How Tremor Medications May Worsen Your Fatigue

The Cycle of How Medications for Tremor Exacerbate Your Fatigue

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MS Fatigue and Tremors. PeopleImages / Getty Images

Most people with multiple sclerosis (MS) suffer from fatigue. While much of our fatigue comes from the disease itself, there are also secondary causes of fatigue in MS, like medications you take to manage MS-related symptoms. Tremor is one common and difficult-to-treat MS symptom with the added burden that the medications used often contribute to fatigue.

Tremor in Multiple Sclerosis

The two most common types of tremor in MS are intention tremor and postural tremor. Intention tremor occurs when you reach for something and your hand starts shaking. The closer you get to your target or the smaller the movement required, the more your hand or arm will shake. Postural tremor occurs when you voluntarily hold a body position against gravity -- like a tremor in your hands and arms may be present if you hold them out in front of you.

Tremor typically occurs in the head, neck, trunk, and limbs. It may also be heard in your voice -- as it can occur in the vocal cords. The precise cause of tremor is still unknown but ​appears to be linked to the cerebellum -- a region of your brain that controls movement and coordination. 

Treating MS-Related Tremor in Multiple Sclerosis

MS-related tremor is very difficult to treat and can be an incredibly disabling and social isolating symptom. In addition, the medications that are available to treat tremor often have unwanted side effects, especially fatigue, which seem to outweigh the benefits for most people. Some people, though, report success with these medications, because they may have a higher tolerance for the side effects or are so bothered by the tremor that any benefit is considered “worth it." In addition, who knows, you may just be one of those lucky people for whom the medication is simply a good fit -- it does happen and when it does, it's wonderful. 

Medications for Tremor in Multiple Sclerosis

Isoniazid (nydrazid): This is a medication generally used to treat tuberculosis and is available as an injection, oral syrup or tablet. Besides fatigue, other side effects may include a loss of appetite, nausea, and abnormal liver function tests. 

Ondansetron (Zofran): An anti-nausea drug, available as an injection, oral solution or tablet.

Inderal (propranolol): A blood pressure medication, known as a beta-blocker, available as an injection, oral solution, tablet or extended-release capsule. In addition to exacerbating fatigue, it can cause a low blood pressure or low heart rate. 

Gluthetimide: A medication originally created as an alternative to a barbiturate to treat insomnia. It's used in some small studies but not generally prescribed. 

Mysoline (primidone): A drug which is chemically similar to a barbiturate and is used to control epileptic seizures or convulsions. It's available as oral suspension, tablets or chewable tablets.

Klonopin (clonazepam): This is a benzodiazepine and is used to control seizures and anxiety disorders. It's available as a tablet, oral disintegrating tablet, oral solution, or injection. 

Marijuana (cannibis): While there has been growing interest in the use of marijuana for treating certain symptoms of MS like pain, tremor, and spasticity, studies are not all that promising at this time.

What Does This Mean for Me If I Have Tremor?

To be frank, tremor is quite challenging to treat. But the good news is that if medication does not work, there are other modalities like physical therapy, limb cooling, and even surgery. In addition, scientists are working hard to better understand tremor so people like you can be helped. 

DISCLAIMER: The information in this site is for educational purposes only. It should not be used as a substitute for personal care by a licensed physician. Please see your doctor for diagnosis and treatment of any concerning symptoms or medical condition.

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Article Sources

  • Birnbaum, M.D. George. (2013). Multiple Sclerosis: Clinician’s Guide to Diagnosis and Treatment, 2nd Edition. New York, New York. Oxford University Press.
  • Koch M, Mostert J, Heersema D & DeKeyser J. Tremor in multiple sclerosis. J Neurol. 2007 Feb;254(2):133-45.