Which of the following is recommended as first-line treatment for essential tremor?

Propranolol, commonly known as Inderal, is recognized as the first-line treatment for essential tremor. This non-selective beta-blocker helps to alleviate the involuntary shaking associated with the condition by dampening the excessive neural activity that contributes to tremors. The mechanism involves blocking beta-adrenergic receptors, which can reduce the physiological tremor response and provide symptomatic relief.

In contrast, while phenytoin is an anticonvulsant medication that might be used for seizures, it is not effective for treating essential tremor. Similarly, amitriptyline, a tricyclic antidepressant, is not indicated for this condition; it may help with mood disorders but does not address the tremor directly. Lastly, fluoxetine, a selective serotonin reuptake inhibitor (SSRI) used primarily for depression and anxiety disorders, does not have established efficacy for essential tremor symptoms. Therefore, propranolol remains the most appropriate and widely accepted initial choice for managing essential tremor.