{
  "schema_version": 1,
  "kind": "condition",
  "id": "essential-tremor",
  "name": "Essential tremor",
  "category": "chronic",
  "sources": "Primidone SERB 250 mg Tablets SmPC section 4.2, Essential tremor (eMC product 2940): \"Initially a dose of 50 mg daily should be introduced in a single intake late afternoon, using, when available, the 50 mg tablet. The daily dose (given in 2 divided doses) should be increased gradually over a 2 to 3-week period until remission of symptoms or the highest dose tolerated up to a maximum of 750 mg daily.\" · Egyptian National Drug Formulary - Cardiovascular 2024 (propranolol monograph)",
  "review_status": "reviewed",
  "verified_against": "Egyptian National Drug Formulary - Cardiovascular 2024 (propranolol monograph) · Primidone SERB 250 mg Tablets SmPC section 4.2, Essential tremor (eMC product 2940): \"Initially a dose of 50 mg daily should be introduced in a single intake late afternoon, using, when available, the 50 mg tablet. The daily dose (given in 2 divided doses) should be increased gradually over a 2 to 3-week period until remission of symptoms or the highest dose tolerated up to a maximum of 750 mg daily.\"",
  "verified_date": "2026-08",
  "treatments": [
    {
      "id": 710,
      "generic": "Propranolol",
      "line": 1,
      "is_adjunct": false,
      "form": "oral.solid",
      "strength_mg": 40.0,
      "adult_dose": "40 mg twice daily initially, titrate up to 80-160 mg daily in divided doses (max 320 mg daily)",
      "adult_duration": "long-term",
      "dose_source": "Egyptian National Drug Formulary - Cardiovascular 2024 (propranolol monograph)",
      "rationale": "Non-selective beta-blocker used first-line for essential tremor; it dampens the peripheral component of the tremor, reducing its amplitude.",
      "cautions": [
        "CONTRAINDICATED in bronchial asthma, severe COPD, second/third-degree heart block, and sick sinus syndrome.",
        "May mask symptoms of hypoglycemia in diabetic patients.",
        "Avoid abrupt withdrawal (risk of rebound tachycardia and hypertension)."
      ],
      "peds_mgkg_low": null,
      "peds_mgkg_high": null,
      "peds_max_mg": null,
      "peds_basis": null,
      "peds_unit": null,
      "peds_note": "Essential tremor is rare in pediatric populations; specialist referral required",
      "peds_min_weight_kg": null,
      "peds_max_weight_kg": null,
      "peds_age_min_months": null,
      "peds_age_max_months": null,
      "peds_age_bands": null,
      "peds_doses": null,
      "brands": [
        {
          "trade_name": "INDOLOL 40 MG 50 TAB",
          "scientific_name": null,
          "normalized_ingredient": null,
          "manufacturer": "KAHIRA",
          "price_egp": 13.5,
          "pack_count": 50,
          "unit_price": 0.27,
          "strength_mg": 40.0,
          "exact_strength": true,
          "exact_form": true,
          "discontinued": false,
          "also_contains": null
        },
        {
          "trade_name": "PROLOL 40 MG 50 TABS.",
          "scientific_name": null,
          "normalized_ingredient": null,
          "manufacturer": "EIPICO",
          "price_egp": 70.0,
          "pack_count": 50,
          "unit_price": 1.4,
          "strength_mg": 40.0,
          "exact_strength": true,
          "exact_form": true,
          "discontinued": false,
          "also_contains": null
        },
        {
          "trade_name": "INDERAL 40 MG 50 TABS",
          "scientific_name": null,
          "normalized_ingredient": null,
          "manufacturer": "ASTRA ZENECA",
          "price_egp": 100.0,
          "pack_count": 50,
          "unit_price": 2.0,
          "strength_mg": 40.0,
          "exact_strength": true,
          "exact_form": true,
          "discontinued": false,
          "also_contains": null
        }
      ],
      "condition_id": "essential-tremor"
    },
    {
      "id": 711,
      "generic": "Primidone",
      "line": 2,
      "is_adjunct": false,
      "form": "oral.solid",
      "strength_mg": 50.0,
      "adult_dose": "50 mg once daily in the late afternoon initially, then increase gradually in two divided doses over a 2 to 3-week period until the tremor settles or the highest tolerated dose is reached, to a maximum of 750 mg daily",
      "adult_duration": "long-term",
      "dose_source": "Primidone SERB 250 mg Tablets SmPC section 4.2, Essential tremor (eMC product 2940): \"Initially a dose of 50 mg daily should be introduced in a single intake late afternoon, using, when available, the 50 mg tablet. The daily dose (given in 2 divided doses) should be increased gradually over a 2 to 3-week period until remission of symptoms or the highest dose tolerated up to a maximum of 750 mg daily.\"",
      "rationale": "Primidone is not registered or marketed in Egyptian commercial pharmacies; propranolol is the primary Egyptian first-line agent.",
      "cautions": [
        "Unregistered and unavailable in Egyptian commercial pharmacies.",
        "First-dose acute reaction (severe dizziness, ataxia, nausea) common if started at standard dose; start very low.",
        "Metabolized in part to phenobarbital; causes sedation, lethargy, and ataxia.",
        "Abrupt withdrawal can precipitate seizures."
      ],
      "peds_mgkg_low": null,
      "peds_mgkg_high": null,
      "peds_max_mg": null,
      "peds_basis": null,
      "peds_unit": null,
      "peds_note": "Specialist neurology use only in children",
      "peds_min_weight_kg": null,
      "peds_max_weight_kg": null,
      "peds_age_min_months": null,
      "peds_age_max_months": null,
      "peds_age_bands": null,
      "peds_doses": null,
      "brands": [],
      "condition_id": "essential-tremor"
    }
  ]
}