First line of treatment

• propranolol
• primidone
• combination of propranolol and primidone

Second line of treatment

• gabapentin
  
• pregabalin
  
• topiramate
• clonazepam, alprazolam
• atenolol
• zonisamide

Third line of treatment

• nimodipine
  
• clozapine
  

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These drugs have not received FDA approval to treat essential tremor specifically, but some doctors prescribe them for this purpose on an off-label basis.

​Talk to your doctor about the risks of using this medication for your condition.
When the diagnosis of essential tremor is made, you may be offered one of these medicines. A low dose is usually started at first and gradually increased until your tremor is eased. If you reach the maximum dose without a satisfactory improvement, then the other medicine can be tried. If that also doesn't work, you can try them together. Other medicines can be tried if these two are not effective. A wide range of medicines have been shown to have some effect on reducing the severity of the tremor.

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* A Movement Disorder Specialist is a neurologist with additional training in Essential Tremor disease — may have information on the latest treatments and research. Seeing a movement disorder specialist for your regular ET care or even only once a year can help to optimize your treatment regimen.)

Medication 
There are two main medicines used initially for ET - propranolol and primidone. These medicines have been shown to ease the tremor in up to 8 in 10 affected people.

Propranolol - this is a medicine that is usually used in heart disease. It is in a class of medicines called beta-blockers. It has also been shown to be effective in essential tremor. This medicine should be used with care if you have a heart conduction problem or a lung disease such as asthma. The most common side effects of propranolol are dizziness, tiredness, and nausea (feeling sick).
Read More: Propranolol

Primidone (Mysoline) - this medicine is primarily used for epilepsy, but it also works very well for essential tremor. The most common side-effects are sleepiness, dizziness and nausea. These may improve if you continue to take this medicine.
Learn More: Primidone
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Tranquilizers Doctors may use drugs such as alprazolam (Xanax) and clonazepam (Klonopin) to treat people for whom tension or anxiety worsens tremors. Side effects can include fatigue or mild sedation. These medications should be used with caution because they can be habit-forming.
Read More: alprazolam
Read More: Clonazepam

OnabotulinumtoxinA (Botox) injections  Botox injections might be useful in treating some types of tremors, especially head and voice tremors. Botox injections can improve tremors for up to three months at a time.
However, if Botox is used to treat hand tremors, it can cause weakness in your fingers. If it's used to treat voice tremors, it can cause a hoarse voice and difficulty swallowing.
Read More: onabotulinumtoxinA

Gabapentin
​Gabapentin is also sometimes used to relieve the pain of diabetic neuropathy (numbness or tingling due to nerve damage in people who have diabetes).T. Gabapentin capsules, tablets, and oral solution are used along with other medications to help control certain types of seizures in people who have epilepsy. Gabapentin capsules, tablets, and oral solution are also used to relieve the pain of postherpetic neuralgia (PHN; the burning, stabbing pain or aches that may last for months or years after an attack of shingles). Gabapentin extended-release tablets (Horizant) are used to treat restless legs syndrome (RLS; a condition that causes discomfort in the legs and a strong urge to move the legs, especially at night and when sitting or lying down). Gabapentin is in a class of medications called anticonvulsants. Gabapentin treats seizures by decreasing abnormal excitement in the brain. Gabapentin relieves the pain of PHN by changing the way the body senses pain. It is not known exactly how gabapentin works to treat restless legs syndrome.
Read More: Gabapentin

Pregabalin
Pregabalin capsules, oral solution (liquid), and extended-release (long-acting) tablets are used to relieve neuropathic pain (pain from damaged nerves) that can occur in your arms, hands, fingers, legs, feet, or toes if you have diabetes and postherpetic neuralgia (PHN; the burning, stabbing pain or aches that may last for months or years after an attack of shingles). Pregabalin capsules and oral solution are also used to relieve neuropathic pain that can occur after a spinal cord injury and to treat fibromyalgia (a long-lasting condition that may cause pain, muscle stiffness and tenderness, tiredness, and difficulty falling asleep or staying asleep). Pregabalin capsules and oral solution are used along with other medications to treat certain types of seizures in adults and children 1 month of age and older. Pregabalin is in a class of medications called anticonvulsants. It works by decreasing the number of pain signals that are sent out by damaged nerves in the body.
Read More: Pregablin
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Topiramate
Topiramate is also sometimes used for the management of alcohol dependence and for the treatment of binge eating disorder and essential tremors (a movement disorder that causes involuntary shaking, especially in the hands).
Read More: topiramate

Atenolol
Atenolol is also used sometimes to prevent migraine headaches and to treat alcohol withdrawal, heart failure, and irregular heartbeat. Talk to your doctor about the possible risks of using this medication for your condition.
This medication may be prescribed for other uses; ask your doctor or pharmacist for more information.
Read More: Atenolol

Zonisamide
Zonisamide is used in combination with other medications to treat certain types of seizures. Zonisamide is in a class of medications called anticonvulsants. It works by decreasing abnormal electrical activity in the brain.
Read More: Zonisamide

Medications & Research

One New York-based study showed only 8 percent of patients had actually been prescribed medication for tremor. Furthermore, patients who try one or more medications for treatment usually find them to be less than satisfactory. No medication has been specifically developed to treat ET.

Experts consider the best medications to be propranolol, an FDA-approved beta blocker, and primidone, an anti-epileptic. The anti-anxiety medications clonazepam, diazepam, lorazepam, and alprazolam, and the anti-convulsants gabapentin and topiramate, have also shown some benefit for ET.

Most experts agree that primidone is the most effective treatment for ET, followed by propranolol and other beta-blockers. If tremor is not sufficiently controlled with one of these medications, the two can be used in combination. If these medications do not control tremor or cause intolerable side effects, then gabapentin or topiramate are probably the next most commonly tried medications. Benzodiazepines are also used, especially if anxiety is also an issue, but the potential for addiction should be considered.

Meanwhile, current research focuses on finding the gene that causes ET. In many large families, the condition appears to be dominantly inherited—that is, there's a 50–50 chance each child has it.

Finding a dominantly inherited gene is viewed by experts as crucial to finding a cure.

Types of Tremor * Inherited ET