Medication-Induced Tremors

Antidepressants and Psychotropic Medications

The American Academy of Family Physicians notes that SSRIs commonly cause tremor as a dose-related adverse effect, with sweating, nervousness, and tremors reported as typical side effects across this drug class 1, 2, 3
SNRIs (duloxetine, venlafaxine, desvenlafaxine, levomilnacipran) cause tremor through similar serotonergic mechanisms and may have slightly higher discontinuation rates due to adverse effects compared to SSRIs 1, 4
The American Academy of Child and Adolescent Psychiatry recommends that when SSRI-induced tremor occurs early in treatment or with dose increases, consider dose reduction or slower up-titration, particularly in younger children 5
The American Academy of Family Physicians reports that TCAs including amitriptyline, desipramine, nortriptyline, doxepin, and imipramine cause tremor, likely through central mechanisms affecting physiological tremor 3, 4
Bupropion can cause tremor and should be avoided in patients with seizure disorders, according to the American Academy of Family Physicians 3
Mirtazapine is generally well-tolerated but tremor remains a potential adverse effect, as noted by the American Academy of Family Physicians 3

The American Academy of Family Physicians states that elderly patients taking lithium are particularly prone to neurotoxicity at higher doses, with therapeutic levels of 0.2-0.6 mEq/L generally adequate in older adults 3

Beta-agonists (albuterol, salmeterol, terbutaline) cause tremor through peripheral β-adrenergic receptor stimulation in muscle, representing classic enhancement of physiological tremor, as reported by the Journal of Crohn's and Colitis 4

Tramadol, meperidine, methadone, and fentanyl can cause tremor, with particular concern when combined with serotonergic medications due to risk of serotonin syndrome, according to the Journal of the American Academy of Child and Adolescent Psychiatry and the Journal of Crohn's and Colitis 4, 5

MAO inhibitors, including phenelzine, isocarboxazid, selegiline, linezolid, and tranylcypromine, carry risk of tremor and serious interactions with serotonergic drugs, as noted by the Journal of the American Academy of Child and Adolescent Psychiatry and the Journal of Crohn's and Colitis 4, 5
Ozanimod (S1P receptor modulator) may interact with medications causing tremor, though direct tremor causation is not clearly established, according to the Journal of Crohn's and Colitis 4

The Journal of the American Academy of Child and Adolescent Psychiatry recommends avoiding combining multiple serotonergic drugs without careful monitoring, starting the second agent at low dose and increasing slowly, with particular vigilance in the first 24-48 hours after dosage changes 5
The American Academy of Family Physicians notes that failing to recognize that approximately 63% of patients on second-generation antidepressants experience at least one adverse effect, with tremor being commonly reported, is a common pitfall 1, 2
The Journal of the American Academy of Child and Adolescent Psychiatry emphasizes the importance of distinguishing between benign drug-induced tremor and serotonin syndrome, which requires immediate hospitalization and discontinuation of all serotonergic agents 5

Neonates exposed to escitalopram during the third trimester can develop withdrawal symptoms, including tremors, irritability, jitteriness, hypertonia, and feeding difficulties, with onset ranging from hours to days after birth and typically resolving within 1-4 weeks, as reported by the Pediatrics journal 6

Beta‑agonists (e.g., albuterol, salmeterol, terbutaline) enhance physiological tremor by peripheral β‑adrenergic stimulation of skeletal muscle. – American Heart Association (AHA) [Circulation] 7

Cocaine and amphetamines produce fine tremor, tachycardia, and sweating through central and peripheral sympathomimetic stimulation. – American Heart Association (AHA) [Circulation] [7][8]
Ephedra alkaloids (including “ma huang”) induce tremor via direct myocardial sympathomimetic activation. – American Heart Association (AHA) [Circulation] 8
Decongestants and anorectic agents that contain sympathomimetics are associated with tremor. – American Heart Association (AHA) [Circulation] 7

Nicotine exposure (e.g., smoking) is linked to the development of tremor. – American Heart Association (AHA) [Circulation] 7
Alcohol use can cause tremor both during acute intoxication and during withdrawal phases. – American Heart Association (AHA) [Circulation] 7

Immunosuppressants cyclosporine and tacrolimus are associated with tremor. – American Heart Association (AHA) [Circulation] 7
Erythropoiesis‑stimulating agents have been reported to cause tremor. – American Heart Association (AHA) [Circulation] 7
Abrupt withdrawal of clonidine can precipitate tremor. – American Heart Association (AHA) [Circulation] 7