Propranolol for anxiety: How beta blockers treat anxiety

Finding peace while struggling with the symptoms of anxiety is challenging, pushing you to search for solutions. Propranolol is a medication primarily used to treat conditions such as high blood pressure (hypertension).

During your search for online anxiety treatment options, you may have run across propranolol for anxiety. In recent years, the medical community has propranolol as an effective option for treating some mental health conditions. 

In this article, we cover how propranolol, sold under the brand name Inderal LA, works in the body, who should take it for anxiety, the warnings and common side effects you should know about before taking it, and more. We also answer your questions about what to do if you forget to take your dosage or what the best time to take it is. 

Anxiety is treatable

Discover treatment options and find a provider today.

Learn more

Klarity Health’s online platform connects you to licensed medical professionals. Your chosen provider listens to your symptoms and discusses an individualized anxiety treatment plan that may include propranolol or another medication. 

How propanol treats anxiety

Propranolol hydrochloride or just propranolol, sold under the brand name Inderal, was first approved for use by the U.S. Food and Drug Administration (FDA) for cardiovascular conditions. It’s indicated to treat high blood pressure, angina (chest pain), and migraines.

Propranolol is also used off-label effectively in psychiatry to treat physical symptoms of anxiety, particularly social anxiety, like rapid heart rate and sweating.

Propranolol is a non-selective beta-blocker, which means it blocks both beta-1 and beta-2 adrenergic receptors.

Propranolol works by blocking the action of adrenaline (epinephrine) and noradrenaline (norepinephrine), which are stress hormones involved in the “fight or flight” response. By reducing the effects of these hormones, propranolol helps to lower heart rate, blood pressure, and reduce tremors.

Propranolol comes in several forms:

• Tablets: Tablets taken orally are the most common form. They come in various strengths depending on the prescribed dose.
• Extended-release capsules: These release the drug slowly over time to allow for once-daily dosing instead of requiring that multiple pills be taken throughout the day.
• Oral solution (liquid): This is an option for people who have difficulty swallowing pills or need more precise dosing, like children.
• Injectable: In some cases, propranolol is administered as an injection for rapid control of heart conditions typically in a hospital setting.

Although it’s an off-label use, propranolol can be effective in treating the physical symptoms of anxiety. It doesn’t directly alter mood or emotional responses but reduces bodily sensations that can trigger or worsen anxiety. It’s especially useful in situational anxiety (like performance anxiety), where reducing physical symptoms of anxiety can prevent a full-blown anxiety attack.

Blocking the effects of adrenaline makes propranolol a good option if you’re facing mental health issues like situational anxiety caused by public speaking. It temporarily relieves the physical symptoms that social situations might make you feel.

In addition to its use for situational anxiety, propranolol is considered for broader anxiety management for anxiety disorders under specific circumstances. Although it’s not the main treatment for generalized anxiety disorder (GAD), its advantages for quickly relieving physical symptoms offer a benefit.

How does propanol for anxiety work?

Propranolol is a beta blocker, a type of medicine that helps to control things like heart rate and blood pressure. It blocks the effects of adrenaline on certain receptors in the body. This reduces the physical symptoms associated with anxiety disorders, such as a racing heart, trembling, and sweating. 

Propranolol primarily targets the beta-1 receptors, which are part of your body’s cells that help regulate things like heart rate and blood pressure. It may also affect beta-2 receptors in other parts of the body that help relax your airways and blood vessels.  

How quickly does propranolol work for anxiety?

How quickly propranolol works for anxiety varies from person to person. Generally, it starts to take effect within 30 minutes to an hour. Keep in mind that your responses may differ due to metabolism and dosage among other factors. 

Follow your healthcare provider’s medical advice and give your medication enough time to work. And don’t make adjustments to your dosage without first talking with your healthcare provider.

How long does propranolol last?

How long the effects of propranolol last vary based on several factors, including dosage, the drug’s half-life in the body, individual metabolism, and the specific formulation of propranolol you’re prescribed.

Typically, the effects of a single dose of propranolol last around 3 to 6 hours. If you’re prescribed the sustained-release formula, the effects can last up to 8 to 12 hours.

Best time to take propanol for anxiety

The best time to take propranolol depends on your individual needs and lifestyle. Some people take propranolol “as-needed,” meaning they don’t need to take it every day.

Instead, you can take propranolol before situations you expect to cause you anxiety, such as public speaking or important events. This lets it take effect before any physical symptoms of anxiety show up.

Other people need to take it every day, as advised by their healthcare provider, to manage persistent symptoms of general anxiety. 

Discussing the best time to take propranolol with your healthcare provider is important. They can assess your specific situation and provide personalized recommendations. They’ll consider the timing of your anxiety symptoms, the prescribed dose, any other medications you take, and any other conditions you’re managing.

Who should take propanol for anxiety?

Propranolol is a good option for many people who experience physical symptoms caused by mental health issues like an anxiety disorder. But it isn’t suitable for everyone, and determining whether propranolol is the right medication for your anxiety needs should be done with a qualified licensed healthcare professional. 

Propranolol may be recommended for you if you:

• Experience situational or performance anxiety: if you frequently face anxiety-inducing situations, such as public speaking, social interactions, or performances, propranolol may help alleviate the physical symptoms associated with these situations. It can provide a sense of calm and reduce the physical symptoms of anxiety.
• Have generalized anxiety disorder (GAD) or panic disorder: in cases of GAD or panic disorder, propranolol may be prescribed as part of your comprehensive treatment plan. It can be particularly helpful in managing the physical symptoms of anxiety, such as a racing heart, trembling, and sweating, which can contribute to the overall distress experienced with these conditions.
• Have cardiovascular conditions: propranolol is primarily used to treat heart conditions, such as high blood pressure (hypertension), irregular heart rhythms, and angina. It may also improve survival after a heart attack. If you have both anxiety symptoms and a cardiovascular condition, your healthcare provider may consider propranolol as a suitable option to address both at the same time.

Propranolol dose for anxiety

The amount of propranolol you’re prescribed can vary depending on the specific condition being treated, your response, and healthcare provider’s recommendation. You should follow your healthcare provider’s instructions and don’t change your dosage on your own.

Here are some general considerations regarding propranolol dosage:

• Initial dosage: typically, the initial dosage of propranolol for anxiety is low. This is so your provider can monitor your response and minimize potential side effects. Your provider may gradually increase your dose based on your specific needs and how well you tolerate it.
• Maintenance dosage: once your optimal dosage is determined, you’ll be prescribed a maintenance dosage to manage your anxiety symptoms effectively. Your maintenance dosage may vary depending on the severity of your symptoms and your individual response to propranolol.
• Sustained-release dosage: in some cases, your healthcare provider may prescribe a sustained-release dosage of propranolol. These formulations (in 80 milligrams and 160 milligrams tablets) release it gradually over a longer period. This extends its effects so you can potentially reduce how often you take it.

What if you forget to take a dose?

If you accidentally miss a dose of propranolol, take it as soon as you remember. However, if it’s close to the time for your next scheduled dose, skip the missed dose and resume your regular dosing schedule.

Never take a double dose to make up for a missed dose. Doubling your dose increases the risk for side effects.

What if you take too much propranolol for anxiety?

If you accidentally take more propranolol than prescribed, seek immediate medical attention. An overdose of propranolol can have serious consequences and may require emergency treatment. 

Symptoms of an overdose may include severe dizziness, slow heart rate, shortness of breath, fainting, or confusion. Contact your local poison control center or call 9-1-1 right away if you suspect you’ve overdosed.

It’s important to adhere to your prescribed dosage and communicate with your healthcare provider if you have any concerns or questions regarding propranolol dosing. They can provide specific guidance based on your individual needs and monitor your progress throughout your treatment.

Propranolol side effects

Like any medication, propranolol may cause certain side effects. It’s important to be aware of potential side effects and discuss them with your healthcare provider. While not everyone experiences them, some common side effects associated with propranolol include:

• Fatigue and dizziness: propranolol can cause a feeling of tiredness or dizziness, particularly when starting the medication or adjusting the dosage. It’s advisable to avoid activities that require alertness until you know how propranolol affects you.
• Gastrointestinal issues: you may experience gastrointestinal discomfort, such as nausea, vomiting, diarrhea, or stomach cramps. These symptoms are typically mild and transient.
• Cold hands and feet: propranolol may lead to reduced blood flow to the extremities, resulting in cold hands and feet. This is usually temporary and not a cause for concern, but if you experience prolonged or severe coldness, it’s important to inform your healthcare provider.
• Changes in sleep patterns: propranolol can occasionally cause sleep disturbances, such as insomnia or vivid dreams. If sleep issues persist or significantly impact your daily life, consult your healthcare provider for further guidance.

It’s important to note that these aren’t the only possible side effects of propranolol. Individual responses may vary, and other side effects may occur.

Propranolol can also have serious side effects that may include:

• Allergic reactions that are characterized by rash, itching, hoarseness, difficulty breathing or swallowing, or swelling of your face or mouth
• Very low blood pressure characterized by significant dizziness or fainting
• Overdose that can cause lightheadedness, slow heart rate or irregular heartbeat, or seizures

If you experience any unusual or bothersome symptoms while taking propranolol, immediately tell your healthcare provider.

Warnings for propranolol

When taking any type of prescribed medication, it’s important to be aware of specific warnings and considerations to ensure its safe and effective use. Propranolol carries important warnings, and there are factors to keep in mind, such as the boxed warning regarding discontinuation and considerations during pregnancy and breastfeeding.

Understanding and discussing these aspects with your healthcare provider is crucial for informed decision-making, maximizing the benefits of propranolol, and minimizing potential risks.

Boxed warning

Propranolol comes with a boxed warning, which is the strongest warning issued by the FDA. This warning highlights the potential risks associated with sudden discontinuation of propranolol. 

Follow your healthcare provider’s instructions for gradually tapering off propranolol if needed. Abruptly stopping propranolol can lead to withdrawal symptoms and a rebound effect, which can cause an increase in heart rate, blood pressure, or even chest pain if you have heart problems. To ensure your safety, always consult your healthcare provider before making any changes to your propranolol dosage or treatment plan.

Pregnancy and breastfeeding

If you’re pregnant, planning to become pregnant, or currently breastfeeding, discuss the potential risks and benefits of propranolol with your healthcare provider. Propranolol may have certain implications during your pregnancy or while you’re breastfeeding. 

While limited studies suggest that propranolol is generally considered safe during pregnancy, it’s important to talk with a healthcare professional to weigh the potential benefits for you and the potential risks for your baby. 

If you’re breastfeeding, discuss using propranolol with your provider to assess any potential risks to your infant and decide what to do.

Medication contraindications

Propranolol may interact with other medications, so inform your healthcare provider about any medications, supplements, or herbal products you’re taking. 

Certain medications, including antidepressants such as monoamine oxidase inhibitors (MAOIs) and selective serotonin reuptake inhibitors (SSRIs), antipsychotics, and calcium channel blockers, may interact with propranolol and cause adverse effects.

And combining propranolol and certain medications may increase or decrease the effectiveness of either medication. 

Medical considerations

Before starting propranolol, tell your healthcare provider about any pre-existing medical conditions you’ve had or have. This includes conditions like asthma, diabetes, liver or kidney disease, and heart failure and any other heart-related conditions.

Certain medical conditions may need monitoring to ensure using propranolol is safe to use. By providing a comprehensive medical history, you let your healthcare provider make informed decisions regarding the suitability of Propranolol for your circumstances and make any necessary adjustments to your treatment plan.

The information provided here offers a general overview of the warnings and considerations associated with propranolol. Your healthcare provider is best positioned to provide guidance and address any concerns you may have to ensure the safe and effective use of propranolol for anxiety.

Start anxiety treatment in 24 hours or less*

At Klarity Health, our goal is to support you in finding the right healthcare provider for your needs. See if propranolol for anxiety is right for you. Find a provider who specializes in anxiety on Klarity Health for an online or in-person visit today.