As the severity of the tremor lessens, functional disability also diminishes. However, some individuals will not respond to propranolol and the drug is often not well tolerated in older individuals. The typical beginning oral dosage of propranolol is 40mg twice a day. Possible side effects of propranolol therapy include dizziness, fatigue, depression, diarrhea, nausea and vomiting, changes in blood sugar levels, or sexual difficulties. Patients should not abruptly discontinue their treatment with a beta-adrenergic blocking agent such as propranolol.
Physicians typically work with patients to establish a schedule of a gradual reduction in dosage.
In this way, patients are slowly weaned from the medication. Primidone, an anticonvulsant medication related to phenobarbital, slows the central nervous system and helps to reduce or control seizure activity in certain types of epilepsy. In addition, primidone is considered a first-line therapy for the treatment of patients with essential tremor. Most clinicians recommend that patients start with half of a fifty tablet of primidone. Six studies have been conducted to determine the rate of response to primidone.