Can you use propranolol and Xanax together?

By OptimistMinds
Page last updated: 23/09/2022 | Next review date: 23/09/2024

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The Optimistminds editorial team is made up of psychologists, psychiatrists and mental health professionals. Each article is written by a team member with exposure to and experience in the subject matter.  The article then gets reviewed by a more senior editorial member. This is someone with extensive knowledge of the subject matter and highly cited published material.


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In this blog post, we are going to answer the question, “Can you use propranolol and xanax together?”. Both propranolol and xanax are prescription medications and can be used to treat a number of health conditions, but are they safe when used together?

This is what we are going to talk about in this blog. We will cover all the important points that you should know before using the combination of propranolol and xanax. 

Can you use propranolol and xanax together?

Yes, you can use propranolol and xanax together, but only if prescribed by your healthcare provider. This combination does hold some clinical importance and many researchers have investigated the safety and efficacy of the concomitant use of propranolol and xanax.

What does research suggest?

A 1986 study indicated that xanax can be used along with propranolol in patients with anxiety and stable angina pectoris. The researchers revealed that xanax caused no changes in the cardiac condition of such patients. Both of these meds were well tolerated on low doses. 

However, the study indicated that may not work with every patient and the data regarding the safety of this combination in unstable angina is inconclusive. 

Another study indicated that the combination of propranolol and xanax can be used to control panic attacks. The combination seemed to work together, but they did not start working at the same time. 

This is because xanax is a short acting benzodiazepine and starts working in about 20-30 minutes. Propranolol, however, takes more time to start working and stays longer in your body as compared to xanax.

Several other studies indicated that these two meds can significantly help reduce the frequency of panic attacks, anxiety and tremors in patients with mild cardiac conditions. 

Another recent study indicated that propranolol can be a good addition when you are trying to cut back on xanax, or any other benzodiazepine. The beta blocker can reduce the intensity of xanax withdrawal symptoms and is usually well tolerated.

What is the difference between propranolol and xanax?

Propranolol is a beta blocker or beta-adrenergic blocker. It is a drug which blocks beta receptors present in the heart and lungs and inhibits the effects of adrenaline, also known as epinephrine. 

It can also dilate blood vessels and decrease the workload of the heart. Propranolol can be used for the treatment of following health conditions:

  • Cardiovascular diseases, including high blood pressure, angina pectoris, management of congestive heart failure, arrhythmia or irregular heart beat, myocardial infarction, tachycardia, and coronary artery diseases. 
  • Glaucoma 
  • Migraine 
  • Anxiety 
  • Tremors or essential tremors

Xanax, on the other hand, is a brand name for alprazolam, which is a benzodiazepine. It is used to help control anxiety, convulsions and panic attacks. This medication basically mimics inhibitory chemicals in your brain, like GABA, to control the excessive neuronal activity. 

What are the side effects associated with use of propranolol and xanax?

Both propranolol and xanax are associated with some side effects. It is impossible to take an antidepressant, a drug that affects your brain, without having any unwanted effects. 

The intensity of these side effects depends on how much med you’re taking. If you’re at higher doses, you are more likely to suffer from them. Side effects associated with the use of propranolol include:

  • Xerostomia or dry mouth 
  • Nausea 
  • Vomiting 
  • Constipation 
  • Flatulence 
  • Acid reflux 
  • Depression 
  • Fatigue 
  • Lightheadedness 
  • Abnormal pain
  • Acid reflux 
  • Flu like symptoms 
  • Skin rash

Some serious side effects include:

  • Difficulty in breathing and chest tightness 
  • Swollen hands and feet as a result of an allergic reaction. 
  • Wheezing
  • Blackouts 
  • Unexplained weight gain or loss
  • Arrhythmia 

The serious side effects of propranolol can become quite disturbing, especially when you’re on higher doses. Every single chemical out there has a potential to kill you. It’s the dose which makes it a medicine. Make sure you stick to the recommended doses and refrain to deviate from it. 

Side effects associated with the use of xanax include:

  • Dizziness
  • Tiredness or fatigue 
  • Drowsiness 
  • Muscle pain
  • Vision problems 
  • Headache 
  • Hypersomnia 
  • Forgetfulness 
  • Troubled or intrusive thoughts
  • Impairment of motor coordination 
  • Constipation or diarrhoea 
  • Nausea 
  • Vomiting 
  • Increased or decreased appetite 

Some serious and rare side effects of xanax include:

  • Allergic reaction associated with symptoms like redness of skin, itching, painful blisters, blue-purple patches, burning sensation etc. 
  • Serious respiratory depression which lowers down breathing rate and can decrease the availability of oxygen in the blood. It could be life-threatening for people suffering from asthma or chronic obstructive pulmonary disease (COPD) 
  • Terrible addiction 
  • Dementia 
  • Abnormal behaviour
  • Blackouts 

These side effects, as mentioned earlier, are rare and serious. It is impossible to predict your body’s response to either one medicine or the combination of these two meds. 

The side effects can also relate to the underlying health condition. Make sure you ask your doctor before using any medication and it is strictly prohibited to use someone else’s prescription medication. 

How to ensure the proper use of propranolol?

The proper use of propranolol is crucial. It is contraindicated to be used in patients who suffer from chronic breathing illnesses, including asthma and chronic obstructive pulmonary disease (COPD). 

Propranolol is a non selective beta blocker which blocks beta-receptors present in heart, lung and airways. This drug causes vasodilation to reduce blood pressure and heart rate, and at the same time, it also causes bronchoconstriction and makes the airways narrow. 

People with asthma and COPD already live with breathing difficulty and this propranolol bronchoconstriction can make their symptoms much more severe. It can also lead to hospitalisation. This is why the drug would never be prescribed to such patients. 

Propranolol should be used cautiously in people with diabetes. People who are diabetic are often on prescription medications to manage their blood glucose levels. 

Propranolol should be used cautiously in pregnancy. You should also ask your healthcare provider if you are trying to get pregnant as this drug may produce unwanted side effects. However, the intensity of these effects can vary from woman to woman. 

Propranolol actually comes with a black box warning, issued by the Food and Drug Administration (FDA), stating that this med should never be stopped abruptly because of the life threatening risks. This risk is much greater in patients who are at risk of a heart attack.

How to ensure the proper use of xanax?

Immediately talk to your healthcare provider if you experience unusual side effects while taking xanax. The sooner you consult medical attention, the less time it will take for them to control your condition. 

Do not recommend this medication to someone else and use it as long as your doctor has advised. Self medication is not something you should consider. 

Inform your doctor if you’re pregnant, trying to conceive. Xanax should not be used by pregnant women as it can be dangerous for the fetus, especially when used in the third trimester. 

Inform your doctor if you’re a breastfeeding mother. Xanax is capable of passing into the breastmilk and may cause side effects in newborns. 

Xanax may cause depression and induce suicidal behavior in users. If you have someone who shows suicidal behavior or you see hopelessness in them, make sure you keep an eye on them and get medical attention as soon as you can. 

Do not stop xanax abruptly. If it’s time for you to stop using this medication, your doctor will simply recommend a taper schedule for you, which should be followed vigilantly if you wish to keep withdrawal symptoms at bay. 

Report any problems with bleeding or bruising to your doctor. If you see any unexplained blisters or rashes on your body, or experience any problems with urination, or if you feel changes in your vision, immediately report to your healthcare provider. 

Make sure you avoid certain activities if xanax makes you drowsy, dizzy or tired during the day time. These include:

  • Do not drive. Driving requires your full physical and mental alertness and it’s in your best interest to avoid it when you’re tired and have low energy levels. If there’s somewhere you need to be, just ask a friend to drop you or book a ride. 
  • If you’re an employee in some factory where you are supposed to operate heavy machinery, don’t! Your drowsiness might cause an accident and can make you or others around you severely injured. 
  • Do not drink alcohol, or you’ll end up dulling your senses even more. Alcohol itself is responsible for causing fatigue and drowsiness. It clouds your mind and messes up with your mental alertness.

Conclusion 

In this blog post, we have discussed the safety and efficacy of the concomitant use of propranolol and xanax. This combination does hold some clinical importance. Make sure you do not use any other medication in combination unless your doctor recommends it. 

Make sure you use this medication or any other medication only when your doctor has advised it. Using medications which can affect your brain is not something ideal and should not be encouraged unless it is absolutely necessary to do so. 

FAQs: propranolol and xanax

What medications should not be taken with propranolol?

Propranolol should not be taken with other beta blockers or any other drug that can reduce blood pressure or workload of your heart rate. The additive effects can dangerously slow down your circulatory system and give rise to a number of complications. 

Can you take propranolol with other anxiety meds?

Yes, you can take propranolol with anti-anxiety meds together, but only if advised by your healthcare provider. This combination does hold some clinical importance and many researchers have investigated the safety and efficacy of the concomitant use of propranolol and antianxiety meds, most commonly benzodiazepines.

Which is better for anxiety propranolol or Xanax?

Propranolol and xanax are entirely different medications and they can not be compared. Xanax is a brand name for alprazolam, which is a benzodiazepine. It is used to help control anxiety, convulsions and panic attacks. This medication basically mimics inhibitory chemicals in your brain, like GABA, to control the excessive neuronal activity. 

Propranolol, on the other hand, is a beta blocker or beta-adrenergic blocker. It is a drug which blocks beta receptors present in the heart and lungs and inhibits the effects of adrenaline, also known as epinephrine. It can also dilate blood vessels and decrease the workload of the heart.

What drugs should not be taken with alprazolam?

  • Antifungals and antivirals. They may inhibit the metabolism of clonazepam and cause toxicity. 
  • Antiepileptics. The concomitant use may decrease the beneficial effects of clonazepam. 
  • Anti-allergy medications. The concomitant use increases the risk of sedation 
  • Narcotic analgesics or any other controlled substance. The concomitant use can cause serious CNS side effects. 
  • Sleeping pills
  • Other anxiolytics and tricyclic antidepressants (TCAs). 

How long does propranolol 25 mg stay in your system?

The half life of propranolol is around 8-11 hours, which means that the concentration of this drug in your body is reduced to half after this time period has passed. 

The remaining amount of propranolol is further reduced to half within the next 8-11 hours. The concentration of the drug keeps getting halved by this process, until it is completely washed out from your system. 

References

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