From the FDA Drug Label
In a 34-week, placebo-controlled, 4-period, dose-finding crossover study with a double-blind randomized treatment sequence, 62 patients with migraine received propranolol 20 to 80 mg 3 or 4 times daily The headache unit index, a composite of the number of days with headache and the associated severity of the headache, was significantly reduced for patients receiving propranolol as compared to those on placebo
The treatment approach for essential tremor in a patient with hypertension is not directly addressed in the provided drug labels. However, propranolol is used to treat migraine and hypertension.
- Propranolol can be used to treat essential tremor although it is not explicitly stated in the labels.
- Propranolol is used to treat hypertension.
- The dosage of propranolol for migraine is 20 to 80 mg 3 or 4 times daily.
- The dosage of propranolol for hypertension is not specified in the labels, but it is mentioned that 120 mg t.i.d. was used in a study. It is essential to consult a healthcare professional to determine the best course of treatment for a patient with essential tremor and hypertension. 1 1
From the Research
For treating essential tremor with hypertension, propranolol is the first-line medication as it effectively addresses both conditions, as supported by the most recent study 2. Start with 20-40mg twice daily, gradually increasing to 120-320mg daily as needed for tremor control. Beta-blockers like propranolol work by blocking beta-adrenergic receptors, reducing sympathetic nervous system activity which lowers blood pressure and decreases tremor amplitude. Some key points to consider when treating essential tremor with hypertension include:
- If propranolol is contraindicated or ineffective, consider primidone (starting at 12.5-25mg at bedtime, increasing gradually to 100-250mg three times daily) for tremor, alongside a different antihypertensive like an ACE inhibitor or calcium channel blocker, as suggested by 3 and 4.
- For patients with severe tremor unresponsive to medications, referral for deep brain stimulation may be appropriate while maintaining separate hypertension management, as indicated by 2.
- Lifestyle modifications including limiting caffeine, alcohol, and stress can help manage both conditions, as generally recommended for patients with essential tremor.
- Regular monitoring of blood pressure and tremor severity is essential to adjust medication dosages appropriately, ensuring the best possible outcome for the patient. It's also important to note that other beta-blockers, such as those with partial agonist activity, may induce or exacerbate tremor, as reported in 5. Therefore, propranolol remains the preferred choice for treating essential tremor in patients with hypertension, due to its efficacy in addressing both conditions, as supported by the latest evidence 2.