Is lorazepam (Ativan) indicated for non-essential tremor, and what is a suitable medication for tremor?

From the Guidelines

Lorazepam is not indicated for tremors that are not essential tremor, and instead, medications like propranolol should be considered as a first-line treatment for various types of tremors. For non-essential tremors, the medication choice depends on the underlying cause.

• Propranolol, a beta-blocker, is often considered a good first-line medication for many types of tremors, including essential tremor, at doses ranging from 10-40 mg twice daily, as supported by its long history of use for essential tremor 1.
• For Parkinsonian tremors, medications like levodopa/carbidopa (starting at 25/100 mg three times daily) or dopamine agonists such as pramipexole (0.125-0.5 mg three times daily) are more appropriate.
• Primidone (starting at 12.5-25 mg at bedtime and gradually increasing) is another effective option for various tremors.
• Topiramate and gabapentin can also be considered for tremor management. The choice of medication should be based on the specific tremor type, underlying cause, and patient factors such as age and comorbidities. Treatment typically starts with a low dose and gradually increases to minimize side effects while monitoring for efficacy. If one medication is ineffective or poorly tolerated, switching to or adding another agent may be necessary.

From the Research

Lorazepam for Non-Essential Tremor

• Lorazepam is a benzodiazepine that may be effective in treating essential tremor, as mentioned in studies 2, 3.
• However, there is limited information on the use of lorazepam for non-essential tremor.
• The studies provided do not specifically address the use of lorazepam for non-essential tremor, but rather focus on essential tremor and other movement disorders.

Medications for Tremor

• Primidone and propranolol are first-line treatments for essential tremor, as stated in studies 3, 4.
• Other medications that may be effective for essential tremor include:
  • Benzodiazepines, such as lorazepam 2, 3
  • Gabapentin 2, 3
  • Topiramate 2, 3, 5
  • Botulinum toxin injections 2, 3, 5
• For non-essential tremor, the treatment options may vary depending on the underlying cause of the tremor.
• Carbidopa/levodopa may be effective in improving primary writing tremor in patients with Parkinson's disease, as shown in study 6.