Does Propranolol work for treating tremors?

Propranolol is one of the most effective choices for treating 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. The drug typically can also be used to treat other health conditions, such as heart rhythm problems, heart attack prevention, anxiety, and tremors. Propranolol has been in use for almost sixty years and is one of the first beta-blocker medications. It ranks among the top 100 most prescribed drugs in the US and European markets.  

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, so that as a hypertension patient, you can either take a capsule twice a day (typically 80 mg) or take one sustained-release capsule (160 mg) that will last for the whole day. 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 after about half an hour of taking the medication. But it will take about 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 and family history plays an important role: in 60% of cases a parent and/or grandparent already suffered from tremors. The condition can also be a symptom of an underlying disease, like Parkinson's disease.

Out of all clinically observed essential tremor cases, 95% tend to be in the upper arms and limbs, while only about 30% of patients will also experience head and leg/feet tremors. Voice and face 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 the drug isn’t as effective for voice and head tremors. Propranolol treatment usually starts at a low dose (approximately 40mg twice a day). This dosage then is gradually increased and readjusted until an optimal level is found. Usually, the daily dosage doesn’t exceed 320 mg daily.

 

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 the treatment and in most cases go away after several days.

There also are more serious side effects but they are rare (<1% chance of occurrence). However, if you experience any of the following symptoms while on a Propranolol treatment, it’s recommended that you 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

  1. 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.
  2. 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.
  3. 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.

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