From the Research
The starting dose of propranolol for essential tremor is typically 10-20 mg taken orally two to three times daily. This low initial dose helps minimize side effects while beginning treatment. The dose can be gradually increased as needed and tolerated, with most patients requiring 120-320 mg total daily dose for optimal tremor control, as shown in a study where maximum tremor suppression occurred within a dose range between 160 and 320 mg/day 1. Propranolol works by blocking beta-adrenergic receptors, which reduces the effect of adrenaline and noradrenaline on these receptors, thereby decreasing tremor amplitude. This medication is most effective for action tremors (tremors that occur during voluntary movement) and postural tremors (tremors that occur when maintaining a position against gravity).
Some key points to consider when prescribing propranolol for essential tremor include:
- The dose may need to be individually adjusted, with some patients requiring lower doses, such as 30-40 mg daily in divided doses 2.
- A single oral dose of propranolol can produce a rapid and sustained reduction of essential tremor, with tremor suppression lasting up to 8 hours in some patients 3.
- Propranolol may cause side effects such as fatigue, dizziness, and bradycardia, and should be used with caution in patients with asthma, diabetes, heart failure, or certain cardiac conduction disorders.
- Taking propranolol with food can help reduce gastrointestinal side effects, and the medication should not be stopped abruptly but rather tapered gradually when discontinuing.
It's also important to note that propranolol has been shown to be effective in the treatment of essential tremor, with studies demonstrating significant improvements in tremor control and quality of life 4, 5. However, the response to propranolol can vary greatly between individuals, and some patients may not experience significant benefits or may experience adverse effects 5, 1.