Drug-Induced Tremor

Aka: Drug-Induced Tremor, Toxic Tremor, Medication Causes of Tremor, Metabolic Causes of Tremor

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II. Causes: Metabolic Causes of Tremor

  1. Hepatic Encephalopathy (Ammonia)
  2. Hypocalcemia
  3. Hypoglycemia
  4. Hyponatremia
  5. Hypomagnesemia
  6. Hyperthyroidism
  7. Hyperparathyroidism
  8. Vitamin B12 Deficiency

III. Causes: Postural Tremor

  1. Antiarrhythmics
    1. Amiodarone
      1. Postural Tremor, Ataxia, and Peripheral Neuropathy
    2. Procainamide
    3. Mexiletine
  2. Adrenergic Agents (Sympathomimetics)
    1. Beta Adrenergic Agonists (Albuterol)
    2. Epinephrine
    3. Pseudophedrine
    4. Terbutaline
    5. Methylphenidate (Ritalin)
    6. Amphetamines
    7. Cocaine
  3. Antidepressants
    1. Tricyclic Antidepressants
    2. Selective Serotonin Reuptake Inhibitors (e.g. Fluoxetine)
  4. Endocrine agents
    1. Corticosteroids
    2. Levothyroxine (Synthroid)
    3. Calcitonin
  5. Phosphodiesterase Inhibitors
    1. Theophylline
    2. Caffeine
  6. Anticonvulsants
    1. Valproic Acid
    2. Carbamazepine (Tegretol)
    3. Phenytoin (Dilantin)
    4. Lamotrigine (Lamictal)

IV. Causes: Intention Tremor

  1. Alcohol
  2. Lithium Toxicity

V. Causes: Rest Tremor

  1. Dopamine depleting or blocking agents
    1. Metoclopramide (Reglan)
    2. Haloperidol (Haldol) and other Neuroleptics
    3. Trifluoperazine
    4. Tetrabenazine

VI. Causes: Chemotherapeutic Agents

  1. Cytotoxic drugs
    1. Cisplatin
    2. Doxorubicin
    3. 5-Fluorouracil
    4. Methotrexate
    5. Paclitaxel
    6. Vincristine
  2. Immunomodulators
    1. Cyclosporine
    2. Tacrolimus
    3. Interferon

VII. Causes: Miscellaneous

  1. Atorvastatin (Lipitor)
  2. Hypoglycemic medications
  3. Calcium Channel Blockers
    1. Verapamil
    2. Nifedipine
    3. Amlodipine

VIII. Causes: Toxins

  1. Inhalations
    1. Carbon Monoxide Poisoning
    2. Cyanide Poisoning
  2. Heavy Metal Poisoning
    1. Mercury Poisoning
    2. Lead Poisoning
    3. Manganese Poisoning
    4. Arsenic Poisoning
  3. Hydrocarbon Ingestion
    1. Toluene (e.g. Huffing)
    2. Naphthalene
    3. Lindane Toxicity (Organochlorine)
    4. DDT Poisoning

IX. Causes: Psychoactive Drugs

  1. Stimulants
    1. Amphetamines
    2. Cocaine
    3. Nicotine
  2. Hallucinogens
    1. Lysergic Acid Diethylamide (LSD)
    2. Mescaline
    3. Psilocybin
    4. Methylenedioxymethamphetamine (MDMA, Ecstasy)
  3. Withdrawal
    1. Alcohol Withdrawal
    2. Benzodiazepine Withdrawal

X. References

  1. Crawford (2011) Am Fam Physician 83(6): 697-702 [PubMed]
  2. Deuschl (1998) Mov Disord 13:13 [PubMed]
  3. Hopfner (2020) Neurotherapeutics 17(4):1603-21 +PMID: 32915385 [PubMed]
  4. Smaga (2003) Am Fam Physician 68:1545-53 [PubMed]

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