Symptomatic relief for essential tremors includes medications such as propranolol. The condition does not presently have any cure and all methods or therapy are intended to offer relief to the manifested symptoms. As propranolol and other medications work on the physical effects of the condition, it is necessary to understand the speed of the onset of actions; as it is important to pick medications that work fast enough to have desired results. Following subsections offer a detailed look at how long does propranolol take to work for tremors? Information also includes the possible side effects and the contra indications linked to the medication when used for managing the symptoms.

What is essential tremor?

This refers to a condition that is actually an involuntary movement that occurs in the arms of afflicted individuals. Patients with the condition are known to gradually get used to the condition and live with it, with age. The shaking movements typically start gradually and can have an impact on the on the individuals’ ability to perform routine activities.  As outlined above, presently there is no cure for the condition, and all treatments are focused on offering relief from the symptoms. The actual intensity or severity of the shaking movements differ from patient to patient, with some having mild tremors, whereas others may have intense shaking.

Individuals with the condition receive treatment that includes medications, procedures, changes in lifestyle to reduce impact on routines and use of specialized equipment to assist and stabilize the patient. It is not out of place to mention here that the condition is known to worsen with aging, and patients almost always end up taking up additional treatment options. The movement disorder is attributed to an autosomal dominant trait that is generally genetically passed to the patient. The involuntary shaking occurs primarily in the upper limbs, and very rarely involve the head or the lower limbs. It is also rarely known to have an impact on the voice, the tongue and the face of the patient. The impact of this involuntary shaking movement includes ability of the individual to write, eat, and grasp objects, apart from actions such as dressing up.

There is additional indirect long-term impact from the condition – psychosocial disability, anxiety and stress. Patients with the rare form of the condition that impacts the head and speaking ability often undergo depression due to the social embarrassment. It is necessary to distinguish the difference between essential tremors and other shaking that is linked to other conditions such as Parkinson’s, hyperthyroidism, and head tremors.

What is the best medication for essential tremor?

As mentioned above, propranolol is used in managing the symptoms linked to essential tremor. Belonging to the category of non-selective beta-adrenergic antagonist, it is also used in the treatment of hypertension, migraines, angina, myocardial infarction and atrial fibrillation, apart from thyroid conditions.  The racemic mixture is known to have a very high binding affinity to beta adrenergic receptors, and this makes it highly effective as a drug for treating various conditions.  The medicine is known to have a lengthy duration of action and is available in oral form as tablets, extended-release tablets and liquid.

How does propranolol work?

As a beta-adrenergic receptor antagonist, the drug works by blocking the receptors and this blocking action results in certain outcomes that offer relief from various conditions. For instance, it brings about vasoconstriction, and this helps in hypertension, it reduces renin secretion, and it impacts T3 levels. This offers desired outcomes in patients diagnosed with hyperthyroidism and thyroid storm.  The effect of propranolol on essential tremor is linked to dual action of the drug. The first is the blocking of the peripheral beta receptor, while the second is the central depressant effect. It is also assumed that the drug has an effect on the spindles, the tiny sensory organs that have a role in detecting speed and stretching action of muscles.

How is essential tremor treated with therapy and propranolol?

Therapies and medications for essential tremor are only symptomatic in nature and will not offer any cure to the condition. Depending on the extent of social disability, behavioral therapies include relaxation therapy, and methods to combat and reduce emotional stress and depressive state of mind. Individuals with the condition are trained to use the better hand for writing, and to perform tasks with the hand that has lesser tremors. Other therapies include use of wrist weights, to strengthen the wrists and offer improved control over actions. The individual is also educated on the need to avoid foods that are known to be tremorogenic. For instance, beverages that contain caffeine and drugs are known to exacerbate the condition.

Medications for treating essential tremors are often given on a as required basis, or given on an intermittent basis. For instance, the patient is given the drug when required, if present or a part of any social activity or social gathering. This is mainly to prevent any reaction that are induced by anxiety in a social setting. This is known to increase the involuntary shaking in individuals, and preventive medication can help manage the condition better.  Patients are also given prophylactic doses of benzodiazepine, to offer preventive management. It is however, necessary to note that these drugs can trigger certain adverse outcomes in the central nervous system and should therefore be used only with medical advice or supervision.

How does propranolol help essential tremor? 

Propranolol when used for symptomatic treatment of essential tremor is given in dosages of 10 mg every day, and this is gradually increased to 20 mg doses administered two times daily. This increase is typically achieved in a staggered manner, once in a week. Elderly patients are started off on a lower dose, and this is gradually increased after the medication is tolerated without any adverse effects. The maximum dosage, after gradual increase could reach as much as a total of 240 mg per day, taken in divided doses. The efficacy of propranolol is best seen in managing hand tremors, while voice tremors are known to have lesser effects.

What is the dosage of propranolol for anxiety?

The dosage of propranolol differs, depending on the condition being treated. For instance, when the drug is recommended for treating essential tremor, it is almost always started off with a smaller dose of around 80 mg per day, which is taken in two divided doses. This is then gradually increased and the maximum dosage for the condition is typically 320 mg daily, which is again divided in to equal doses.  This increase occurs over time and is intended to help the patient’s body adjust to the drug and its effects.

How long does it take for propranolol to work for tremors?

The time taken for propranolol to work depends on the condition being treated. The medication achieves peak concentration levels in lesser than four hours, but the effects of the drug may be experienced in a shorter period. For instance, patients with tremors may experience lesser shaking within an hour of taking the drug. Similarly, heart beat rates may also reduce within an hour of taking the medication. Results may last longer when the patient is on the extended-release formulations. Specialists determine the actual time before certain specific actions to take the medication. This is intended to help the individual prevent, pre-empt or cope with anxiety related issues in a social setting.

Duration of onset of action of Propranolol

The half-life of propranolol is anywhere between 3 to 6 hours, with extended-release formulations having a half-life anywhere between 8 to 11 hours. Half-life refers to the period required for the active amount of the drug in the body to reduce by half. The half life of a drug depends on factors such as the processes and the time taken by the body to flush out the drug. Elderly individuals benefit from a longer half-life of the drug, mainly because of the changes in oxidation speeds.

What are the common side effects of using propranolol?

All medications come with the possibility of side effects and propranolol may also trigger undesirable outcomes. This could be mild/moderate or serious/adverse, and depending on the type of effect, the individual may or may not require medical intervention. Mild effects may occur more frequently, while the serious effects are known to occur rarely. It is necessary to bear in mind that not all users of medications will experience undesirable outcomes. Some are known to be fully free from all unwanted effects and will receive the full benefits or desired outcomes of medications. Here is a list of some commonly occurring side effects of propranolol.

A light headed feeling is more common among patients on the medication, while some are known to experience overall tiredness. A reduction in blood pressure levels, and possible reduction in heart beat rate is also likely when on propranolol. The patient may also end up with impotence due to the mechanism of action of the medication.  Other conditions that are attributed to the medication include diarrhea and constipation, apart from skin conditions. Certain skin related issues need to be evaluated and treated on priority as this could, if left untreated result in possibly serious conditions. For instance, there could be outbreak of rashes on the skin, or there could be blistering and peeling of the skin without any other apparent reason. Symptoms that are similar to that of hives, such as itching, and any difficulty in breathing are to be treated at the earliest to prevent it from turning into an emergency.

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