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Tremors: sometimes drug-induced

Many drugs expose patients to tremors. The appearance or aggravation of tremors should prompt a re-evaluation of the benefits or the dosage of the drugs in question.

Tremors are involuntary, rhythmic, oscillatory movements, occurring either at rest or during a muscular contraction. They sometimes disrupt patients' lives.

Many drugs expose patients to tremors. For some, the appearance of tremors is a sign of overdose. The tremors generally regress within a few weeks or months after halting the drug treatment or reducing the dosage. For others, tremors appear when the medication is halted abruptly, especially benzodiazepines. Factors that increase the risk of drug-induced tremors are age, presence of a tremor-causing condition, chronic alcohol consumption, and medication dosage.

A number of psychotropic drugs expose patients to tremors, including neuroleptics (used as antipsychotics, antiemetics or antihistamines), antidepressants, lithium and antiepileptics. Tremors are caused or aggravated by some Alzheimer's treatments (anticholinesterase), heart drugs (cardiac stimulants, calcium channel blockers, antiarrhythmics), asthma or chronic obstructive pulmonary disease medications, smoking and alcohol cessation drugs, antitumour drugs and immunosuppressants as well as anti-infectives.

In these cases, medication should be considered as a possible cause. The benefits of such drugs should then be re-evaluated, possibly halting treatment altogether or reducing the dosage. Sometimes, this will reduce or even stop the tremors, thus avoiding the prescription of anti-tremor medication, such as antiparkinsonians, which in turn expose patients to various adverse effects.

©Prescrire 1 February 2018

"Drug-induced tremor" Prescrire Int 2018; 27 (190): 41-44. (Pdf, subscribers only).

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