Navigate Up

Neurology Center - A-Z Index

#
J
Q
X
Y
Z

Print This Page

Drug-induced tremor

Drug-induced tremor is involuntary shaking due to the use of medication. Involuntary means you shake without trying to do so. The shaking occurs when you move or try to hold your arms, hands, or head in a certain position. It is not associated with other symptoms.

See also:

Alternative Names

Tremor - drug-induced

Causes, incidence, and risk factors

Drug-induced tremor is a simple nervous system and muscle response to certain medications. Drugs that can cause tremor include the following:

  • Cancer medicines such as thalidomide and cytarabine
  • Seizure medicines such as valproic acid (Depakote), and sodium valproate (Depakene)
  • Asthma medicines such as theophylline and albuterol
  • Immunosuppressants such as cyclosporine
  • Mood stabilizers such as lithium carbonate
  • Stimulants such as caffeine  and amphetamines
  • Selective serotonin reuptake inhibitors
  • Tricyclic antidepressants
  • Heart medicines such as amiodarone, procainamide, and others
  • Certain antibiotics
  • Certain antivirals such as acyclovir and vidarabine
  • Alcohol
  • Nicotine
  • Certain high blood pressure drugs
  • Epinephrine and norepinephrine
  • Weight loss medication (tiratricol)
  • Too much thryoid medication (levothyroxine)
  • Tetrabenazine, a medicine to treat excessive movement disorder 

Symptoms

The tremor may affect the hands, arms, head, or eyelids. It rarely affects the lower body and may not affect both sides of the body equally.

The shaking is usually fast, at about 4 to 12 movements per second.

The tremor may be:

  • Episodic (occurring in bursts, sometimes about an hour after taking the medication)
  • Intermittent (comes and goes with activity, but not always)
  • Sporadic (only happens on occasion)

The tremor can:

  • Occur either with movement or at rest
  • Disappear during sleep
  • Get worse with voluntary movement and emotional stress

Other symptoms may include:

  • Head nodding
  • Shaking or quivering sound to your voice

Signs and tests

Your doctor or nurse can make the diagnosis by performing a physical exam and asking questions about your medical and personal history, especially your medication use.

A physical exam will show shaking with movement. There are usually no problems with coordination or mental function.

Other tests are usually not needed. However, further tests may be done to rule out other reasons for the tremor. A tremor that occurs when the muscles are relaxed or that affects the legs or coordination may be a sign of another condition, such as Parkinson's disease. The speed of the tremor can be an important way to determine its cause.

Other causes of tremors may include:

Blood tests and imaging studies (such as a CT scan of the head, brain MRI , and x-rays) are usually normal.

Treatment

Drug-induced tremor will usually go away when you stop taking the medicine that is causing the shaking.

You may not need treatment or changes in medications if the tremor is mild and does not interfere with your daily activity.

If the benefit of the medicine is greater than the problems caused by the tremor, you may try different doses or types of medicines. Different doses or similar medications may not cause the tremor.

In rare cases, a drug such as propanalol may be added to help control the tremor.

Never stop taking any medicine without first talking to your health care provider.

Complications

Severe tremor can interfere with daily activities, especially fine motor skills such as writing, and other activities such as eating or drinking.

Calling your health care provider

Call your health care provider if you are taking a medication and a tremor develops that interferes with your activity or is accompanied by other symptoms.

Prevention

Always tell your doctor about the medicines you take. Take over-the-counter drugs with caution, especially those that contain stimulants or a medicine called theophylline.

Caffeine can cause tremor and make tremor caused by other medications worse. Avoid caffeinated drinks such as coffee, tea, and soda. Also avoid other stimulants if you have tremor.

References

Elble RJ. Tremor: Clinical features, pathophysiology, and treatment. Neurol Clin. 2009;27:679-695.

Jankovic J, Lang AE. Movement disorders: Diagnosis and assessment. In: Daroff RB, Fenichel GM, Jankovic J, Mazziotta JC. eds. Bradley's Neurology in Clinical Practice. 6th ed. Los Angeles, Ca: Saunders Elsevier;2012:chap 21..

Lang A. Other movement disorders. In: Goldman L, Schafer AI, eds. Cecil Medicine. 24th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 417.

 

Updated: 7/15/2012

Linda J. Vorvick, MD, Medical Director and Director of Didactic Curriculum, MEDEX Northwest Division of Physician Assistant Studies, Department of Family Medicine, UW Medicine, School of Medicine, University of Washington. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M. Health Solutions, Ebix, Inc.


©  UPMC | Affiliated with the University of Pittsburgh Schools of the Health Sciences
Supplemental content provided by A.D.A.M. Health Solutions. All rights reserved.

For help in finding a doctor or health service that suits your needs, call the UPMC Referral Service at 412-647-UPMC (8762) or 1-800-533-UPMC (8762). Select option 1.

UPMC is an equal opportunity employer. UPMC policy prohibits discrimination or harassment on the basis of race, color, religion, ancestry, national origin, age, sex, genetics, sexual orientation, marital status, familial status, disability, veteran status, or any other legally protected group status. Further, UPMC will continue to support and promote equal employment opportunity, human dignity, and racial, ethnic, and cultural diversity. This policy applies to admissions, employment, and access to and treatment in UPMC programs and activities. This commitment is made by UPMC in accordance with federal, state, and/or local laws and regulations.

Medical information made available on UPMC.com is not intended to be used as a substitute for professional medical advice, diagnosis, or treatment. You should not rely entirely on this information for your health care needs. Ask your own doctor or health care provider any specific medical questions that you have. Further, UPMC.com is not a tool to be used in the case of an emergency. If an emergency arises, you should seek appropriate emergency medical services.

For UPMC Mercy Patients: As a Catholic hospital, UPMC Mercy abides by the Ethical and Religious Directives for Catholic Health Care Services, as determined by the United States Conference of Catholic Bishops. As such, UPMC Mercy neither endorses nor provides medical practices and/or procedures that contradict the moral teachings of the Roman Catholic Church.

© UPMC
Pittsburgh, PA, USA UPMC.com