What are the recommended pharmacological treatments for managing essential tremor in adults?

For managing essential tremor in adults, the first-line pharmacological treatments typically include beta-blockers such as propranolol and anticonvulsants like primidone. These agents are recommended due to their efficacy in reducing tremor amplitude and improving patient quality of life. If these first-line treatments are ineffective or not tolerated, other options such as gabapentin, topiramate, or benzodiazepines may be considered. Referral to a specialist is advised if tremor symptoms are disabling and initial pharmacological treatments are ineffective or not tolerated. Additionally, it is important to review and manage any contributing factors such as medication side effects, thyroid dysfunction, or alcohol consumption before initiating treatment. This approach aligns with UK clinical guidance emphasizing a stepwise pharmacological strategy and specialist referral for refractory cases NICE NG127.

Recent systematic reviews support these recommendations, highlighting propranolol and primidone as the most effective pharmacological agents for essential tremor, with long-term use improving patient quality of life. The literature also notes that while other agents like gabapentin and topiramate can be beneficial, their evidence base is less robust, and side effect profiles must be considered. The review underscores the importance of individualized treatment plans and monitoring for adverse effects during long-term therapy Alharbi et al. 2024.