Propranolol For Anxiety

What is Propranolol?

Propranolol is a prescription medication used for a wide range of conditions from high blood pressure to performance anxiety. 

How Propranolol works

Propranolol is a beta-blocker.  Beta blockers work by blocking the effects of adrenaline on organs such as the heart, lungs and blood vessels and may also block nerve impulses to muscle.  

Adrenaline causes the heart to beat faster and more forcefully, and also constricts the arteries.  A beta blocker such as propranolol can cause the heart to slow down and beat less forcefully and arteries to widen or dilate.  This in turn can reduce the symptoms of anxiety such as chest pain or palpitations and alleviate sweating as well.  

It is not clear how Propranolol reduces tremors and shaking, although it is speculated that it may reduce nerve impulses to the muscles.

Propranolol uses

Propranolol is used to treat a range of conditions including high blood pressure, migraines, and anxiety. Propranolol is used for a specific type of anxiety, known as ‘performance anxiety’, which includes exam nerves, a fear of public speaking (glossophobia), and other stressful situations. 

How Propranolol helps anxiety

When using Propranolol for anxiety, it blocks the effects of adrenaline on the beta receptors in your heart. When you get anxious, your body releases epinephrine. This gives you the physical symptoms of anxiety such as a pounding heart rate, nervous trembling, and a shaking voice. Therefore, Propranolol can be a useful way to combat the physical symptoms of anxiety. However, Propranolol does not directly help the psychological symptoms of anxiety. Although, many people find that without the physical symptoms of anxiety, they can cope with the psychological symptoms more easily.  

How quickly does Propranolol work for anxiety?

Propranolol takes approximately 30-60 minutes to have a noticeable effect on anxiety. For general anxiety, Propranolol is usually taken every day, but some people choose to take Propranolol for a one-off event such as a public-speaking arrangement. In this situation, Propranolol may be taken around 1 hour, before the event. 

How long does Propranolol last for performance anxiety?

For anxiety, 40mg Propranolol is usually taken once a day (the dose may be increased up to three times daily in some cases). The half-life of Propranolol is 3-6 hours. This means that within 3-6 hours, the amount of Propranolol remaining in your system will be halved. Therefore, you can expect the effects of Propranolol to last for approximately 3-6 hours. 

Is Propranolol safe for anxiety?

Propranolol is an off-label treatment for anxiety. This means that it has not been FDA-approved for anxiety treatment, but it can still be prescribed safely and effectively. Your doctor will evaluate the risks and benefits of using Propranolol for anxiety and it will only be prescribed if it is considered safe and likely to be effective. 

Propranolol and anxiety types

Propranolol can be used for several different types of anxiety. It is usually prescribed for a general feeling of anxiety with physical symptoms, such as increased heart rate, shaking, and sweating. In this way, Propranolol can help people to carry on with their day-to-day lives if they are suffering from high anxiety levels. 

Propranolol for PTSD

Propranolol can also be used for post-traumatic stress disorder (PTSD). Propranolol can help people with PTSD avoid the physical symptoms of anxiety. This can help people better engage in psychotherapy and may also reduce flashbacks in some people. It has been suggested that Propranolol may also help reduce traumatic memories, but this has not yet been confirmed. 

Propranolol for public speaking

Propranolol is a popular medication used for glossophobia - the fear of public speaking. Public speaking can cause high levels of anxiety. Tremors, shaking and a rapid heart rate can produce a trembling voice, which often makes the anxiety levels worse. Taking a one-off dose of Propranolol about one hour before the event can help to alleviate the physical symptoms of anxiety, and help you with your speech. 
 

Active ingredients

The active ingredient in Propranolol is propranolol hydrochloride. Propranolol hydrochloride is a beta-blocker. 

Inactive ingredients

The inactive ingredients in Propranolol can vary between different manufacturers. Inderal is a brand of Propranolol. It contains the following inactive ingredients: lactose, magnesium stearate, microcrystalline cellulose, and stearic acid. 

Which ingredients can cause an allergic reaction?

If you have previously had an anaphylactic shock to this medication, please refrain from taking it again. Symptoms to look out for are swelling of the lips, face or tongue, difficulty breathing, hives and dizziness. After taking the medication, if you experience these symptoms you should seek medical attention immediately. 
 

Propranolol dosage

When using Propranolol to treat anxiety the usual starting dose is 20-40mg taken once a day. The dose may be increased and you may need to take Propranolol up to three times a day to get the desired effects. Your doctor will inform you of which dose you should take. Propranolol may also be taken on a one-off basis for an anxiety-triggering event such as public speaking. Your doctor may prescribe a different dose for this, which would be taken approximately one hour before the event.

Do not crush, split or chew Propranolol tablets. This can cause the medication to be absorbed too quickly into your bloodstream, which could lead to a sudden drop in blood pressure or other dangerous side effects. 

Propranolol for migraines, tremors, high blood pressure, and other conditions may be taken at different dosages, so ensure you follow the recommendations of your doctor. 

Propranolol side effects

Common Propranolol side effects include:

• Dizziness
• Fatigue
• Sleeping difficulties (insomnia) and nightmares
• Nausea
• Reduced libido
• Stomach cramps
• Constipation
• Low blood pressure (Your fingers and toes may feel cold due to reduced blood flow)

Taking Propranolol with food may help to reduce some of these side effects, such as nausea and dizziness. 

Propranolol adverse effects

For many people Propranolol is a safe medication, however, some people do experience more severe side effects such as:

• Breathing difficulties 
• Swollen ankles or legs
• Slow or irregular heartbeat
• Vision problems
• Chest pain
• Wheezing
• Yellowing of your skin and whites of the eyes (jaundice)
• Confusion or anxiety
• Severe allergic skin reactions

If you experience any of these side effects, it is important that you seek immediate medical attention. 
 

Drug interactions

You should always tell your doctor if you are taking or plan to take any other medications, alternative medicines, or recreational drugs. Some of these can interact with Propranolol. Specifically, you should avoid:

• High blood pressure medications
• Blood thinners e.g. Warfarin
• Medications for heart rhythm disorders
• NSAID painkillers e.g. Aspirin, Ibuprofen, Naproxen, and Diclofenac
• Antidepressants
• Drugs treating prostate disorder e.g. Doxazosin or Tamsulosin
• Nitrates 
• Certain muscle relaxants 
• Parkinson's disease medicines e.g. Levodopa
• Diabetes medications
• Allergy drugs e.g. Ephedrine
   

Contraindications

Propranolol is contraindicated for people who:

• Are allergic to any ingredient contained in the medication prescribed
• Have asthma or COPD
• Have an abnormally slow heartbeat 
• Have serious heart conditions (sick sinus syndrome, AV block) 
• Suffer from impaired liver function.

Do not take Propranolol if any of the above conditions apply to you. 

Propranolol, can you drink while taking it?

It is best to avoid taking Propranolol and alcohol together. Propranolol reduces your blood pressure, but alcohol can increase this effect, causing light-headedness and fainting. Therefore, you should avoid drinking while taking Propranolol. 

Propranolol and pregnancy

Propranolol should be avoided during pregnancy. It should only be used if there are no alternatives and if the benefits outweigh the risks. Taking Propranolol in pregnancy may decrease the blood flow that the baby receives in the womb, and can also affect the baby’s blood sugar and heart rate. 

Can Propranolol cause weight gain?

Propranolol does not cause an increase in body fat. However, some people do experience an increase in weight as Propranolol can cause your body to retain more fluid than usual. 

Why can't you take Propranolol if you have asthma or COPD?

Propranolol works by blocking the effects of adrenaline. Adrenaline is a bronchodilator, meaning, it acts to relax and open the airways which makes breathing easier.  If you have asthma or COPD, you may need adrenaline to avoid airway constriction, wheezing and shortness of breath.  As Propranolol can block the effects of adrenaline, it can induce constriction of the airways, or bronchospasm, and lead to exacerbation of asthma or COPD.  Patients with asthma or COPD should therefore avoid beta blockers, such as Propranolol, unless prescribed under the supervision of their primary provider or specialist.  

Alternatives to Propranolol

Propranolol is an effective anxiety treatment for many people. You may only need to take it on a one-off basis, but if you suffer from regular anxiety, it may help to use Propranolol alongside other therapies, such as cognitive behavioral therapy (CBT) or counseling. These therapies are also effective anxiety treatments if you do not wish to take any prescription medication. 
However, if your anxiety is severe, other medications such as benzodiazepines (e.g. Valium) may be more appropriate, although they can be addictive. Your doctor will consider this before issuing a prescription.