Propranolol - Patient Information
What is Propranolol
Propranolol is a Beta-blocker. This is a class of medication that helps control your body’s fight-or-flight response and reduce its effects on your heart. Many people take beta-blockers to treat heart-related conditions, such as:
- high blood pressure
- heart failure
- an irregular heartbeat
Doctors can also prescribe beta-blockers for off-label use like for help managing performance anxiety symptoms. Examples of situations when Propranolol can be used include the following:
- General social anxiety
- Performances and auditions
- Presentations at work
- Public speaking
- Networking events
- Dating or personal conversations
Read on to learn more about how beta-blockers impact anxiety, and whether they could work for you.
How do beta-blockers work
Beta-blockers are also called beta-adrenergic blocking agents. They prevent adrenaline — a stress-related hormone — from making contact with your heart’s beta receptors. This prevents adrenaline from making your heart pump harder or faster.
In addition to relaxing your heart, some beta-blockers also relax your blood vessels, which can help to reduce blood pressure.
There are many beta-blockers available, but some of the more common ones include:
- acebutolol (Sectral)
- bisoprolol (Zebeta)
- carvedilol (Coreg)
- atenolol (Tenormin)
- metoprolol (Lopressor)
The beta-blocker that is prescribed by our hims/hers physicians is called Propranolol. This is sometimes known as the brand name Inderal.
All beta-blockers used to treat anxiety are prescribed off-label. Propranolol and atenolol are two beta-blockers that are often prescribed to help with anxiety.
OFF-LABEL DRUG USE Using a drug off-label means that a drug has been approved by the FDA for one purpose, and it’s being used for a different purpose that hasn’t been approved. A doctor can still prescribe it for this purpose because the FDA regulates the testing and approval of drugs, not how doctors use them to treat their patients. Your doctor can prescribe a drug off-label if they think it’s best for your care.
How can beta-blockers help anxiety
Beta-blockers won’t treat the underlying psychological causes of anxiety, but they can help you manage some of yours, such as:
- a fast heart rate
- shaky voice and hands
By decreasing your body’s physical reactions to stress, you may feel less anxious during stressful times.
Beta-blockers work best for managing short-term anxiety about specific events, rather than long-term anxiety. For example, you can take a beta-blocker before giving a public speech if that’s something that makes you feel anxious.
A 2016 review of existing research about using short-term propranolol for treating different anxiety disorders found that its effects were similar to those of benzodiazepines. These are another class of medication that’s often used to treat anxiety and panic disorders. However, benzodiazepines can cause a range of side effects, and some people have a higher risk of becoming dependent on them.
People respond differently to medications, especially when it comes to treating mental health issues like anxiety. What works for one person may not work at all for someone else. You may also need additional treatment options for your anxiety while taking beta-blockers, to get to the more psychological aspects.
How do I take beta-blockers for performance anxiety
Propranolol comes in a pill form. The amount you should take depends on both the type of beta-blocker and your medical history. Never take more than what your doctor prescribes. You’ll likely notice results the first time you take beta-blockers for anxiety, but they can take an hour or two to reach their full effect. During this time, you’ll feel your heart rate decrease, which might make you feel more relaxed.
Our physicians recommend a single Propranolol 20mg tablet to be taken approximately 30-minutes prior to the stressful event. You will be provided a total of 5 pills per month.
What are the possible side effects
Beta-blockers can cause some side effects, especially when you first start taking them. These side effects are more common if you take Beta Blockers every day. Our physicians only recommend taking a Beta Blocker only “as needed” and do NOT advise daily use for performance anxiety.
Possible side effects include:
- cold hands and feet
- dizziness or lightheadedness
- shortness of breath
- vomiting, diarrhea, or constipation
Call your doctor if you experience any more serious side effects, including:
- very slow or irregular heartbeat
- low blood sugar
- an asthma attack
- swelling and fluid retention, along with weight gain
If you notice mild side effects, don’t stop taking the beta-blocker without talking to your doctor first. If you take beta-blockers regularly, you may have serious withdrawal symptoms if you suddenly stop.
For some people, the side effects of beta-blockers may actually cause anxiety symptoms. You should follow up with your doctor as soon as possible if you feel like taking beta-blockers is increasing your anxiety.
Who shouldn’t take beta-blockers
While beta-blockers are generally safe, certain people shouldn’t take them. Before taking beta-blockers, make sure to tell your doctor if you have one or more of the following conditions:
- Anaphylactic reaction/Anaphylaxis (severe)
- Angina (severe chest pain)
- Recent heart attack
- Muscle problems (eg, myopathy, myotonia or myasthenia gravis)
- Asthma or Bronchospasm
- Bradycardia (slow heartbeat), Heart block/heart rhythm disorder, Sick sinus syndrome
- (type of abnormal heart rhythm), Tachycardia (fast heartbeat)
- Wolff-Parkinson-White syndrome (rare heart condition)
- Heart failure
- Tremors due to Parkinson's disease
- Hypotension (low blood pressure)
- Pheochromocytoma (an adrenal problem)
- Hypoglycemia (low blood sugar)
- Hyperthyroidism (overactive thyroid)
- Kidney disease
- Liver disease
- Lung disease (eg, chronic bronchitis, emphysema, COPD)
- Blood circulation problems (e.g., Raynaud's disease)
If you have any of these conditions or symptoms, you may still be able to take beta-blockers, but you’ll need to work with your doctor to weigh the risks and benefits.
Beta-blockers can also interact with other medications used to treat many heart conditions and antidepressants, so make sure you keep your doctor up to date about any medications, supplements, or vitamins you take.
If you are not sure about taking propranolol with another medication please discuss this with your doctor or you can use this interaction checker. Just enter ‘Propranolol Oral’ and add the names of your medication(s).
Tell your doctor if you have ever had any unusual or allergic reaction to this medicine or any other medicines. Also tell your health care professional if you have any other types of allergies, such as to foods, dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully.
Use in pregnancy
|All Trimesters||C||Animal studies have shown an adverse effect and there are no adequate studies in pregnant women OR no animal studies have been conducted and there are no adequate studies in pregnant women.|
What happens if I overdose
Seek emergency medical attention or call the Poison Help line at 1-800-222-1222.
To learn more about Propranolol we recommend accessing the Prescribers Digital
The bottom line
Beta-blockers can be helpful in managing symptoms for some people with performance or situational anxiety. It’s been shown as a viable treatment option for short-term anxiety, especially before a stressful event. However, beta-blockers aren’t as useful for long-term treatment.
If you’re interested in trying beta-blockers for managing your performance anxiety we recommend an online consultation with one of our physicians. They can advise on the best treatment plan for you that will help manage your specific symptoms.
Reviewed by Adrian Rawlinson MD - Vice President of Medical Affairs at Hims,Inc.