New alternative agents in essential tremor therapy: double-blind placebo-controlled study of alprazolam and acetazolamide

Propranolol and primidone are widely used, effective agents in essential tr emor although they are not tolerated by all patients. In the present study, the effectiveness of alprazolam, a triazole analog of benzodiazapine class , and acetazolamide, a carbonic anhydrase inhibitor, were investigated as s ymptomatic treatments for essential tremor. We studied 22 patients with ess ential tremor in a double-blind, cross-over, placebo-controlled design. The patients received in random order alprazolam, acetazolamide, primidone and placebo for four weeks, each separated by a two-week washout period. The s tudy demonstrated that alprazolam was superior to placebo and equipotent to primidone, whereas there was no statistically significant difference betwe en acetazolamide and placebo. The mean effective daily dose of alprazolam w as 0.75 mg and there was not any troublesome side effect reported by the pa tients on alprazolam. Alprazolam can be used as an alternative agent in eld erly essential tremor patients who can not tolerate primidone or propranolo l.