7
Titration Common Side Effects
• May be used PRN: 10–40 mg
• Start with divided doses of 10–60 mg/day
(10 mg in older patients)
• Slowly titrate up to 120 mg/day as needed
• May slowly increase to 320 mg/day if
needed
• Do not abruptly stop
Lightheadedness, bradycardia, fatigue,
impotence, depression, nausea, weight
gain, rash, diarrhea
• Start with 60 mg/day
• Slowly titrate to 120 mg/day
• May slowly titrate higher if needed
• Do not abruptly stop
Same as propranolol
• Start at 12.5 or 25 mg at bedtime
• Increase to 50 mg at bedtime after one week
• Increase by 50 mg/week up to 250 mg/day
as needed
• May slowly increase to higher doses up to
750 mg/day if tolerated
• May be taken at bedtime due to sedation or
in divided doses if tolerated
Sedation, fatigue, nausea, poor
balance, dizziness, flu-like symptoms
• Start with 300 mg three times a day
• Increase to 1800 mg/day as needed
• May increase up to 3600 mg/day
• Stronger evidence for monotherapy than
for adjunctive therapy
Sedation, fatigue, dizziness, ataxia,
nervousness, irritability, nausea,
shortness of breath
• Start with 25–50 mg at bedtime
• Slowly increase up to 150–300 mg/day
• May increase up to 400 mg/day
Dizziness, disorientation, memory
problems, loss of appetite, weight
loss, paresthesia, fatigue, nausea,
somnolence, headache
• Use as directed and titrate as needed
• May be beneficial in those with anxiety
• Caution regarding addiction
Drowsiness, fatigue, lightheadedness,
dizziness, depression, fatigue, loss of
coordination, memory loss, confusion
There is insufficient evidence to make recommendations regarding the use of amantadine, clonidine,
clozapine, gabapentin (adjunct therapy), glutethimide, L-tryptophan/pyridoxine, metoprolol,
nicardipine, olanzapine, phenobarbital, pregabalin, quetiapine, theophylline and zonisamide in the
treatment of limb tremor in ET (AAN Guidelines).
