Can gliclazide, dapagliflozin, sitagliptin (Januvia), metformin, or telmisartan cause essential tremors?

Medications That Can Cause Essential Tremors

None of the medications mentioned (gliclazide, dapagliflozin, sitagliptin/Januvia, metformin, or telmisartan) are known to cause essential tremors. Based on the available evidence, these diabetes and hypertension medications are not associated with essential tremor as an adverse effect.

Medication Review and Tremor Risk

Diabetes Medications

1. Gliclazide (Sulfonylurea)

   • Not associated with essential tremor in the literature 1
   • Main adverse effects include hypoglycemia risk, which can cause tremor-like symptoms that might be confused with essential tremor, but this is a different phenomenon

2. Dapagliflozin (SGLT2 inhibitor)

   • No documented association with essential tremor 1, 2
   • Main side effects include genital mycotic infections, volume depletion, and risk of euglycemic ketoacidosis

3. Sitagliptin (Januvia - DPP-4 inhibitor)

   • No evidence linking it to essential tremor 1, 2
   • Generally well-tolerated with no neurological tremor effects documented

4. Metformin

   • No association with essential tremor in the evidence 1, 2
   • Long-term use may cause vitamin B12 deficiency, but this is not linked to tremor development

5. Telmisartan (ARB)

   • No documented association with essential tremor 1
   • While listed among medications with potential photosensitivity reactions, it is not linked to tremor disorders

Understanding Essential Tremor

Essential tremor is a neurological disorder characterized by involuntary rhythmic shaking, most commonly affecting the hands during voluntary movements. Based on the research evidence:

• The primary medications used to treat essential tremor are propranolol (a beta-blocker) and primidone (an anticonvulsant) 3, 4
• Other medications sometimes used include other beta-blockers (atenolol, metoprolol), benzodiazepines, gabapentin, and topiramate 5, 6
• Essential tremor is thought to involve GABAergic mechanisms in the central nervous system 7

Medications Known to Cause or Worsen Tremor

While the medications you asked about are not associated with essential tremor, it's worth noting that certain other medications can cause or exacerbate tremors:

• Stimulants (caffeine, amphetamines)
• Some psychiatric medications (lithium, valproate, some antipsychotics)
• Certain bronchodilators
• Some immunosuppressants
• Thyroid hormone excess
• Corticosteroids
• Some chemotherapy agents

Clinical Implications

If a patient is experiencing tremors while taking these diabetes or hypertension medications:

1. Consider hypoglycemia as a potential cause, especially with sulfonylureas like gliclazide
2. Evaluate for other medication interactions or newly added drugs
3. Assess for underlying neurological conditions unrelated to these medications
4. Consider referral to neurology if tremor persists and is functionally limiting

Conclusion

The medications you inquired about (gliclazide, dapagliflozin, sitagliptin/Januvia, metformin, and telmisartan) are not known to cause essential tremor based on current evidence. If a patient develops tremor while taking these medications, alternative causes should be investigated.