What medications can cause hand tremors?

Number of Possible Causes Could be Source of Hand Tremors

February 11, 2011

Dear Mayo Clinic:

I have been taking lithium since 1979. I have had hand tremors this past year and am wondering if tremors can be a side effect of this medication. My doctor has prescribed medicine for essential tremors and it did not work.

Answer:

People who take lithium often experience hand tremors as a side effect of this medication. But because you have been taking this drug for more than three decades, and the hand tremors are a recent development, your situation may be more complicated. An evaluation of all of the medications you are taking, a review of your medical history, a thorough physical exam, and blood tests may help shed light on what might be causing your tremor.

First, review with your doctor whether there has been a change in your lithium dose recently. An increase in the dose could trigger side effects that you haven't previously experienced. If there hasn't been a dose change, talk to your doctor about having your blood tested to check your level of blood lithium. In some cases, blood lithium may rise even when the medication dose remains the same, and that rise could result in hand tremors.

In addition, a review of your other medications is in order. If you take other medications, the tremors could be a side effect of one of them, rather than the lithium. For example, some people who take lithium also take valproic acid, which may be used to treat some of the same conditions. Tremors are a common side effect of valproic acid, as well as several other medications.

If your lithium dose and lithium blood level are stable, and other medications do not seem to be the problem, the tremor may be a symptom of an underlying medical disorder rather than a medication side effect. Disorders that affect your body's metabolism can result in tremors. For example, overactive thyroid (hyperthyroidism) — a condition in which your thyroid gland produces too much of the hormone thyroxine — can significantly speed up your body's metabolism, causing tremors, weight loss, a rapid or irregular heartbeat, sweating, and nervousness or irritability. A diagnosis of hyperthyroidism usually can be confirmed with a blood test that measures the level of thyroxine in your blood.

Also, although you mention that your doctor tried medication for essential tremor and it didn't work, it is still possible that essential tremor could be the source of your hand tremors. Essential tremor is a disorder of the nervous system that causes a rhythmic shaking. It can affect other portions of the body, but the trembling occurs most often in the hands. Essential tremor can sometimes be challenging to treat, and not everyone responds to treatment right away. Also, the first drug tried may fail if the dose isn't high enough. Trying a different medication for essential tremor may also be a consideration.

As you can see, a number of possible causes could be the source of your hand tremors. Have a conversation with your doctor about the causes that could fit your situation and discuss the best approach for thoroughly evaluating each one.

— J. Eric Ahlskog, M.D., Ph.D., Neurology, Mayo Clinic, Rochester, Minn.

Acetaminophen, Butalbital and Caffeine

Most Common - Drowsiness, lightheadedness, tremor, dizziness, sedation, shortness of breath, nausea, vomiting, and abdominal pain

Acyclovir

Most Common - Drowsiness, lightheadedness, tremor, dizziness, sedation, shortness of breath, nausea, vomiting, and abdominal pain

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Adalimumab

Most Common - Drowsiness, lightheadedness, tremor, dizziness, sedation, shortness of breath, nausea, vomiting, and abdominal pain

Ademetionine

Most Common - Drowsiness, lightheadedness, tremor, dizziness, sedation, shortness of breath, nausea, vomiting, and abdominal pain

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Albuterol (Salbutamol)

Most Common - Tremor, anxiety, headache, muscle cramps, dry mouth, and palpitations

Alemtuzumab

Most Common - Tremor, anxiety, headache, muscle cramps, dry mouth, and palpitations

Alglucosidase

Most Common - Tremor, anxiety, headache, muscle cramps, dry mouth, and palpitations

Aliskiren and Amlodipine

Most Common - Tremor, anxiety, headache, muscle cramps, dry mouth, and palpitations

Bambuterol

Most Common- Tremor, nervousness, tension, headache and palpitations

Bamipine

Most Common- Tremor, nervousness, tension, headache and palpitations

Basiliximab

Most Common - Pimples, constipation, diarrhea, headache, indigestion, nausea, runny nose, sleeplessness, stomach pain, tremor and vomiting

Beclomethasone Dipropionate

Most Common - Pimples, constipation, diarrhea, headache, indigestion, nausea, runny nose, sleeplessness, stomach pain, tremor and vomiting

Benserazide

Most Common - Pimples, constipation, diarrhea, headache, indigestion, nausea, runny nose, sleeplessness, stomach pain, tremor and vomiting

Benznidazole

Most Common - Pimples, constipation, diarrhea, headache, indigestion, nausea, runny nose, sleeplessness, stomach pain, tremor and vomiting

Benzphetamine

Most Common - Pimples, constipation, diarrhea, headache, indigestion, nausea, runny nose, sleeplessness, stomach pain, tremor and vomiting

Chlorpheniramine- Hydrocodone- Pseudoephedrine

Most Common - Sedation, drowsiness, mental clouding, lethargy, impairment of mental and physical performance, anxiety, fear, dizziness, psychic dependence, mood changes, nervousness, sleeplessness, visual disturbances, confusion, headache, emotion, involuntary repetitive movements of face, lightheadedness, agitation, restlessness, irritability, tremor

Ciclosporin

Most Common - Sedation, drowsiness, mental clouding, lethargy, impairment of mental and physical performance, anxiety, fear, dizziness, psychic dependence, mood changes, nervousness, sleeplessness, visual disturbances, confusion, headache, emotion, involuntary repetitive movements of face, lightheadedness, agitation, restlessness, irritability, tremor

Cidofovir

Most Common - Sedation, drowsiness, mental clouding, lethargy, impairment of mental and physical performance, anxiety, fear, dizziness, psychic dependence, mood changes, nervousness, sleeplessness, visual disturbances, confusion, headache, emotion, involuntary repetitive movements of face, lightheadedness, agitation, restlessness, irritability, tremor

Ciprofloxacin

Most Common - Sedation, drowsiness, mental clouding, lethargy, impairment of mental and physical performance, anxiety, fear, dizziness, psychic dependence, mood changes, nervousness, sleeplessness, visual disturbances, confusion, headache, emotion, involuntary repetitive movements of face, lightheadedness, agitation, restlessness, irritability, tremor

Citalopram

Most Common - Sedation, drowsiness, mental clouding, lethargy, impairment of mental and physical performance, anxiety, fear, dizziness, psychic dependence, mood changes, nervousness, sleeplessness, visual disturbances, confusion, headache, emotion, involuntary repetitive movements of face, lightheadedness, agitation, restlessness, irritability, tremor

Cyclobenzaprine

Most Common - Drowsiness, headache, dizziness, blurred vision, nausea, abnormal taste, palpitations, tremor, dry throat, pimples, attention disturbances, sleeplessness, fatigue, constipation and indigestion

Cycloserine

Most Common - Drowsiness, headache, dizziness, blurred vision, nausea, abnormal taste, palpitations, tremor, dry throat, pimples, attention disturbances, sleeplessness, fatigue, constipation and indigestion

Cyclosporine

Most Common - Kidney dysfunction, tremor and high blood pressure

Cyproheptadine

Most Common - Kidney dysfunction, tremor and high blood pressure

Cysteamine Bitartrate

Most Common - Kidney dysfunction, tremor and high blood pressure

Daclizumab

Most Common - Kidney dysfunction, tremor and high blood pressure

Danazol

Most Common - Kidney dysfunction, tremor and high blood pressure

Delavirdine

Most Common - Kidney dysfunction, tremor and high blood pressure

Desipramine

Most Common - Kidney dysfunction, tremor and high blood pressure

Dothiepin

Most Common - Dizziness, blurred vision, fast heart rate, urinary retention, tremor, blood disorders, low blood pressure, sexual dysfunction and sweating

Doxepin

Most Common - Dizziness, blurred vision, fast heart rate, urinary retention, tremor, blood disorders, low blood pressure, sexual dysfunction and sweating

Duloxetine

Most Common - Dizziness, blurred vision, fast heart rate, urinary retention, tremor, blood disorders, low blood pressure, sexual dysfunction and sweating

Epinephrine

Most Common- Tremor, weakness, dizziness, sweating, palpitations, lung swelling, fast heart rate, transient, moderate anxiety, apprehensiveness,restlessness, pallor, nausea, vomiting, headache, and/or respiratory difficulties

Fluoxetine and Olanzapine

Most Common - Disturbance in attention, dry mouth, fatigue, excessive sleepiness, increased appetite, swelling in the extremities, drowsiness, tremor, blurred vision , and increased weight

Flupenthixol

Most Common - Disturbance in attention, dry mouth, fatigue, excessive sleepiness, increased appetite, swelling in the extremities, drowsiness, tremor, blurred vision , and increased weight

Fluphenazine

Most Common - Disturbance in attention, dry mouth, fatigue, excessive sleepiness, increased appetite, swelling in the extremities, drowsiness, tremor, blurred vision , and increased weight

Flupirtine

Most Common - Disturbance in attention, dry mouth, fatigue, excessive sleepiness, increased appetite, swelling in the extremities, drowsiness, tremor, blurred vision , and increased weight

Flurbiprofen

Most Common - Disturbance in attention, dry mouth, fatigue, excessive sleepiness, increased appetite, swelling in the extremities, drowsiness, tremor, blurred vision , and increased weight

Ipratropium Bromide

Most Common- Flu-like symptoms, tremor, sleeplessness, nervousness, constipation, sore throat, chest pain and difficulty in breathing

Miglustat

Most Common - Weight loss, diarrhea, tremor, flatulence, abdominal pain, headache, and influenza-like symptoms

Milnacipran Hcl

Most Common - Weight loss, diarrhea, tremor, flatulence, abdominal pain, headache, and influenza-like symptoms

Milrinone

Most Common - Weight loss, diarrhea, tremor, flatulence, abdominal pain, headache, and influenza-like symptoms

Mirtazapine

Most Common - Weight loss, diarrhea, tremor, flatulence, abdominal pain, headache, and influenza-like symptoms

Moclobemide

Most Common- Dry mouth, headache, sleeplessness, nausea, dizziness, tremor, agitation, restlessness, constipation, fast heart rate, sleepiness and low blood pressure

Mometasone Furoate and Formoterol Fumarate

Most Common- Dry mouth, headache, sleeplessness, nausea, dizziness, tremor, agitation, restlessness, constipation, fast heart rate, sleepiness and low blood pressure

Mycophenolate Mofetil

Most Common- Anxiety, back pain, constipation, cough, diarrhea, dizziness, headache, loss of appetite, tiredness, weakness, nausea, tremor, sleeplessness, stomach upset and vomiting

Nefopam

Most Common- Drowsiness, lightheadedness, dry mouth, pink colored urine, nervousness, difficulty in urination, nausea, fainting, tremor and confusion

Nisoldipine

Most Common- Drowsiness, lightheadedness, dry mouth, pink colored urine, nervousness, difficulty in urination, nausea, fainting, tremor and confusion

Nitroxazepine

Most Common- Drowsiness, lightheadedness, dry mouth, pink colored urine, nervousness, difficulty in urination, nausea, fainting, tremor and confusion

Norepinephrine

Most Common- Drowsiness, lightheadedness, dry mouth, pink colored urine, nervousness, difficulty in urination, nausea, fainting, tremor and confusion

Nortriptyline

Most Common- Drowsiness, lightheadedness, dry mouth, pink colored urine, nervousness, difficulty in urination, nausea, fainting, tremor and confusion

Oxcarbazepine

Most Common- Dizziness, drowsiness, double vision, running nose, fatigue, nausea, vomiting, ataxia, abnormal vision, sore throat, abdominal pain, tremor, indigestion, abnormal gait

Paroxetine

Most Common - Weakness, sweating, nausea, decreased appetite, drowsiness, dizziness, sleeplessness, tremor, nervousness, ejaculatory disturbance, and other male genital disorders

Tiagabine

Most Common- Dizziness, lightheadedness, weakness, drowsiness, nausea, nervousness, tremors, abdominal pain, abnormal or difficulty with thinking or concentration or attention

Tianeptine

Most Common- Dizziness, lightheadedness, weakness, drowsiness, nausea, nervousness, tremors, abdominal pain, abnormal or difficulty with thinking or concentration or attention

Tocainide

Most Common- Dizziness, lightheadedness, weakness, drowsiness, nausea, nervousness, tremors, abdominal pain, abnormal or difficulty with thinking or concentration or attention

Valganciclovir

Most Common - Diarrhea, fever, nausea, tremor, anemia, graft rejection, decrease in white blood cells and platelet counts, vomiting

Valproic Acid

Most Common - Diarrhea, fever, nausea, tremor, anemia, graft rejection, decrease in white blood cells and platelet counts, vomiting

Vasopressin

Most Common - Diarrhea, fever, nausea, tremor, anemia, graft rejection, decrease in white blood cells and platelet counts, vomiting

Venlafaxine

Most Common - Diarrhea, fever, nausea, tremor, anemia, graft rejection, decrease in white blood cells and platelet counts, vomiting

Vigabatrin

Most Common- Headache, drowsiness, fatigue, dizziness, seizures, increased weight, upper respiratory tract infection, visual defects, depression, tremor, night blindness, nausea, diarrhea, memory loss, sleeplessness, irritability, abnormal coordination, blurred vision, double vision, vomiting, influenza, fever and rash

Vildagliptin

Most Common - Low blood sugar level, tremor, headache, weight gain and fluid retention

What is the most common cause of hand tremors?

Essential tremor is a nervous system (neurological) disorder that causes involuntary and rhythmic shaking. It can affect almost any part of your body, but the trembling occurs most often in your hands — especially when you do simple tasks, such as drinking from a glass or tying shoelaces.

What medication has a side effect of tremors?

Some common medications that can cause or enhance tremors include amiodarone, antidepressants, β-adrenergic agonists, cyclosporine, DBAs, lithium, tacrolimus, theophylline, and valproic acid. Multiple tremorogenic drugs can have additive effects (e.g., albuterol and theophylline in patients with asthma).

Can certain medications cause tremors?

Tremor is a common complaint for many patients. Caffeine and beta-adrenergic agonists are well-recognised drugs that cause or exacerbate tremors. Other tremorogenic drugs, such as selective serotonin reuptake inhibitors and tricyclic antidepressants, are less well recognised.

Can medication cause shaking hands?

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.