Severe essential tremor can be reduced using medication in most (approx. 50–75%) cases. Beta-blockers, such as propranolol (Inderal®), and antiseizure medications (e.g., primidone [Mysoline®], gabapentin [Neurontin®]) often are prescribed.
Beta-blockers usually are prescribed for younger patients because they may cause memory loss and confusion in older patients. Other side effects of beta-blockers include dizziness, fatigue, shortness of breath, and nausea.
Side effects of antiseizure medications include drowsiness, nausea, difficulty concentrating, and lack of balance and coordination (ataxia).
Other medications used to treat essential tremor include benzodiazepines (e.g., diazepam [Valium®], clonazepam [Klonopin®], alprazolam [Xanax®]) and carbonic anhydrase inhibitors (e.g., methazolamide [Glauctabs®, Neptazane®], acetazolamide [Diamox®]).
Side effects of benzodiazepines include drowsiness, fatigue, ataxia, and blood clots (thrombosis). Carbonic anhydrase inhibitors may cause tingling in the hands and feet, ringing in the ears (tinnitus), fatigue, and malaise.
Botulinum toxin injections (BOTOX® Cosmetic) treat essential tremor by producing local muscle weakness. When used to treat tremor in the hands, it may cause weakness in the fingers.