Drugs Used in Essential Tremor, Chorea, Tics and Related Disorders

Warning

Essential Tremor or Tremors Associated With Anxiety or Thyrotoxicosis

Preferred list (P)

PROPRANOLOL

Prescribing Notes:

Beta-blockers are generally considered first-line treatment for management of essential tremor and tremors associated with hyperthyroidism (whilst awaiting specialist input from an endocrinologist). They can also be useful for management of tremors associated with anxiety.

Patients taking a beta-blocker should have their pulse and blood pressure checked following initiation and dose titration. Once pulse and blood pressure are stable this can be monitored annually.

In the management of essential tremor:

  • Primidone is often tried for benign essential tremor in patients unable to take beta-blockers due to, for example, asthma or peripheral vascular disease. Sedation is often a limiting side effect.
  • Treatment should be trialled for at least 8 weeks at the maximum tolerated dose before moving to the next choice.

NHSL Joint Adult Formulary Key

To indicate the category of a formulary medicine, updated sections adopt the following key:

Preferred list (P): First-line formulary choices.

Total list (T): Alternative choices when preferred list options not effective/not tolerated, or not indicated.

Specialist initiation (S1): Specialist initiation, or on the advice of a Consultant or Specialist Practitioner in this therapeutic area. Continuation in primary care is acceptable.

Specialist use only (S2): Supply via hospital, Homecare Service or a hospital based prescription (HBP) for dispensing by community pharmacy. Not prescribed in primary care setting.

Editorial Information

Last reviewed: 31/01/2022

Next review date: 31/01/2025

Author(s): NHSL.

Version: Please refer to the introduction section for an explanation of the review dates above.

Approved By: ADTC

Reviewer name(s): ADTC.