Propranolol for Performance Anxiety: How it Works, Studies & Dosages

Feeling anxious before a speech, event or social engagement? Originally designed to treat heart conditions, propranolol is also a highly effective medication for treating for the physical symptoms of social and performance anxiety.

Below, we’ve explained what propranolol is, how it works and how you can use it to manage most performance anxiety symptoms. We’ve also explained how propranolol differs from the other drugs used to treat anxiety, such as alprazolam (Xanax) and diazepam (Valium).

What is Propranolol?

Propranolol is a beta blocker -- a type of medication that works by blocking the beta receptors found in your heart, lungs and arteries.

Developed in the 1960s, propranolol is one of the oldest and most widely used beta blockers in existence. There are more than 15 million prescriptions for propranolol in the US alone, making it an incredibly popular medication.

Propranolol is available in a variety of forms, from an oral tablet to an injection. The majority of people who use propranolol are prescribed the oral version of the medication.

Like other beta blockers, propranolol was originally designed as a treatment for heart conditions, such as irregular heart rate or high blood pressure. Most people who are prescribed propranolol use it for this purpose.

In addition to treating certain heart conditions, propranolol also works as a treatment for some of the effects of anxiety. Today, it’s commonly prescribed off-label to treat performance anxiety and social anxiety.

How Does Propranolol Treat Performance Anxiety?

First off, it’s important to understand that propranolol technically isn’t an antianxiety medication like Xanax (alprazolam, a benzodiazepine) or Zoloft (sertraline, an SSRI).

These drugs work by targeting specific parts of your brain and central nervous system, causing you to feel relaxed and calm. Although the specifics are complicated, they essentially work by stopping you from feeling the physical and psychological effects of anxiety.

Medications like Xanax and Zoloft are usually prescribed to treat long-term, persistent anxiety disorders such as panic disorder and generalized anxiety disorder (GAD).

Instead, propranolol works by specifically targeting the receptors in your heart to block some of the physical effects of anxiety. It’s prescribed off-label as a treatment for specific types of anxiety that occur in certain situations, such as social anxiety or performance anxiety.

Social anxiety usually occurs when you’re around other people. Many people feel anxiety about being judged by others or by doing or saying something embarrassing in a social environment.

Performance anxiety is a type of anxiety that can occur when you’re required to perform in front of others. It can strike when you need to perform in public, such as giving a speech, as well as in private, such as before having sex.

When you feel anxiety, such as before meeting a new person or performing in front of others, it can trigger certain physical symptoms. These include:

  • A dry mouth, taut throat and difficulty speaking
  • A faster pulse and rapid breathing
  • Nausea, discomfort and dizziness
  • Shakiness in your hands, jaw and lips
  • Sweating, especially from your hands

When performance anxiety strikes before sex, it can even cause erectile dysfunction. This often creates a vicious circle of anxiety, with each episode of performance anxiety causing the next to become even worse.  

These symptoms don’t just develop out of nowhere. Instead, they’re a physical reaction caused by the presence of specific stress hormones in your body, particularly the hormones adrenaline (epinephrine) and noradrenaline (norepinephrine).

When you feel nervous and stressed, such as before delivering a speech, your body ramps up its production of these stress hormones. These hormones work by attaching to beta receptors, specifically the β1, β2 and β3 receptors throughout your body.

Once these hormones attach to your beta receptors, they trigger the anxiety symptoms listed above, from shaky hands to sweating, nausea and a rapid heartbeat.

Propranolol works by blocking these receptors. With these receptors blocked, stress hormones like adrenaline don’t have their normal effects on your heart and other tissue. This means you’re less likely to experience physical symptoms like shaking, sweating or a rapid pulse.

Since propranolol only blocks beta receptors, it doesn’t actually stop the psychological effects of anxiety. You might still feel nervous before delivering a speech or meeting someone, but it’s less likely to result in any kind of physical reaction.

Interestingly, although propranolol doesn’t directly affect your brain, it can help to make you feel less nervous. Without the shaking, rapid heartbeat and sweating that usually happens when you feel anxious, it can become easier to relax, perform and stay focused.

Studies show that propranolol works best as a short-term treatment for specific types of anxiety, such as performance anxiety, social anxiety and specific phobias. Propranolol isn’t used to treat other types of anxiety, such as generalized anxiety disorder.

How to Use Propranolol for Performance Anxiety

Propranolol is a prescription medication, meaning you’ll need to talk to your doctor before you can buy and use it.

Using propranolol to treat performance or social anxiety is a simple process. Most people take 10 to 80mg of propranolol approximately one hour before the event that’s likely to cause stress, depending on the severity of their anxiety.

Propranolol has a duration of action of approximately 12 hours, meaning its effects can last for significantly longer than most stressful events. Using a lower dose of propranolol (such as 10 or 20mg) can reduce the drug’s effects and provide shorter-acting relief from anxiety symptoms.

Like with other medications for anxiety, it can take time to work out the right dose of propranolol for you. Most doctors recommend starting with a low to moderate dose and adjusting your dose based on your results and side effects.

Propranolol vs. Benzodiazepines for Performance Anxiety

Benzodiazepines such as alprazolam (Xanax) and diazepam (Valium) are also commonly used to treat anxiety. Although they might seem similar, beta blockers such as propranolol differ from benzodiazepines in several ways:

  • Propranolol is not physically addictive. Although it’s possible to abuse propranolol and other beta blockers, these drugs aren’t physically addictive. Benzodiazepines such as Valium and Xanax, on the other hand, have a high risk of causing physical addiction.
  • Propranolol is designed for short-term, event-based anxiety. Benzodiazepines are normally prescribes for long-term, generalized anxiety, whereas propranolol works best as a treatment for short-term, event-based anxiety.
  • Propranolol primarily affects the body, not the brain. Benzodiazepines like Xanax reduce anxiety by targeting parts of the brain and central nervous system. Propranolol primarily works by targeting the heart and other tissue with beta receptors.

In general, propranolol works best as a treatment for event-based anxiety, whereas drugs like benzodiazepines and SSRIs are normally used to treat recurrent, persistent anxiety disorders that aren’t triggered by specific events or settings.

Does Propranolol Have Side Effects?

Used responsibly at a normal dose, propranolol is a safe, effective treatment for performance and social anxiety. However, like other beta blockers, it can result in some side effects.

Our guide to beta blockers goes into more detail on the side effects you might experience after taking propranolol, as well as potential drug interactions you should be aware of before taking propranolol or any other beta blockers.  

Learn More About Propranolol

Whether you need something to calm your nerves before performances or need help reducing the effects of social anxiety, propranolol’s effects on the physical symptoms of anxiety make it an effective treatment.

Our guide to propranolol goes into more detail on how propranolol works, as well as its main potential side effects.

This article is for informational purposes only and does not constitute medical advice. The information contained herein is not a substitute for and should never be relied upon for professional medical advice. Always talk to your doctor about the risks and benefits of any treatment.