From the Research
For tremor, propranolol can be taken as needed (PRN) at a dose of 10-40 mg by mouth, typically starting at 10-20 mg per dose, as recommended by the most recent and highest quality study 1. This can be repeated every 4-6 hours as needed, not exceeding a total daily dose of 120-160 mg.
Key Considerations
- Start with the lowest effective dose and adjust based on response.
- Propranolol works quickly, usually within 30-60 minutes, by blocking beta-adrenergic receptors which reduces the effect of adrenaline on muscles, thereby decreasing tremor amplitude.
- It's particularly effective for situational tremors that occur during specific activities or stressful situations.
- Patients should be aware that propranolol may cause side effects such as fatigue, dizziness, or lowered blood pressure.
- Those with asthma, certain heart conditions, or diabetes should use it cautiously.
- If tremors become more frequent or severe, a scheduled (regular) dosing regimen rather than PRN might be more appropriate.
Supporting Evidence
- A study published in 2020 1 provides the most recent and highest quality evidence for the treatment of essential tremor with propranolol.
- Other studies, such as those published in 2003 2, 2014 3, 1975 4, and 1976 5, also support the use of propranolol for tremor, but are less recent or of lower quality.
Important Notes
- Propranolol is not a cure for essential tremor, but it can help reduce the severity of symptoms.
- Patients should be closely monitored for side effects and adjusted dosing regimens as needed.
- Alternative treatments, such as botulinum toxin injections or deep brain stimulation, may be considered for patients who do not respond to propranolol or have severe side effects.