6
Management
Table 3. Currently Recommended Pharmacological Treatments for ET
Drug Class
Propranolol
(the only FDA-approved medication for ET)
(Level A)
Beta-blocker
a
Propranolol Long Acting (Level A) Beta-blocker
Primidone (Level A) Anticonvulsant
Propranolol and primidone may be used in combination if tremor not well controlled with either alone
Gabapentin Monotherapy (Level B)
Adjunct
(insufficient evidence)
Anticonvulsant
Topiramate (Level B) Anticonvulsant
Alprazolam (Level B)
Clonazepam (Level C)
Diazepam
Lorazepam
Benzodiazepines
a
Small studies have shown benefit from other beta-blockers such as atenolol (50–150 mg/day;
Level B — probably effective), sotalol (75–200 mg/day; Level B — probably effective), and nadolol
(120–240 mg/day; Level C — possibly effective), all of which could be tried in patients with ET.
Acetazolamide, flunarizine, isoniazid, levetiracetam, pindolol, methazolamide, mirtazapine,
nifedipine, trazodone, verapamil, and 3,4-diaminopyridine are not recommended for treatment of
limb tremor in ET (AAN Guidelines).
