From the Guidelines
Carvedilol (Coreg) is not a recommended treatment for essential tremor, as the most recent and highest quality evidence suggests that propranolol and other selective beta-blockers are more effective for this condition. According to the study published in Hypertension in 2022 1, propranolol has been used to treat essential tremor for more than 40 years, and other beta-blockers like metoprolol may also be effective. The study does not mention carvedilol as a preferred treatment for essential tremor.
The mechanism behind beta-blockers' effectiveness for tremor involves blocking peripheral beta-2 adrenergic receptors in skeletal muscle, reducing the amplitude of physiologic tremor. Carvedilol has both beta and alpha blocking properties, which may limit its effectiveness for tremor compared to selective beta-blockers.
If a beta-blocker is used for essential tremor, dosing usually starts at a low dose and may be titrated up as needed and tolerated. For example, propranolol is typically started at 40-80 mg daily and may be increased up to 320 mg daily 1. Patients should be monitored for side effects including fatigue, dizziness, hypotension, and bradycardia. Those with asthma, certain cardiac conditions, or diabetes should use beta-blockers cautiously.
Alternatives to beta-blockers for essential tremor include primidone, topiramate, gabapentin, or benzodiazepines, though each has its own side effect profile. The choice of treatment should be individualized based on the patient's medical history, comorbidities, and response to treatment.
Key points to consider when treating essential tremor include:
- Propranolol and other selective beta-blockers are preferred treatments
- Carvedilol is not a recommended treatment due to its combined beta and alpha blocking properties
- Patients should be monitored for side effects and treated cautiously if they have certain medical conditions
- Alternative treatments are available if beta-blockers are ineffective or not tolerated.
From the Research
Effectiveness of Carvedilol for Essential Tremor
- There is no direct evidence in the provided studies to support the effectiveness of Carvedilol (Coreg) for treating essential tremor 2, 3, 4, 5, 6.
- The studies suggest that propranolol and primidone are considered effective treatments for essential tremor, while other medications such as topiramate, atenolol, and alprazolam may also be effective 2, 3, 4, 5, 6.
- Beta-adrenoceptor antagonists, such as atenolol and metoprolol, are mentioned as alternative options for patients who experience adverse effects with propranolol, but Carvedilol is not specifically mentioned 2, 6.
- The lack of evidence on Carvedilol's effectiveness for essential tremor suggests that it may not be a recommended treatment option for this condition 2, 3, 4, 5, 6.