Table 1
Common Medication-induced Tremors and Typical Tremor Phenomenology
| Medication Class | Action or Postural Tremor | Intention Tremor | Resting Tremor |
|---|---|---|---|
| Antiarrhythmics | Amiodarone | – | Amiodarone |
| Antidepressants/mood stabilizers | Amitriptyline, lithium, SSRIs | Lithium | Lithium, SSRIs |
| Antiepileptics | Valproic acid | – | Valproic acid |
| β-Adrenergic agonists | Albuterol, salmeterol | Albuterol, salmeterol | – |
| Chemotherapeutics | Cytarabine | Cytarabine | – |
| Drugs of abuse | Cocaine, ethanol | Ethanol | Cocaine, ethanol |
| Gastrointestinal drugs | Metoclopramide | – | Metoclopramide, promethazine |
| Hormones | Thyroxine, epinephrine | Thyroxine, epinephrine | – |
| Immunosuppressants | Tacrolimus, cyclosporine | Tacrolimus, cyclosporine | – |
| Methylxanthines | Theophylline | – | – |
| DBAs/dopamine depleters | Haloperidol, tetrabenazine | – | Haloperidol, tetrabenazine |
Table 2
Mechanisms of Medication-induced Tremor for More Common Offending Agents
| Medication/Drug | Mechanism(s) | Reference(s) |
|---|---|---|
| Amiodarone | Likely EPT, possible hyperthyroidism in some | 19,23,25 |
| Amitriptyline | EPT (enhances central component) | 10 |
| β-Adrenergic agonists | EPT (enhance the mechanical reflex component) | 51–55 |
| Cyclosporine | EPT (enhances peripheral component) | 60 |
| Cytarabine | Cerebellar toxicity to Purkinje cells | 75 |
| DBA | Blockade of striatal dopamine receptors | 17,18,57,58 |
| Ethanol | EPT in withdrawal statesCerebellar toxicity in alcoholism | 73,76 |
| Lithium | Likely EPT | 7–9,38 |
| SSRIs | Likely EPT | 29 |
| Tacrolimus | EPT (enhances peripheral component) | 60 |
| Theophylline | Likely EPT | 71,72 |
| Valproic acid | EPT? dopaminergic dysfunction as well | 15,48 |