Propranolol for anxiety (A brief guide)

In this guide, we will discuss propranolol for anxiety treatment, the definition of propranolol, dosage, side effects, and some additional considerations when taking propranolol for anxiety.

Propranolol for anxiety treatment

Propranolol for anxiety is used short-term, used for the relief of symptoms of social anxiety disorder.

May reduce some of the physical symptoms such as tachycardia and sweating, and general tension, can help control symptoms of stage fright and public-speaking fears, has few side effects.

It is known as Inderal (brand name).

This is considered a beta-blocker and it works by controlling your body’s “flight-or-fight” response, reducing the physical symptoms.

Propranolol has the ability to prevent the adrenaline from getting in contact with your heart’s beta receptors, which will prevent your heart from beating faster or harder. 

A systematic review study performed in  2016 studied the efficacy of propranolol in the treatment of anxiety comparing the results from 8 studies.

They found that the quality of the studies and the evidence was insufficient to determine the routine use of propranolol in the treatment of any anxiety disorder. 

However, there is conflicting information. At the ECNP congress earlier this year, Marieke Soeter, Ph.D.  suggested that “A single 40-mg dose of oral propranolol, judiciously timed, constitutes an outside-the-box yet highly promising treatment for anxiety disorders, and perhaps for posttraumatic stress disorder as well” (MDedge). 

It seems that they have found a way to “erase” selectively the memories that cause the emotional response that leads to fear and this can lead to altering the fear associated with a certain stimulus/situation. 

What is propranolol?

Propranolol is classed as a beta-blocker and according to the NHS, it used mainly for the treatment of heart problems, but it also gets prescribed for anxiety and to prevent migraines. 

If you have a heart problem you can take propranolol for the treatment of:

• High blood pressure
• Illnesses that cause irregular heartbeat such as atrial fibrillation
• Prevention of future heart diseases, heart attacks, and strokes
• Prevention of chest pain caused by angina

Additionally, according to the NHS Propranolol can help reduce your symptoms if you have too much thyroid hormone in your body (thyrotoxicosis).

You’ll usually take it together with medicines to treat an overactive thyroid.

Brand names: Inderal LA, Inderal XL, and InnoPran XL are brand names for the longer-acting versions of propranolol.

Hemangeol is the liquid form of propranolol.

Key aspects of propranolol

The NHS mentions there are some key aspects of propranolol to keep in mind:

• It slows down your heart rate and makes it easier for your heart to pump blood around your body.
• It is prescribed for high blood pressure and other heart problems, but it can also help with the physical signs of anxiety, like sweating and shaking.
• Your very first dose of propranolol may make you feel dizzy, so take it at bedtime. After that, if you don’t feel dizzy, you can take it in the morning.
• The main side effects of propranolol are feeling dizzy or tired, cold hands or feet, difficulties sleeping and nightmares. These side effects are usually mild and short-lived.
• Propranolol is also called by the brand names Angilol, Bedranol, Beta-prograne, and Half Beta-prograne.

Who can take propranolol?

Propranolol can be taken by adults and children alike.

But it hasn’t been approved for treating high blood pressure in children under 12 years of age. 

However, it is not safe for everyone.

Make sure you tell your doctor if you have any of the following medical conditions before you start taking propranolol:

• had an allergic reaction to propranolol or any other medicine in the past
• low blood pressure or a slow heart rate
• heart failure which is getting worse
• severe blood circulation problems in your limbs (such as Raynaud’s phenomenon), which may make your fingers and toes tingle or turn pale or blue
• metabolic acidosis – when there is too much acid in your blood
• lung disease or asthma

Benefits of Beta-blockers

According to Medical News Today, Beta-blockers may be beneficial for the following reasons: 

• are fast-acting, making them an ideal choice for people who need rapid relief
• work well for acute short term anxiety
• can help lower blood pressure and heart rate, relieving physical symptoms
• may be an alternative for people who experience intolerable side effects when they take other anti-anxiety medications
• may be an effective option for people with anxiety disorders who also have high blood pressure or other heart health problems
• may reduce tremors
• Boost the confidence of people anxious

Propranolol for anxiety dosage

The recommended dose for adults and children over 12 years is 40mg before anxious situations.

For long-term anxiety 40mg two or three times a day, treatment is reviewed after 6-12 months (Package Leaflet, information for the patient).

Propranolol and alcohol

According to the Package Leaflet, information for the patient,  You are advised to avoid alcohol intake while taking this medicine. 

What happens if I miss a dose?

If you forget your dose, take it as soon as you remember.

If it is getting closer to your next dose then discard the one you missed and take the next one as usual.

Do not double dose to compensate for the missed dose. 

What happens if I overdose?

If you have taken too much propranolol, tell your doctor or seek emergency medical attention. 

Overdose causes difficulty breathing, low blood pressure, drowsiness, fits, dilated pupils, an excessively slowed heartbeat with symptoms such as dizziness, sickness, confusion, hallucinations, body spasms, breathlessness on exertion, fainting or coma.

An overdose can result in a heart attack.

What happens if I stop taking propranolol?

If you stop taking propranolol tablets suddenly you may experience unpleasant side effects including sweating, shaking, worsening of angina, irregular or fast heartbeat, heart attack or death.

Withdrawal should be gradual over 10 to 14 days.

If you have any further questions on the use of this medicine, ask your doctor or pharmacist (Package Leaflet, information for the patient).

Types of Beta-blockers

There are two distinctive types:

• Nonselective beta-blockers: they block epinephrine from binding to the beta receptors that are located throughout your body.
• Selective beta-blockers: they prevent epinephrine from binding to the beta receptors in your heart.

Some common beta-blockers are:

• Acebutolol (Sectral)
• Bisoprolol (Zebeta)
• Carvedilol (Coreg)
• Propranolol (Inderal)
• Atenolol (Tenormin)
• Metoprolol (Lopressor)

Side effects of propranolol for anxiety

Every medicine can cause side effects for some people and some others may not have effects or very mild ones.

The side effects may improve while your body adjusts to the medicine.

Talk to your doctor if the side effects are bothering you or if they are persistent:

• Feeling tired, dizzy or lightheaded
• Cold fingers or toes
• Difficulties falling asleep or if you have nightmares
• Feeling nauseous

Serious side effects of propranolol for anxiety

It is considered very rare but it might happen.

Talk to your doctor immediately if you experience any of the following:

• shortness of breath with a cough which gets worse when you exercise (like walking upstairs), swollen ankles or legs, chest pain, or an irregular heartbeat – these are signs of heart problems
• shortness of breath, wheezing and tightening of your chest – these can be signs of lung problems
• yellow skin or the whites of your eyes turn yellow – these can be signs of liver problems

Rare side effects of propranolol

May affect 1 in 1000 people:

• your medicine may alter the number and types of your blood cells. If you notice increased bruising, nosebleeds, sore throats or infections, you should tell your doctor who may want to give you a blood test 
• worsening of heart failure, heart block, low blood pressure/fainting on standing, dizziness, worsening of Intermittent claudication (pain and/or cramping in the leg caused by reduced blood flow) 
• skin rash, worsening of psoriasis, hair loss, dry flaky skin, red/itchy skin, a disorder characterised by blood spots, bruising and discolouration to skin 
• hallucinations, mood changes, pins and needles, psychosis, memory loss, confusion
• patients with asthma or a history of breathing problems may experience difficulty in breathing 
• dry eyes, visual disturbances

Side effects: Incidence not known

• signs of hyperthyroidism may be hidden 

• changes in blood fats
• changes in kidney function 
• changes in blood sugar levels 
• fits (seizures) linked to low blood sugar levels 
• worsening of angina
• Headache
• depression 
• Constipation
• dry mouth
• conjunctivitis (inflammation of the front surface of the eye causing red, sore, itching or weeping eyes) 
• changes in sex drive or potency 
• joint pain 

Allergic reaction to propranolol

If you are allergic to propranolol you could have a serious anaphylactic reaction, which is a life-threatening condition. Some of the typical symptoms include (WebMD): 

• Swelling of your mouth
• Tight feeling in your throat and difficulty breathing
• Hives
• Vomiting
• Dizziness
• Fainting
• Rapid heartbeat

If you have an allergic reaction you need to seek immediate medical attention. 

Propranolol interaction with other drugs

There are several drugs and substances that can interact with propranolol, please talk to your doctor and let him/her know if you are taking any of the following (NHS):

• other medicines for high blood pressure. The combination with propranolol can sometimes lower your blood pressure too much. This may make you feel dizzy or faint. If this keeps happening to you, tell your doctor – they may change your dose.
• other medicines for an irregular heartbeat such as amiodarone or flecainide
• other medicines which can lower your blood pressure. These include some antidepressants, nitrates (for chest pain), baclofen (a muscle relaxant), medicines for an enlarged prostate gland like tamsulosin, or Parkinson’s disease medicines such as levodopa.
• medicines for asthma or chronic obstructive pulmonary disease (COPD)
• medicines for diabetes, particularly insulin – propranolol may make it more difficult to recognize the warning signs of low blood sugar. Speak to your doctor if you have low blood sugar levels without getting any of the usual warning signs. You should check your blood sugar after exercising, and follow the usual advice about checking it before driving, or operating machinery.
• medicines to treat nose or sinus congestion, or other cold remedies (including those you can buy in the pharmacy)
• medicines for allergies, such as ephedrine, noradrenaline or adrenaline
• non-steroidal anti-inflammatory medicines (NSAIDs), such as ibuprofen, diclofenac, and naproxen. These medicines may increase your blood pressure, so it’s best to keep them to a minimum.

Why is this blog about propranolol for anxiety important?

We have discussed how propranolol for anxiety is prescribed off-label in certain situations such as a performance or a presentation but not in the long term.

It is still not approved to be used as a long-term treatment. 

For anxiety treatment, your doctor may discuss other options such as benzodiazepines or psychotherapy.

It is important to weigh the benefits and risks of any drug treatment so ask your doctor as many questions as possible and discuss the potential side effects. 

Please feel free to comment on the content of this blog in the comments section below!

Frequently Asked Questions (FAQs) about propranolol for anxiety

Recommended reading

1. Estimation of Diazepam and Propranolol
2. Beta-adrenergic blockade in essential hypertension: Effects of propranolol on hemodynamic parameters and plasma renin activity (Acta medica Scandinavica. Supplementum)
3. Propranolol Hydrochloride; A Clear and Concise Reference
4. Medication Fact Book for Psychiatric Practice, Fifth Edition
5. INDERAL (Propranolol): Treats High Blood Pressure, Angina, Atrial Fibrillation (Uneven Heartbeat), Tremors, Proliferating Infantile Hemangioma; and Prevents Migraine Headaches by James Lee Anderson (2015-04-22)

References

NHS: propranolol

MDedge

Medical News Today

WebMD

Healthline

Patient leaflet for Propranolol