Author: James Anderson

Drug-Induced Tremor: Symptoms, Diagnosis & Treatments

It’s important to watch out for these symptoms if you or a loved one is taking an antipsychotic. Drug side effects sometimes resemble the symptoms of the condition a drug is being used to treat, but a doctor can help diagnose symptoms. Antipsychotics help improve symptoms by binding to dopamine receptors in your central nervous system and blocking dopamine. This may prevent the basal ganglia from getting enough dopamine. It involves repetitive, involuntary facial movements, such as tongue twisting, chewing motions and lip smacking, cheek puffing, and grimacing.

Diagnosing essential tremor involves a review of your medical history, family history and symptoms and a physical examination. Often the only method of treatment is to try different drugs or lower doses to see which provide the most relief with the fewest side effects. Depending on your symptoms, you may also be prescribed another type of drug along with your antipsychotic to help treat them. Drugs can have varying side effects, and they affect people differently. Treatment involves stopping the antipsychotic immediately and providing supportive medical care. With prompt medical care, full recovery is usually possible, though it may take two weeks or longer.

Typically, when someone stops taking these medications, the symptoms of parkinsonism decrease over time. Diagnosing it is often a matter of ruling out other conditions that could be causing symptoms. To do this, your health care provider may suggest the following tests.

What Can Be Done to Treat My Tremors?

The syndrome typically plateaus and improves within 2–3 weeks of onset. Bromocriptine should therefore be continued for several weeks to ensure the syndrome has completely subsided. Consideration about restarting an antipsychotic requires a specialist psychiatric opinion. Stop the offending drug, and give an intravenous or intramuscular anticholinergic drug (such as benzatropine or trihexyphenidyl (benzhexol) hydrochloride). As the injectable drug has a short half-life it is followed by a short course of oral anticholinergic drugs.4,5,7 Benzodiazepines have also been used.

The shaking is usually fast, about 4 to 12 movements per second. Tremor is a common side effect of many (psycho)pharmacological agents and treatment is often possible.

Calcium channel blockers are used to treat cardiovascular conditions such as high blood pressure and chest pain. In some instances, calcium channel blockers may cause movement disorders and parkinsonism. The types of medications most likely to have this effect include some types of anti-nausea and antipsychotic drugs. The resulting reduction in dopamine levels causes parkinsonism.

What causes extrapyramidal symptoms?

Intermittent apomorphine injections or a continuous infusion may be required in moderate– severe cases. Treatment involves elimination of the medication that caused the symptoms. Even after stopping the medication at fault, symptoms may persist for up to 18 months. The shaking movement created by tremors is usually quick and tends to occur in cycles lasting six to 10 seconds. Drug-induced tremors may also be referred to as drug-induced Parkinson’s (DIP). In fact, 10 percent of Parkinson’s cases at a Parkinson’s disease treatment center turned out to be DIP.

Clozapine, for example, can help relieve tardive dyskinesia symptoms. Anticonvulsant drugs are among the most common causes of drug-induced tremors. Anticonvulsants are used for a variety of medical conditions, including epilepsy and bipolar disorder. Bronchodilators, which are commonly used in the treatment of conditions such as asthma, can also cause tremors. Drug-induced tremors may cause your head to shake or nod uncontrollably. The tremors may not happen all of the time, but they’re likely to occur within the first hour of taking medication.

1. Generally, the first signs are rigid muscles and fever, then drowsiness or confusion.
2. In children, this might show up as physical discomfort, agitation, anxiety, or general irritability.
3. The most common causes of drug-induced movement disorders are dopamine receptor blocking drugs, including antipsychotics and antiemetics (Table 1).
4. If this is not effective, adding a tremor suppressant may help (propranolol, primidone in action tremor and anticholinergics or amantadine in resting tremor.
5. Akathisia often improves following cessation of the offending drug.

It is important to avoid the offending drug in the future due to the risk of a recurrent dystonic reaction. Immunosuppressants, which are used to prevent the rejection of transplanted organs, can also lead to drug-induced tremors. Drugs used to treat a variety of psychiatric disorders such as antipsychotics, lithium, and certain antidepressants are also potential causes of drug-induced tremors. Caffeine is a stimulant that can also cause you to have tremors or can worsen existing tremors.

Drug-induced tremor vs. drug-induced parkinsonism

It’s sometimes referred to as atypical Parkinson’s disease, secondary parkinsonism, or Parkinson’s plus. Serotonin-norepinephrine reuptake inhibitors (SNRIs), another form of antidepressant, may also have this effect. SNRIs are used to treat major depressive disorders, ADHD, fibromyalgia, and other conditions. Certain medications have side effects that look like the physical symptoms of Parkinson’s disease. Drinking caffeinated beverages, like coffee and certain teas or sodas, can make your tremors worse. Tremors aren’t life-threatening, but they may be embarrassing for you if they happen in public.

Medications that cause the tremors include certain antipsychotics, anticonvulsants, and antidepressants. Certain medications can both cause tremors and worsen any tremors you already have from Parkinson’s disease or another similar disorder. It usually doesn’t develop until you’ve been taking the drug for six months or longer.

They most often affect your head and neck, though they can occur in other parts of your body. They often show up a few hours after your first dose but can show up anytime within the first few weeks. The mainstay of treatment includes resuming anti-parkinsonian drugs, usually via nasogastric tube because of the dysphagia resulting from severe parkinsonism.

Parkinsonism vs. Parkinson’s disease

While the movement disorder usually occurs following drug ingestion, it can also occur during the withdrawal phase. Typically, it subsides on cessation of the drug, but can last for months. No specific treatment exists for movement disorders caused by illicit drug use.

With second-generation antipsychotics, side effects tend to occur at lower rates. These drugs have less affinity for dopamine receptors and bind loosely and block some serotonin receptors. It is symmetrical and occurs acutely following drug ingestion or dose escalation. Exceptions include tremor secondary to valproate, which can appear at therapeutic or during stable treatment, or, rarely, tardive tremor. Another underlying aetiology, such as Parkinson’s disease, essential tremor or hyperthyroidism, needs to be excluded.