Propranolol for Tremors

What is Propranolol and how does it work?

Propranolol (generic Inderal) is a beta-blocker available by prescription that is used to lower blood pressure in patients with hypertension. Propranolol can also be used to treat other health conditions, such as heart rhythm problems, chest pain due to coronary artery disease, anxiety and tremors. Propranolol was one of the first in a class of medications known as beta blockers, and has been in use for almost sixty years. It ranks among the top 100 most prescribed drugs in the US and Europe.

Similar to other beta-blockers, Propranolol works by reducing the effects of adrenaline on your body. This widens your blood vessels, reducing your blood pressure and the force needed to pump blood around your body. The active ingredient of Propranolol is Propranolol hydrochloride, and the drug is taken orally as capsules. These come in different doses and are available as a twice a day dose (typically 80 mg) or one sustained-release capsule (160 mg) that will last 24 hours. If you take Propranolol for other conditions the dosage and treatment duration will be different. Follow your doctor’s instructions.

Propranolol’s effect on your blood pressure will be felt approximately 1/2 hour after ingestion. However, it can take up to one week of continuous treatment for Propranolol to reach its full blood-pressure-reducing effect. As for single doses, the effect of a standard release capsule will peak after an hour and last for 5-6 hours in total. When using the sustained release version, it will take six hours before Propranolol blood levels reach the peak.

What are tremors?

Tremors are a common movement disorder that about 3-5% of people will get once they reach a certain age. Naturally, it’s more common in older people. Family history plays an important role: in 60% of cases a parent and/or grandparent already suffered from tremors. Sometimes, tremors can be a symptom of a significant underlying condition, such as Parkinson's disease.

95% of essential tremor cases will affect the upper arms and limbs, while only about 30% of patients will experience head and/or leg and feet tremors. Voice and facial tremors are rare, affecting only 5% of patients.

Can I take Propranolol for tremors?

Propranolol therapy often is the doctor’s first choice for treating tremors and yields positive results —that is a reduction in tremor intensity and amplitude — in up to 70% of patients. This may not seem like a high success rate, but in fact, it’s higher than for other beta-blockers (atenolol, nadolol, and metoprolol) that can be used for treating tremors.

Propranolol works best for alleviating tremors in the arms and hands, but is not as effective for voice and head tremors. Propranolol treatment usually starts at a low dose (approximately 40mg twice a day). The dose is gradually increased and readjusted until an optimal level is found. Usually, the daily dosage doesn’t exceed 320 mg.

Propranolol side effects?

Propranolol can cause side effects in patients, especially during the initial weeks of treatment when your cardiovascular system still is adapting to the new drug. The good news is that many of these side effects disappear after a month of treatment.

Mild side effects that can be experienced by more than 1 out of 100 patients are:

Fatigue
Dizziness
Insomnia
Cold, numb fingers or toes
Reduced sexual appetite

These side effects typically happen during the first couple of weeks of treatment and in most cases go resolve after several days.

There are also more serious side effects, but they are rare (<1% chance of occurrence). However, if you experience any of the following symptoms while taking Propranolol, it’s recommended that you stop the medication and see a doctor right away.

Breathing difficulties and chest pain
Irregular heartbeat
Blurry vision
Swollen ankles or legs
Slow, irregular heartbeat
Vision problems
Skin and eyes turning yellow
Anxiety
Strong skin allergy

To learn more about Propranolol side effects, read the manufacturer’s leaflet that comes with the pills.

What are Propranolol contraindications?

Propranolol isn’t the right choice for you if you have:

Asthma
A very slow heartbeat
Any pre-existing heart conditions
Damaged or impaired liver function

Before you start taking Propranolol, make sure to let your doctor know if you are pregnant or breastfeeding. Also tell your doctor if you suffer from diabetes, depression, kidney, liver, or heart issues, as well as any thyroid disorders.

Does Propranolol interact with other drugs?

Yes, Propranolol can interact with the following drugs when taken simultaneously:

Hypertension medications
Aspirin, ibuprofen, naproxen, and diclofenac
Antidepressants
Blood thinners like warfarin
Prostate disorder treatments like doxazosin
Parkinson's disease medications
Diabetes drugs
Allergy drugs like ephedrine

One last word on Propranolol and alcohol: consuming alcohol can boost Propranolol’s blood pressure-reducing effect, lowering blood pressure to a point where you become lightheaded or dizzy. Generally, while taking the drug, alcohol consumption is best avoided, in particular during the first several weeks of treatment.

References

Pal, PramodKumar. “Guidelines for Management of Essential Tremor.” Annals of Indian Academy of Neurology, vol. 14, no. 5, 2011, p. 25, 10.4103/0972-2327.83097. Accessed 22 July 2020.
Gironell, Alexandre, and Jaime Kulisevsky. “Review: Diagnosis and Management of Essential Tremor and Dystonic Tremor.” Therapeutic Advances in Neurological Disorders, vol. 2, no. 4, 28 May 2009, pp. 215–222, 10.1177/1756285609104791. Accessed 22 July 2020.
Zhang, Manyu, et al. “Oral Propranolol for Treatment of the Subgroups of Essential Tremor: A Systematic Review and Meta-Analysis Protocol.” BMJ Open, vol. 10, no. 1, Jan. 2020, p. e032096, 10.1136/bmjopen-2019-032096. Accessed 22 July 2020.