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I Have Developed Slight Involuntary Hand Movement W/ Slight Tremor
Question: I have developed slight involuntary hand movement w/ slight tremor of left hand. Noticed first about 6 months ago.
I do not know how to "upload" a report but rely on email.
I have seen my personal internist this year in March for bronchitis but did not think to mention this. She doesn't seem much interested in small symptoms anyway so I tend not to bother mentioning.
I have no history of stroke. My mother had a stroke and myocardial infarction but she lived to be 89 and did well until her final 4 years. We have no history of Parkinsons. Do you want a list of my medications?
I am 5'5", 150 lbs. XXXXXXX of Nordic descent.
I have seen my personal internist this year in March for bronchitis but did not think to mention this. She doesn't seem much interested in small symptoms anyway so I tend not to bother mentioning.
I have no history of stroke. My mother had a stroke and myocardial infarction but she lived to be 89 and did well until her final 4 years. We have no history of Parkinsons. Do you want a list of my medications?
I am 5'5", 150 lbs. XXXXXXX of Nordic descent.
Decided to list medications and supplements.
Nexium 40 mgm each morning
Levothyroxine 100 mcg each morning
Hydrochlorothiazise 25 mgm each morning
Duloxentine Hcl caps 30 mgm 10 AM
Lipitor 40 mgm. each evening
Clonazepam 0.5 mgm at bedtime
Zantac 150 mgm tabs 2, 30 min before bedtime. My doctor prescribed for GERD cough this year which is most troublesome at night. It works.
Calcium 1500 mgm daily, divided doses
Vit D3 1000U daily with calcium
I-Caps w/lutein and zeaxanthin one daily
Vitamin B12 1000mcg. One daily
Nexium 40 mgm each morning
Levothyroxine 100 mcg each morning
Hydrochlorothiazise 25 mgm each morning
Duloxentine Hcl caps 30 mgm 10 AM
Lipitor 40 mgm. each evening
Clonazepam 0.5 mgm at bedtime
Zantac 150 mgm tabs 2, 30 min before bedtime. My doctor prescribed for GERD cough this year which is most troublesome at night. It works.
Calcium 1500 mgm daily, divided doses
Vit D3 1000U daily with calcium
I-Caps w/lutein and zeaxanthin one daily
Vitamin B12 1000mcg. One daily
Brief Answer:
Duloxetine may cause tremor and also a few other possible causes in your case- further explanations below
Detailed Answer:
Hello and welcome to "Ask a Doctor" service,
I carefully read your query and understand your concern.
Tremor (involuntary movements) can be caused by a wide range of conditions such as medications, overactive thyroid, stress, low sugar, essential tremor, alcohol withdrawal and withdrawal from benzodiazepines, vitamin B12 deficiency, sleep deprivation, peripheral neuropathies and other neurological conditions such as Parkinson Disease, Multiple Sclerosis, etc.
A very common cause of tremor, among the ones mentioned in the above list is the so-called essential tremor. This is tremor with action and quiets down when resting. It is not dangerous and there is no extensive checks needed for it.
In your case:
- as for medications, Duloxetine is found in some cases to cause symptoms similar to Parkinson. This may happen any time during treatment, which means it may happen even after a long time on the drug. Zantac is a potential contributor in very rare cases as well. You may need to discuss this with your doctor before changes in medications are considered.
- Also, Vit B12 deficiency may predispose to tremors. Vit B12 may be difficult to be absorbed in some patients when taken orally, and Zantac use may add to this problem. In this case, it is not necessarily needed to stop Zantac but blood tests to confirm how is your B12 level are needed to be ordered. If Vit B12 comes out low you may take vitamin B12 intramuscularly.
- you are taking Levothyroxine for the thyroid. I would recommend you to have a TSH check (if not done one in the last 3-6 months) to make sure you are having a proper dose. Taking more Levothyroxine than needed may cause tremors.
- be watchful of the amount of caffeine you use daily as large consumption of coffee may make tremors worse
- you will also need to have a thorough neurological examination to check the tremor and also muscular strength, tone, sensation, and reflexes to rule out neurological conditions such as Parkinson or Multiple Sclerosis.
- if your tremor is worse when you use the hand (and when you are stressed) but better at rest, this very likely is essential tremor and is generally a benign condition (not dangerous and there are medications that your doctor may prescribe if he finds clues during the examination that this is the cause of your tremor)
I hope this answers your query. I remain at your disposal in case further medical assistance is needed.
Regards,
Dr. Antoneta Zotaj,
General and Family Physician
Duloxetine may cause tremor and also a few other possible causes in your case- further explanations below
Detailed Answer:
Hello and welcome to "Ask a Doctor" service,
I carefully read your query and understand your concern.
Tremor (involuntary movements) can be caused by a wide range of conditions such as medications, overactive thyroid, stress, low sugar, essential tremor, alcohol withdrawal and withdrawal from benzodiazepines, vitamin B12 deficiency, sleep deprivation, peripheral neuropathies and other neurological conditions such as Parkinson Disease, Multiple Sclerosis, etc.
A very common cause of tremor, among the ones mentioned in the above list is the so-called essential tremor. This is tremor with action and quiets down when resting. It is not dangerous and there is no extensive checks needed for it.
In your case:
- as for medications, Duloxetine is found in some cases to cause symptoms similar to Parkinson. This may happen any time during treatment, which means it may happen even after a long time on the drug. Zantac is a potential contributor in very rare cases as well. You may need to discuss this with your doctor before changes in medications are considered.
- Also, Vit B12 deficiency may predispose to tremors. Vit B12 may be difficult to be absorbed in some patients when taken orally, and Zantac use may add to this problem. In this case, it is not necessarily needed to stop Zantac but blood tests to confirm how is your B12 level are needed to be ordered. If Vit B12 comes out low you may take vitamin B12 intramuscularly.
- you are taking Levothyroxine for the thyroid. I would recommend you to have a TSH check (if not done one in the last 3-6 months) to make sure you are having a proper dose. Taking more Levothyroxine than needed may cause tremors.
- be watchful of the amount of caffeine you use daily as large consumption of coffee may make tremors worse
- you will also need to have a thorough neurological examination to check the tremor and also muscular strength, tone, sensation, and reflexes to rule out neurological conditions such as Parkinson or Multiple Sclerosis.
- if your tremor is worse when you use the hand (and when you are stressed) but better at rest, this very likely is essential tremor and is generally a benign condition (not dangerous and there are medications that your doctor may prescribe if he finds clues during the examination that this is the cause of your tremor)
I hope this answers your query. I remain at your disposal in case further medical assistance is needed.
Regards,
Dr. Antoneta Zotaj,
General and Family Physician
Above answer was peer-reviewed by :
Dr. Prasad
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