Side Effect: Tremors

Tremors are rhythmic, involuntary shaking or movement of body parts, such as from the hands, arms, head, or legs. Tremors can be mild or severe and can affect a person’s daily activities and quality of life.

Common symptoms of tremors may include:

• Rhythmic shaking of the hands, arms, head, legs, or torso
• Shaky voice
• Trouble with using a pen or pencil to write
• Problems with holding or controlling items such as a cup, tools, utensils or other items that require dexterity

Patients with cancer can develop tremors as a result of chemotherapy treatment or the disease itself. Chemotherapy drugs that cause peripheral neuropathy are a common cause of tremors. Tremors can also be a symptom of another type of movement disorder called tardive dyskinesia which can be caused by medications commonly prescribed for mood, nausea, such as Compazine (prochlorperazine), or from Pseudopephedrine (Sudafed®) found in cold and allergy medication.

Other causes of tremors include:

• Exposure to heavy metals, pesticides or organic solvents
• Too much caffeine
• Overactive thyroid
• High or low blood sugars
• Stress, anxiety, or fatigue

• Preventing tremors in patients with cancer depends on the cause of the tremor. Managing underlying comorbidities such as overactive thyroid and diabetes can help reduce the risk of tremors.
• Patients may also benefit from lifestyle modifications such as reducing caffeine intake, getting enough sleep, and practicing relaxation techniques during times of stress and anxiety.
• Patients who have tremors from certain medications should list these on their “Allergy/intolerance” list at their doctor’s office to avoid being prescribed similar medications.

Treating tremors in patients with cancer depends on the cause.

• If tremors are causes by a medication, switching to a different medication or adjusting the dosage may help.
• Tremors that are caused by chemotherapy-induced peripheral neuropathy can be managed with certain medications such as gabapentin (Neurontin ®) and pregabalin (Lyrica ®).
• In some cases, beta-blockers, benzodiazepines, and antiseizure medications may be used to treat tremors.
• Physical therapy and occupational therapy may be recommended to help manage tremors and improve quality of life.