Sections

Medication

Medication Summary

Beta-adrenergic blockers (principally propranolol) and primidone are the first-line treatments for essential tremor. Each provides good benefit in 50–70% of cases and neither has been demonstrated to be unequivocally superior to the other. Adverse effects are more prominent early in treatment with primidone but are more prominent later in treatment with propranolol. Starting with propranolol is preferable in younger individuals, and primidone is commonly started first in older patients.

Patients who require medication treatment are usually started on one of these medications. The drug is introduced at a low dose and is increased slowly until complete response, intolerability, or usual maximum dose is attained. If some benefit is achieved but is incomplete, the other medication may be added, and slowly increased in an effort to achieve maximum benefit. Treatment with both drugs has been shown to be effective in patients who have had an insufficient response to one. Patients should not expect complete resolution of symptoms.

More evidence exists to support effectiveness in upper extremity tremor than in head or lower extremity tremor. A decrease in tremor amplitude is the usual response, although some evidence indicates that primidone may decrease tremor frequency as well.

For patients who do not achieve an adequate response with primidone and propranolol, the authors try topiramate. Gabapentin and clonazepam may also be tried.

Class Summary

The mechanism of action in the reduction of essential tremor is not known. The action is hypothesized to be mediated primarily by peripheral beta2 adrenoreceptors, but some evidence indicates that beta1-receptor antagonists such as metoprolol also have some efficacy. Peripheral beta2 adrenoreceptors are located in the extrafusal muscle fibers and on the intrafusal fibers of the muscle spindles.

Propranolol hydrochloride (Inderal, InnoPran XL)

View full drug information

Propranolol, 1 of 2 medications of choice for essential tremor, has been shown to be effective in double-blind, placebo-controlled trials. It is a nonselective beta-adrenergic blocker with negative inotropic, chronotropic, and dromotropic properties. Propranolol is lipophilic with central nervous system (CNS) effects. Its mechanism of action is probably related to peripheral beta2 antagonism. The drug's long-acting formulation has efficacy similar to that of the standard formulation and may allow fewer daily doses.

In general, beta1-receptor antagonists are more effective than placebo but are not as effective as beta2-receptor antagonists. Metoprolol, a relatively selective beta1-receptor antagonist, may be useful in patients with asthma and other pulmonary conditions. May be used as monotherapy or in combination with primidone.

Class Summary

Some agents in this class have demonstrated tremor-suppressing effects. Their mechanism of action is unknown, but it presumably involves the CNS.

Primidone (Mysoline)

View full drug information

Primidone is metabolized to phenobarbital and PEMA. It has tremor-suppressing activity independent of plasma concentrations of phenobarbital and is thought to be superior to phenobarbital. PEMA is not tremorolytic. Primidone is believed to have an independent mechanism for its effect on tremor.

It is strongly recommended that treatment with primidone be initiated with low doses because adverse effects at initiation of treatment are common. Start with one quarter or one half of a 50-mg tablet at bedtime and increase the dose slowly every week. Alternatively, introduce primidone using a 250 mg/5 mL suspension. Start with 1 drop at bedtime and increase the dose by 1 drop each night for 20 nights. Then convert the patient to a 50-mg tablet and increase the dose slowly every week.

For patients who initially respond to primidone but later develop a tolerance to it, increasing the dose to as high as 1000 mg/day in an effort to regain benefit is advisable.

Topiramate (Topamax, Qudexy XR, Topamax Sprinkle, Trokendi XR)

View full drug information

Topiramate's mechanism of action is unknown, but the blockage of voltage-dependent sodium channels and the augmentation of GABA are thought to play a role. Topiramate is not extensively metabolized and is excreted unchanged in the urine.

Clonazepam (Klonopin)

View full drug information

Benzodiazepines, particularly clonazepam, are commonly used in treating essential tremors, but their effectiveness is limited. Clonazepam may probably work to reduce anxiety, which can amplify tremor amplitude. May also enhance GABA activity.

Gabapentin (Gralise, Neurontin)

View full drug information

Gabapentin, a membrane stabilizer, is a structural analog of the inhibitory neurotransmitter GABA, although it is thought not to exert an effect on GABA receptors. Appears to exert its action via the alpha(2)delta1 and alpha(2)delta2 auxiliary subunits of voltage-gated calcium channels. May also modulate excitatory neurotransmitter release.

Questions

Wagle Shukla, MD. Diagnosis and Treatment of Essential Tremor. CONTINUUM (MINNEAP MINN). 2022. 28(5, MOVEMENT DISORDERS):1333–1349.
Bhatia KP, Bain P, Bajaj N, et al. Consensus statement on the classification of tremors. From the task force on tremor of the International Parkinson and Movement Disorder Society. Mov Disord. 2018. 33(1):75-87.
Louis ED, Bares M, Benito-Leon J, et al. Essential tremor-plus: a controversial new concept. Lancet Neurol. 2020. 19(3):266-270.
M Bologna G. Paparella, D. Colella, A et Al. Is there evidence of bradykinesia in essential tremor?. European Journal of Neurology. 2020. 27:1501– 1509.
Cuberas-Borrós G, Lorenzo-Bosquet C, Aguadé-Bruix S, et al. Quantitative evaluation of striatal I-123-FP-CIT uptake in essential tremor and parkinsonism. Clin Nucl Med. 2011 Nov. 36(11):991-6. [QxMD MEDLINE Link].
Antonini A, Berto P, Lopatriello S, Tamma F, Annemans L, Chambers M. Cost-effectiveness of 123I-FP-CIT SPECT in the differential diagnosis of essential tremor and Parkinson's disease in Italy. Mov Disord. 2008 Nov 15. 23(15):2202-9. [QxMD MEDLINE Link].
Tolosa E, Borght TV, Moreno E. Accuracy of DaTSCAN (123I-Ioflupane) SPECT in diagnosis of patients with clinically uncertain parkinsonism: 2-year follow-up of an open-label study. Mov Disord. 2007 Dec. 22(16):2346-51. [QxMD MEDLINE Link].
Ferreira JJ, Mestre TA, Lyons KE, et al. MDS evidence-based review of treatments for essential tremor. Mov Disord. 2019. 34(7):950-958.
Louis ED. Treatment of Essential Tremor: Are there Issues We are Overlooking?. Front Neurol. 2011. 2:91. [QxMD MEDLINE Link]. [Full Text].
Elias WJ, Lipsman N, Ondo WG, Ghanouni P, Kim YG, Lee W, et al. A Randomized Trial of Focused Ultrasound Thalamotomy for Essential Tremor. N Engl J Med. 2016 Aug 25. 375 (8):730-9. [QxMD MEDLINE Link].
Walter AR, Bower JH, Ahlskog JE et al. Increased risk of essential tremor in first-degree relative of patients with Parkinson’s disease. Mov Disord. Aug 15 2007. 22(11):
Louis ED, Vonsattel JP. The emerging neuropathology of essential tremor. Mov Disord. 2008 Jan 30. 23(2):174-82. [QxMD MEDLINE Link].
Shill HA, Adler CH, Sabbagh MN, et al. Pathologic findings in prospectively ascertained essential tremor subjects. Neurology. 2008 Apr 15. 70(16 Pt 2):1452-5. [QxMD MEDLINE Link].
Louis ED, Zheng W, Mao X, Shungu DC. Blood harmane is correlated with cerebellar metabolism in essential tremor: a pilot study. Neurology. 2007 Aug 7. 69(6):515-20. [QxMD MEDLINE Link].
Louis ED, Honig LS, Vonsattel JP, Maraganore DM, Borden S, Moskowitz CB. Essential tremor associated with focal nonnigral Lewy bodies: a clinicopathologic study. Arch Neurol. 2005 Jun. 62(6):1004-7. [QxMD MEDLINE Link].
Louis ED, Vonsattel JP, Honig LS, Ross GW, Lyons KE, Pahwa R. Neuropathologic findings in essential tremor. Neurology. 2006 Jun 13. 66(11):1756-9. [QxMD MEDLINE Link].
Shin DH, Han BS, Kim HS, Lee PH. Diffusion tensor imaging in patients with essential tremor. AJNR Am J Neuroradiol. 2008 Jan. 29(1):151-3. [QxMD MEDLINE Link].
Bermejo-Pareja F, Louis ED, Benito-Leon J. Risk of incident dementia in essential tremor: a population-based study. Mov Disord. 2007 Aug 15. 22(11):1573-80. [QxMD MEDLINE Link].
Benito-Leon J, Louis ED, Bermejo-Pareja F. Elderly-onset essential tremor is associated with dementia. Neurology. 2006 May 23. 66(10):1500-5. [QxMD MEDLINE Link].
Klebe S, Stolze H, Grensing K, Volkmann J, Wenzelburger R, Deuschl G. Influence of alcohol on gait in patients with essential tremor. Neurology. 2005 Jul 12. 65(1):96-101. [QxMD MEDLINE Link].
Daniels C, Peller M, Wolff S, et al. Voxel-based morphometry shows no decreases in cerebellar gray matter volume in essential tremor. Neurology. 2006 Oct 24. 67(8):1452-6. [QxMD MEDLINE Link].
Ross GW, Dickson D, Cersosimo M. Pathological investigation of essential tremor. Neurology. Apr 2004. 62(7) S5:A537-A538.
Ma S, Davis TL, Blair MA, et al. Familial essential tremor with apparent autosomal dominant inheritance: should we also consider other inheritance modes?. Mov Disord. 2006 Sep. 21(9):1368-74. [QxMD MEDLINE Link].
Deng H, Le W, Jankovic J. Genetics of essential tremor. Brain. 2007 Jun. 130:1456-64. [QxMD MEDLINE Link].
Higgins JJ, Pho LT, Nee LE. A gene (ETM) for essential tremor maps to chromosome 2p22-p25. Mov Disord. 1997 Nov. 12(6):859-64. [QxMD MEDLINE Link].
Shatunov A, Sambuughin N, Jankovic J, et al. Genomewide scans in North American families reveal genetic linkage of essential tremor to a region on chromosome 6p23. Brain. 2006 Sep. 129:2318-31. [QxMD MEDLINE Link].
Higgins JJ, Lombardi RQ, Pucilowska J, Jankovic J, Tan EK, Rooney JP. A variant in the HS1-BP3 gene is associated with familial essential tremor. Neurology. 2005 Feb 8. 64(3):417-21. [QxMD MEDLINE Link].
Thier S, Lorenz D, Nothnagel M, et al. LINGO1 polymorphisms are associated with essential tremor in Europeans. Mov Disord. 2010 Apr 30. 25(6):717-23. [QxMD MEDLINE Link].
Clark LN, Park N, Kisselev S, Rios E, Lee JH, Louis ED. Replication of the LINGO1 gene association with essential tremor in a North American population. Eur J Hum Genet. 2010 Jul. 18(7):838-43. [QxMD MEDLINE Link]. [Full Text].
Tan EK, Teo YY, Prakash KM, et al. LINGO1 variant increases risk of familial essential tremor. Neurology. 2009 Oct 6. 73(14):1161-2. [QxMD MEDLINE Link]. [Full Text].
Louis ED et Al. Regional and Racial Differences in the Prevalence of Physician- Diagnosed Essential Tremor in the United States. Movement Disorders. 2003. Vol. 18, No. 9:pp. 1035–1040.
Song P, Zhang Y, ZHa M, Yang Q, Ye X, Yi Q, et al. The global prevalence of essential tremor, with emphasis on age and sex: A meta-analysis. J Glob Health. 2021. 11:04029:
Louis ED, Barnes LF, Ford B, Pullman SL, Yu Q. Ethnic differences in essential tremor. Arch Neurol. 2000 May. 57(5):723-7. [QxMD MEDLINE Link].
Tan EK, Lum SY, Prakash KM. Clinical features of childhood onset essential tremor. Eur J Neurol. 2006 Dec. 13(12):1302-5. [QxMD MEDLINE Link].
Louis ED, Dogu O. Does age of onset in essential tremor have a bimodal distribution? Data from a tertiary referral setting and a population-based study. Neuroepidemiology. 2007. 29(3-4):208-12. [QxMD MEDLINE Link].
Louis ED, Ottman R. Study of possible factors associated with age of onset in essential tremor. Mov Disord. 2006 Nov. 21(11):1980-6. [QxMD MEDLINE Link].
Louis ED, Benito-Leon J, Ottman R, Bermejo-Pareja F. A population-based study of mortality in essential tremor. Neurology. 2007 Nov 20. 69(21):1982-9. [QxMD MEDLINE Link].
Rajput A, Robinson CA, Rajput AH. Essential tremor course and disability: A clinicopathologic study of 20 cases. Neurology. 2004 Mar 23. 62(6):932-6. [QxMD MEDLINE Link].
Chatterjee A, Jurewicz EC, Applegate LM, Louis ED. Personality in essential tremor: further evidence of non-motor manifestations of the disease. J Neurol Neurosurg Psychiatry. 2004 Jul. 75(7):958-61. [QxMD MEDLINE Link].
Miller KM, Okun MS, Fernandez HF, Jacobson CE 4th, Rodriguez RL, Bowers D. Depression symptoms in movement disorders: comparing Parkinson's disease, dystonia, and essential tremor. Mov Disord. 2007 Apr 15. 22(5):666-72. [QxMD MEDLINE Link].
Benito-Leon J, Louis ED, Bermejo-Pareja F. Reported hearing impairment in essential tremor: a population-based case-control study. Neuroepidemiology. 2007. 29(3-4):213-7. [QxMD MEDLINE Link].
Ondo W, Jankovic J, Schwartz K, Almaguer M, Simpson RK. Unilateral thalamic deep brain stimulation for refractory essential tremor and Parkinson's disease tremor. Neurology. 1998 Oct. 51(4):1063-9. [QxMD MEDLINE Link].
Stolze H, Petersen G, Raethjen J, Wenzelburger R, Deuschl G. The gait disorder of advanced essential tremor. Brain. 2001 Nov. 124:2278-86. [QxMD MEDLINE Link].
Deeb J. Gannon K. Shah M, et al. Comparison of datscan imaging and smell testing in essential tremor and Parkinson disease. Jr Neurol, Neurosurg. & Psych. Sept 2007. 78(9):1018-1019.
Findley LJ, Shah M. Muhammed N, et al. Olfactory tests distinguish essential from parkinsonian tremor. Evidence of enhanced detection and age resistance in familial essential tremor. J Neurol Neurosurg Psych. Jan 2006. 77(1):140.
Robert A. Hauser, MD, Donald G. Grosset, MD. [123I]FP-CIT (DaTscan) SPECT Brain Imaging in Patients with Suspected Parkinsonian Syndromes. J Neuroimaging. 2012. 22:225-230.
Doep F. Plotkin M, Siegel L. Brain parenchyma sonography and 123I-FP-CIT SPECT in Parkinson’s disease and essential tremor. Mov. Disord. Dec 7 1007. 23(3):(405-410).
Stockner H, Sojer M, K KS, et al. Midbrain sonography in patients with essential tremor. Mov Disord. 2007 Feb 15. 22(3):414-7. [QxMD MEDLINE Link].
Luo WF, Zhang YC, Sheng YJ, Fang JC, Liu CF. Transcranial sonography on Parkinson's disease and essential tremor in a Chinese population. Neurol Sci. 2011 Dec 11. [QxMD MEDLINE Link].
Kim JS, Oh YS, Kim YI, Koo JS, Yang DW, Lee KS. Transcranial sonography (TCS) in Parkinson's disease (PD) and essential tremor (ET) in relation with putative premotor symptoms of PD. Arch Gerontol Geriatr. 2012 Jan 23. [QxMD MEDLINE Link].
di Biase L, Brittain JS, Shah SA, Pedrosa DJ, Cagnan H, Mathy A, et al. Tremor stability index: a new tool for differential diagnosis in tremor syndromes. Brain. 2017 Jul 1. 140 (7):1977-1986. [QxMD MEDLINE Link].
Koller WC, Vetere-Overfield B. Acute and chronic effects of propranolol and primidone in essential tremor. Neurology. 1989 Dec. 39(12):1587-8. [QxMD MEDLINE Link].
Winkler GF, Young RR. Efficacy of chronic propranolol therapy in action tremors of the familial, senile or essential varieties. N Engl J Med. 1974 May 2. 290(18):984-8. [QxMD MEDLINE Link].
Teräväinen H, Fogelholm R, Larsen A. Effect of propranolol on essential tremor. Neurology. 1976 Jan. 26(1):27-30. [QxMD MEDLINE Link].
Fytagoridis A, Sandvik U, Aström M, Bergenheim T, Blomstedt P. Long term follow-up of deep brain stimulation of the caudal zona incerta for essential tremor. J Neurol Neurosurg Psychiatry. 2011 Dec 28. [QxMD MEDLINE Link].
Benabid AL, Pollak P, Gao D, et al. Chronic electrical stimulation of the ventralis intermedius nucleus of the thalamus as a treatment of movement disorders. J Neurosurg. 1996 Feb. 84(2):203-14. [QxMD MEDLINE Link].
[Guideline] Zesiewicz TA, Elble RJ, Louis ED, et al. Evidence-based guideline update: treatment of essential tremor: report of the Quality Standards subcommittee of the American Academy of Neurology. Neurology. 2011 Nov 8. 77(19):1752-5. [QxMD MEDLINE Link]. [Full Text].
O'Brien MD, Upton AR, Toseland PA. Benign familial tremor treated with primidone. Br Med J (Clin Res Ed). 1981 Jan 17. 282(6259):178-80. [QxMD MEDLINE Link]. [Full Text].
Ondo WG. Current and emerging treatments of essential tremor. Neurol Clin. 2020. 38(2):309-323.
Jeffrey, S. FDA Okays Brio Neurostimulation System for PD, ET. Medscape Medical News. Available at http://www.medscape.com/viewarticle/846456. June 12, 2015; Accessed: June 17, 2015.
Iorio-Morin C, Hodaie M, Lozano AM. Adoption of focused ultrasound thalamotomy for essential tremor: why so much fuss about FUS?. J Neurol Neurosurg Psychiatry. 2021. 92(5):549-554.
Wagle Shukla. Rationale and evidence for peripheral nerve stimulation for treating essential tremor. Tremor Other Hyperkinet Mov. 2022. 12(1):20.
Dogu O, Sevim S, Camdeviren H, et al. Prevalence of essential tremor: door-to-door neurologic exams in Mersin Province, Turkey. Neurology. 2003 Dec 23. 61(12):1804-6. [QxMD MEDLINE Link].
Thawani SP, Schupf N, Louis ED. Essential tremor is associated with dementia: prospective population-based study in New York. Neurology. 2009 Aug 25. 73(8):621-5. [QxMD MEDLINE Link]. [Full Text].
Elias WJ, Huss D, Voss T, Loomba J, Khaled M, Zadicario E, et al. A pilot study of focused ultrasound thalamotomy for essential tremor. N Engl J Med. 2013 Aug 15. 369(7):640-8. [QxMD MEDLINE Link].
Goldman MS, Ahlskog JE, Kelly PJ. The symptomatic and functional outcome of stereotactic thalamotomy for medically intractable essential tremor. J Neurosurg. 1992 Jun. 76(6):924-8. [QxMD MEDLINE Link].
Kondziolka D, Ong JG, Lee JY, Moore RY, Flickinger JC, Lunsford LD. Gamma Knife thalamotomy for essential tremor. J Neurosurg. 2008 Jan. 108(1):111-7. [QxMD MEDLINE Link].
Pahwa R, Lyons KL, Wilkinson SB, et al. Bilateral thalamic stimulation for the treatment of essential tremor. Neurology. 1999 Oct 22. 53(7):1447-50. [QxMD MEDLINE Link].
Schuurman PR, Bosch DA, Bossuyt PM, et al. A comparison of continuous thalamic stimulation and thalamotomy for suppression of severe tremor. N Engl J Med. 2000 Feb 17. 342(7):461-8. [QxMD MEDLINE Link].
Taha JM, Janszen MA, Favre J. Thalamic deep brain stimulation for the treatment of head, voice, and bilateral limb tremor. J Neurosurg. 1999 Jul. 91(1):68-72. [QxMD MEDLINE Link].
Tasker RR. Deep brain stimulation is preferable to thalamotomy for tremor suppression. Surg Neurol. 1998 Feb. 49(2):145-53; discussion 153-4. [QxMD MEDLINE Link].

Media Gallery

of 0

Author

Natalya V Shneyder, MD Assistant Professor, Department of Neurology, Movement Disorders Center, University of South Florida Morsani College of Medicine; Attending Physician, Movement Disorders Specialist, Department of Neurology, James A Haley Veterans Hospital

Natalya V Shneyder, MD is a member of the following medical societies: American Academy of Neurology, Movement Disorder Society

Disclosure: Nothing to disclose.

Coauthor(s)

Robert A Hauser, MD, MBA Professor of Neurology, Molecular Pharmacology and Physiology, Director, USF Parkinson's Disease and Movement Disorders Center, National Parkinson Foundation Center of Excellence, Byrd Institute, Clinical Chair, Signature Interdisciplinary Program in Neuroscience, University of South Florida College of Medicine

Robert A Hauser, MD, MBA is a member of the following medical societies: American Academy of Neurology, American Medical Association, American Society of Neuroimaging, International Parkinson and Movement Disorder Society

Disclosure: Received consulting fee from Cerecor for consulting; Received consulting fee from L&M Healthcare for consulting; Received consulting fee from Cleveland Clinic for consulting; Received consulting fee from Heptares for consulting; Received consulting fee from Gerrson Lehrman Group for consulting; Received consulting fee from Indus for consulting; Received consulting fee from University of Houston for consulting; Received consulting fee from AbbVie for consulting; Received consulting fee from Adama.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Chief Editor

Selim R Benbadis, MD Professor, Director of Comprehensive Epilepsy Program, Departments of Neurology and Neurosurgery, Tampa General Hospital, University of South Florida Morsani College of Medicine

Selim R Benbadis, MD is a member of the following medical societies: American Academy of Neurology, American Academy of Sleep Medicine, American Clinical Neurophysiology Society, American Epilepsy Society, American Medical Association

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Bioserenity, Ceribell, Eisai, Jazz, LivaNova, Neurelis, Neuropace, SK life science, Sunovion, Takeda, UCB<br/>Serve(d) as a speaker or a member of a speakers bureau for: Aquestive, Bioserenity, Eisai, Jazz, LivaNova, Neurelis, SK life science, Stratus, Sunovion, UCB<br/>Received research grant from: Cerevel Therapeutics, Ovid Therapeutics, Neuropace, Greenwich Jazz, SK Life Science, Xenon Pharmaceuticals, UCB, Marinus, Neuroelectrics Corporation, Longboard, Janssen, Equilibre Biopharmaceuticals.

Additional Contributors

Deborah A Burke, MD Clinician, Sub-Investigator, USF Parkinson's Disease and Movement Disorders Center, University of South Florida Morsani College of Medicine; Investigator, Physician, Roskamp Institute Memory Clinic

Deborah A Burke, MD is a member of the following medical societies: American Academy of Neurology, International Parkinson and Movement Disorder Society

Disclosure: Nothing to disclose.

Theresa A McClain, RN, MSN, ARNP-BC Advanced Registered Nurse Practitioner and Investigator, Parkinson’s Disease and Movement Disorders Center, University of South Florida College of Medicine

Theresa A McClain, RN, MSN, ARNP-BC is a member of the following medical societies: Sigma Theta Tau International

Disclosure: Received consulting fee from Teva for consulting; Received consulting fee from Schering Plough for consulting; Received consulting fee from Biotie for consulting; Received consulting fee from Novartis for consulting.

Acknowledgements

Nestor Galvez-Jimenez, MD, MSc, MHA Chairman, Department of Neurology, Program Director, Movement Disorders, Department of Neurology, Division of Medicine, Cleveland Clinic Florida

Nestor Galvez-Jimenez, MD, MSc, MHA is a member of the following medical societies: American Academy of Neurology, American College of Physicians, and Movement Disorders Society

Disclosure: Nothing to disclose.

Daniel H Jacobs MD, FAAN, Associate Professor of Neurology, University of Florida College of Medicine; Director for Stroke Services, Orlando Regional Medical Center

Daniel H Jacobs is a member of the following medical societies: American Academy of Neurology, American Society of Neurorehabilitation, and Society for Neuroscience

Disclosure: Teva Pharmaceutical Grant/research funds Consulting; Biogen Idex Grant/research funds Independent contractor; Serono EMD Royalty Speaking and teaching; Pfizer Royalty Speaking and teaching; Berlex Royalty Speaking and teaching

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Essential Tremor Medication

Medication Summary

Beta-Blockers, Nonselective

Class Summary

Propranolol hydrochloride (Inderal, InnoPran XL)

Propranolol hydrochloride (Inderal, InnoPran XL)

Anticonvulsants, Other