Propranolol and primidone are the two first-line medications for essential tremor, and both reduce rather than eliminate tremor. Treatment is generally offered when the tremor interferes with daily tasks rather than automatically at diagnosis. Reducing caffeine and adapting tasks with weighted utensils help alongside medication and cost nothing to try.
Propranolol and primidone are the two first-line medications for essential tremor, and both reduce rather than eliminate tremor. Treatment is generally offered when the tremor interferes with daily tasks rather than automatically at diagnosis. Reducing caffeine and adapting tasks with weighted utensils help alongside medication and cost nothing to try.
Propranolol is a beta blocker and primidone is an anti-seizure medication, and both have good evidence in essential tremor despite working differently. Either may be tried first, and they are sometimes combined. Realistic expectation matters: they typically reduce tremor amplitude meaningfully rather than abolishing it, and a partial improvement that makes eating or writing manageable is a success rather than a disappointment.
Propranolol slows heart rate and lowers blood pressure, so it is used cautiously or avoided in asthma, certain heart conduction problems and where blood pressure is already low; fatigue and cold hands are common effects. Primidone commonly causes drowsiness, unsteadiness and nausea when started, which is why it is introduced at a low dose and increased slowly, and those effects often settle. Neither should be stopped abruptly, propranolol in particular.
Mild tremor is often monitored rather than medicated, which is a reasonable position rather than neglect. Reducing caffeine, managing stress and adapting tasks with weighted utensils and stabilising techniques all help and cost nothing. If both first-line drugs fail or are not tolerated, other medications and botulinum toxin injection may be considered, and focused ultrasound or deep brain stimulation are options in severe cases, evaluated at specialised centres. This practice performs no surgery.
Clinical Neurology Specialists has been physician-owned since 1998, when Leo Germin, M.D., FAANEM founded it. Five board-certified neurologists and four advanced practice providers see patients at the Las Vegas and Henderson offices, each with its own AANEM-accredited electrodiagnostic laboratory.
Clinical Neurology Specialists is an adult outpatient neurology practice for patients 18 and older. The practice performs no surgery and operates no imaging suite, infusion suite or interventional pain programme, and provides no emergency or inpatient care.
Physician-reviewed. Reviewed by the physicians of Clinical Neurology Specialists — board-certified neurologists, AANEM-accredited electrodiagnostic laboratories, physician-owned since 1998. Reviewed 1 August 2026. This article is general education for adults 18 and older and is not a substitute for a consultation.
Sources and further reading: National Institute of Neurological Disorders and Stroke; MedlinePlus: Parkinson's disease; MedlinePlus, National Library of Medicine.
Adults 18 and older, at the Las Vegas and Henderson offices. Call 702-804-1212 or request an appointment online.