhibitors (SSRIs/SNRIs) 3, 4, 5
- Amitriptyline 3
- Lithium 3
- Valproate 3
- β-adrenoceptor agonists 3, 4
- Dopamine receptor antagonists 3
- VMAT2 inhibitors 3
- Drugs of abuse: ethanol, cocaine, etc. 3
- Caffeine 4
- Tricyclic antidepressants 4
- Venlafaxine 5
- Duloxetine 5
- Milnacipran 5
- Levomilnacipran 5
Characteristics of Drug-Induced Tremor
- Usually resembles essential or parkinsonian tremor, depending on the offending drug 3
- 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
- Risk factors for drug-induced tremor include polypharmacy, male gender, older age, high doses and immediate-release preparations or reaching toxic levels of the offending drugs 3