From the FDA Drug Label
Nervous System Abnormal coordination, depersonalization, emotional lability, hyperkinesia, hypertonia, hypesthesia, vertigo, amnesia, ataxia, derealization, abnormal electroencephalogram (EEG), aggression, akinesia, aphasia, coma, dysarthria, dyskinesia, dystonia, euphoria, extrapyramidal syndrome, hypokinesia, increased libido, neuralgia, neuropathy, paranoid ideation, restlessness, suicide attempt, and unmasking tardive dyskinesia. 7. 4 Dopaminergic Drugs (Levodopa and Amantadine) Bupropion, levodopa, and amantadine have dopamine agonist effects. CNS toxicity has been reported when bupropion was coadministered with levodopa or amantadine. Adverse reactions have included restlessness, agitation, tremor, ataxia, gait disturbance, vertigo, and dizziness
The medications that can make tremors worse are:
- Bupropion: due to its effects on the nervous system, including hyperkinesia, dyskinesia, and extrapyramidal syndrome, as well as its interaction with dopaminergic drugs.
- LevETIRAcetam: is not directly mentioned in the label, but other medications that affect the nervous system may contribute to tremors.
- Dextroamphetamine-amphetamine: can cause nervous system effects, including tremors, but this is not explicitly stated in the provided label.
- FLUoxetine: can cause nervous system effects, but the label does not explicitly mention tremors. The following medications may also contribute to tremors due to their effects on the nervous system, although this is not explicitly stated in the provided label:
- Gabapentin
- LORazepam
From the Research
Several medications in this list can potentially worsen tremors, including dextroamphetamine-amphetamine, fluoxetine, bupropion, and lorazepam. The most recent and highest quality study, 1, published in 2022, highlights that selective serotonin reuptake inhibitors (SSRIs), such as fluoxetine, can cause or exacerbate tremors. Additionally, stimulants like dextroamphetamine-amphetamine can increase central nervous system activity, leading to tremors as a side effect. Bupropion, an antidepressant, can also cause tremors due to its effects on dopamine and norepinephrine, as noted in 2 and 3. Lorazepam, while used to treat tremors, can paradoxically worsen them during withdrawal or when doses are missed. It is essential to discuss any tremors with a healthcare provider, as they may adjust dosages, switch medications, or add treatments specifically for tremor management, considering the timing of tremors in relation to medication administration to identify the causative medication. Other medications, such as beta-adrenergic agonists and dopamine receptor antagonists, can also induce tremors, as mentioned in 1. However, the primary concern with the provided medication list is the potential of dextroamphetamine-amphetamine, fluoxetine, bupropion, and lorazepam to worsen tremors. Given the potential for these medications to exacerbate tremors, it is crucial to monitor their effects closely and adjust treatment plans as necessary to minimize morbidity, mortality, and improve quality of life. The study 1 provides the most recent and comprehensive overview of drug-induced tremors, emphasizing the importance of recognizing and managing medication-related tremors to prevent unnecessary tests and allow for prompt corrective action. In clinical practice, prioritizing the most recent and highest quality evidence, such as 1, is essential for making informed decisions about medication management and minimizing the risk of adverse effects like tremors.