Provided no side effects, to what dose do you increase propranolol or primidone before considering them ineffective for a patient with essential tremor?  

If tolerated maximum dose of 250 mg of Primidone bid would be acceptable. This is my personal experience.

I’ll increase propranolol up to 30mg bid but only if patients clearly understand the expected decrease in BP and possible lightheadedness. I make sure they have access to BP cuff. It rarely requires this high a dose. Re mysoline: it causes most patients drowsiness but I advise starting with...