Experiencing Tremors? 11 Medications That Can Cause Shaky Hands
Key takeaways:
Shaky hands and tremors can be caused by several health conditions and medications.
Medications that can cause shaky hands include certain asthma inhalers, antidepressants, and immunosuppressants. Lithium (Lithobid), valproate (Depakote, Depakene), and levothyroxine (Synthroid) can also cause tremors.
If you’re experiencing shaky hands or tremors, let your primary care provider know. They can help you determine if it’s from medications or something else.
Table of contents
Noticing your hands shake or twitch might make you worried that you have Parkinson’s disease. But there are several possible causes for shaky hands, including certain medications.
Here, we'll cover the causes of shaky hands and 11 medications that may be the culprit.
What causes shaky hands?
The cause of shaky hands is sometimes difficult to pinpoint. However, many health conditions can affect your brain and cause tremors. Sometimes, this can happen if your health condition isn’t well-controlled. Other times, it’s just a symptom of the condition itself.
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Some conditions that may involve shaky hands include:
Parkinson's disease
Alcohol use disorder
Hypoglycemia (low blood glucose)
Hyperthyroidism (overactive thyroid)
Kidney or liver failure
Other possible causes of shaky hands include:
Below, we’ll cover 11 of the most common medications to cause shaky hands.
1. Beta-agonist inhalers
Beta-agonist inhalers are prescribed to treat asthma, chronic obstructive pulmonary disease (COPD), and other lung conditions. These medications can cause tremors when you first start using them. But this usually improves after a few days. It’s not known exactly how beta agonists cause tremors, but it may be by acting directly on your muscles.
Some examples of beta agonists include:
Albuterol (Ventolin HFA, ProAir HFA)
Levalbuterol (Xopenex HFA)
Salmeterol (Serevent Diskus)
Formoterol (Perforomist)
Combination medications, like fluticasone / salmeterol (Advair Diskus, Advair HFA) and mometasone / formoterol (Dulera), also contain beta agonists and can cause shaky hands.
2. Amiodarone
Amiodarone (Pacerone) is a heart medication that treats arrhythmias (abnormal heart rhythms). Amiodarone can affect your nervous system, including the brain. This can cause tremors, peripheral neuropathy (nerve pain), and lack of coordination. Additionally, amiodarone can cause or contribute to hyperthyroidism, which can also lead to tremors.
Tremors from amiodarone were more common decades ago when larger amiodarone doses were prescribed (up to 800 mg per day). But now it’s more common to use lower doses. For example, a common amiodarone dose for atrial fibrillation is 100 mg to 200 mg per day. This lower dosage decreases your risk of experiencing tremors.
3. Tricyclic antidepressants
Tricyclic antidepressants (TCAs) are a group of medications that treat many health conditions. This includes peripheral neuropathy, depression, and chronic headache. Examples of TCAs include amitriptyline, nortriptyline (Pamelor), and doxepin (Silenor).
The research on whether TCAs can cause or worsen tremors is conflicting. One study showed that amitriptyline can worsen the normal, existing tremor that all people have. This is called a physiological tremor. Usually, these tremors aren’t visible.
A TCA’s effect on amitriptyline usually improves over time.
Good to know: Stopping TCAs too quickly can lead to antidepressant discontinuation syndrome. Tremors are one possible symptom of this. Don’t stop taking TCAs or reduce your dose without talking to your prescriber first.
4. SSRI and SNRIs
Selective serotonin reuptake inhibitors (SSRIs) and serotonin and norepinephrine reuptake inhibitors (SNRIs) treat depression and anxiety. Examples of SSRIs include fluoxetine (Prozac) and citalopram (Celexa). Examples of SNRIs include duloxetine (Cymbalta) and venlafaxine (Effexor XR).
SSRIs and SNRIs can cause tremors in a similar way to TCAs. Additionally, serotonin syndrome — a possible side effect of these medications — can also cause tremors. Serotonin syndrome is rare. But the risk of it is higher if you take several medications that increase serotonin levels. So make sure your pharmacist and prescriber have an updated list of all medications and supplements you take. This will help them check for medications that increase serotonin levels.
Tremors can also happenif you stop taking your antidepressant abruptly or reduce your dose too quickly. So talk to your prescriber first if you want to stop taking your SSRI or SNRI.
5. Bupropion
Bupropion (Wellbutrin SR, Wellbutrin XL) is another antidepressant that can cause tremors. Tremors likely happen because bupropion increases in a chemical messenger in your brain called norepinephrine.
If you take bupropion and you’re experiencing tremors, let your prescriber know. You may need a lower dose, or to switch to another antidepressant altogether.
6. Lithium
Lithium (Lithobid) is a mood stabilizer that treats bipolar disorder. Shaky hands are one of the most common lithium side effects. Similar to antidepressants, lithium is thought to exaggerate natural physiological tremors.
Tremors caused by lithium usually happen when you first start the medication. In some cases, they’re mild enough to live with. But if they’re bothersome, your prescriber may recommend lowering your lithium dose or switching to another medication. But don’t stop your lithium or adjust your dose without talking to your prescriber first.
Good to know: Tremor is a common symptom of lithium toxicity. You may also experience nausea and vomiting, fatigue, and diarrhea. More seriously, you may develop confusion, a rapid heart beat, or uncontrollable muscle movements. Lithium toxicity can be dangerous. So it’s best to contact your prescriber if you experience tremors, even if they’re mild. They’ll check your lithium levels to make sure they’re within a normal range.
7. Valproate
Valproate medications include valproic acid (Depakene) and divalproex sodium (Depakote). Both medications treat seizures. Divalproex sodium can also treat bipolar disorder and help prevent migraines.
Tremors are a common side effect of valproate medications. They likely occur due to an increase in a chemical messenger called gamma-aminobutyric acid (GABA). Women and older adults may be more likely to experience tremors. It’s also more likely the longer you take valproate and with higher doses.
Tremors from valproate may not improve until you reduce your dose or stop the medication. But don’t stop taking your medication without talking to your prescriber. In some cases, they may prescribe a medication such as propranolol (Inderal) to treat tremors.
8. Typical antipsychotics
Antipsychotic medications are grouped into two categories: typical antipsychotics and atypical antipsychotics. Typical antipsychotics include medications such as thioridazine and fluphenazine. Atypical antipsychotics include olanzapine (Zyprexa), quetiapine (Seroquel), and more. These medications are usually used for mental health conditions, such as schizophrenia.
Typical antipsychotics may cause tremors by blocking dopamine receptors. In some cases, tremors may improve with continued use of the antipsychotic. In other cases, you may need a lower dose or to switch to a different antipsychotic. Switching to an atypical antipsychotic may help because these medications are typically less likely to cause shaky hands or tremors than typical antipsychotics.
However, if you’re unable to stop taking an antipsychotic that’s causing tremors, other medications may help. Examples include amantadine, or benztropine. Talk to your prescriber about your options.
9. Dopamine blockers
Medications that block dopamine can cause tremors. Examples include metoclopramide (Reglan) and prochlorperazine. Metoclopramide treats gastroesophageal reflux disease (GERD) and gastroparesis (delay in stomach emptying) in people with diabetes. It’s also used off label for certain types of nausea and vomiting. Prochlorperazine treats nausea, as well.
Blocking dopamine in the body can lead to Parkinsonism symptoms. These are a group of movement-related symptoms (including tremor) associated with Parkinson's disease. With metoclopramide, tremor usually occurs within the first 6 months of treatment. This is one reason that metoclopramide treatment isn’t usually recommended for more than 12 weeks (3 months) at a time. Similarly, prochlorperazine treatment isn’t typically recommended for more than 3 months at a time.
If you experience tremors while taking either of these medications, your prescriber may recommend switching to another medication.
10. Levothyroxine
Medications that contain levothyroxine (Synthroid) are used to treat hypothyroidism (low thyroid hormones).
Levothyroxine can cause tremors because it increases your thyroid hormone levels. This can activate your nervous system and lead to tremors. Additionally, taking too much levothyroxine can cause side effects similar to symptoms of hyperthyroidism. One of the most common symptoms of hyperthyroidism is shaky hands.
If you experience shaky hands while taking levothyroxine, this may be a sign you need a different dose. Your prescriber will likely check your thyroid hormone levels and adjust your dose if necessary.
11. Immunosuppressants (cyclosporine and tacrolimus)
Cyclosporine (Sandimmune) and tacrolimus (Prograf) are immunosuppressants. They’re used after organ transplants. They may also be taken off label for some autoimmune conditions.
Shaky hands and tremors are common side effects of cyclosporine and tacrolimus. Like many medications, these immunosuppressants can intensify your normal physiological tremor. This may be due to changes in the balance of chemical messengers (like GABA) in the brain.
These immunosuppressants may be essential for your organ transplant to be successful. So don’t stop or change the dose of cyclosporine or tacrolimus on your own. If you’re experiencing tremors, discuss it with your transplant specialist.
Good to know: Other immunosuppressants, such as everolimus (Afinitor) and sirolimus (Rapamune), can also cause tremors. But it’s less common.
When should you contact your healthcare team about shaky hands?
If you’re experiencing tremors or shaky hands, talk to your primary care provider. They can help you determine why they might be happening and come up with a treatment plan. In some cases, you may be referred to a specialist. If shaky hands are due to your medications, they may recommend reducing your dose or switching to another medication.
Frequently asked questions about tremors
Medications can either make existing tremors worse, or cause new tremors. Your medication might be the cause of your shakiness if:
You don’t have other health conditions that can cause tremors (like Parkinson’s disease)
The tremors start after you initiate a new medication or after a dose increase
Tremors consistently appear but they don’t worsen
Tremors or twitching look the same on both sides (symmetrical)
Shaky hands and tremors from medications aren’t usually serious. Still, tremors might make it difficult to perform your daily activities, such as eating or writing. This can impact your quality of life.
In some instances, tremors may not be due to your medications. It can be an early symptom of serious conditions like Parkinson’s disease. If your child has a tremor, it should be evaluated immediately by their pediatrician and possibly a neurologist. Tremors in children can be caused by several conditions. This includes nutritional deficiencies and Wilson’s disease.
Possibly. It’s more likely to experience tremors as you get older.
But tremors are also associated with many health conditions that more commonly occur in older people. These conditions include Parkinson’s disease, mild cognitive impairment, and dementia. So if you’re experiencing tremors, it’s a good idea to let your primary care provider know. They can help you figure out the cause of your tremors and refer you to a neurologist if needed.
The bottom line
Shaky hands or tremors may be caused by several health conditions. This includes Parkinson’s disease, hyperthyroidism (overactive thyroid), and multiple sclerosis. But shaky hands might also be caused by medications. Several antidepressants, typical antipsychotics, and levothyroxine (Synthroid) can cause tremors. Amiodarone (Pacerone), valproate (Depakote, Depakene), and Lithium (Lithobid) can also cause tremors.
Having a tremor is usually a mild condition, even if it’s from medication. Still, you should always let your primary care provider know if you’re experiencing tremors. Sometimes you may need to decrease your dose or switch to a different medication. But don’t make any changes without talking to your prescriber first.
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References
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