We studied the effects of flunarizine (Fz) in 10 patients with moderate to severe essential tremor. Tremor was evaluated after 6 weeks of treatment using patient and physician assessment as well as blinded video analysis. Only one patient had mild subjective transient improvement and three experienced worsening of tremor. No patient elected to remain on Fz. We conclude that Fz is ineffective for moderate to severe essential tremor and may actually worsen the symptoms in some patients.