Propranolol for Tremors: Efficacy, Dosage, and Administration

In this article, we will take a close look at the use of propranolol, a beta-adrenergic receptor blocker, for the treatment of tremors. We will analyze its effectiveness, explain how it works, understand the recommended dosage, and the best time to administer it. We will also discuss the varying impact of propranolol on different types of tremors, such as essential tremor and Parkinson's disease tremor.
Jakub Gwiazdecki

Jakub Gwiazdecki

Fifth year medical student at the Medical Faculty of Comenius University in Bratislava.

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Can propranolol be used for tremors?

Yes, propranolol is used as a treatment for tremors. It is seen as a first-line therapy, especially in essential tremor [1].

For instance, in Parkinson’s disease, propranolol was found to reduce by 70% the amplitude of resting tremor. It also reduced the amplitude of the postural tremor by half [2].

However, the efficiency of propranolol depends on the patient and the type of tremors. The best effects are achieved in the treatment of older patients with low-frequency tremors [3].

Propranolol does not work in every case. Even when it does, with time, the therapeutic effect can decrease [4].

How does propranolol work for tremors?

The exact mechanism by which propranolol reduces tremors is not fully understood. However, it is believed that there are two mechanisms. One is a central depression, and the second is beta receptor inhibition in the periphery [5].

There are also suggestions that propranolol is a cerebellar modulator. The cerebellum is part of the brain through which tremor impulses pass. The modulation of the cerebellum can help with propanolol's therapeutic effect [6].

Central depression is achieved by blocking certain substances. For example, propranolol blocks adrenaline, leading to lower blood pressure and heart rate. Both of these effects help with limiting the amplitude of the tremors [5, 7].

What is the dosage of propranolol for tremors?

The dosage varies depending on the individual's response to the medication and the severity of the tremor. Based on evidence, the most effective dosage is between 120 mg/day and 320 mg/day.

In a study, a group of 15 patients with essential tremors received different doses of the drugs. The amount of propranolol hydrochloride ranged from 80 to 800 mg/day. The dose was increased by 80 mg weekly. It was observed that the maximum tremor suppression took place between 160 and 320 mg/day [8].

This finding can be supported by other studies. In another paper, researchers defined that the effective dose compared to placebo was 240 mg/day. This amount of the drug was able to reduce the amplitude of the tremor by 45% [9].

However, other papers show that the effective dose can be smaller. Even a single oral dose of 120 mg of propranolol can reduce the essential tremor effectively [10].

Also, a comparative study showed that the daily dosage effectiveness is equal between long-acting formulas and conventional ones. A single 160-mg dose of the long-acting propranolol is as effective as 3 dosages of 80 mg daily [11].

What is the max dose of propranolol for tremors?

The maximal dose of propranolol can vary from patient to patient. Additionally, a maximal dose does not necessarily increase the effectiveness of the drugs [8].

The dosing of propranolol can go up to 800mg per day. However, because of individual responses to this medication, some patients may not tolerate more than 640mg per day [8].

What is the best time to take propranolol for tremors?

There is no specific time when to take propranolol. The effect of the medication is often very individual. The best timing for when to take the drug should be observed individually.

How quickly does propranolol work for tremors?

In some cases, a significant effect can be seen after the first week of continuous therapy [12]. In other patients, a single 40 mg dose was found to be effective for 4 hours [5]. While some taking 120 mg show an 8-hour effect beginning 2 hours after the drug intake [10].

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Jakub Gwiazdecki

Jakub Gwiazdecki

Jakub is in his fifth year as a medical student at Comenius University in Bratislava, Slovakia. He has special interested in cardiology and in patient-centered medicine. His love for heart health isn't just book-smarts; he wants to know how it works, what it means for our feelings, and how key it is for health and happiness. Jakub thinks real good health care comes from always putting the patient at the centre, treating each person as a whole.