Their inclusion does not guarantee they will be prescribed to any individual, as treatment decisions are ultimately at the discretion of healthcare providers. Healthcare providers may prescribe other medications or recommend non-pharmacological treatment based on the patient’s unique health circumstances and needs. Read more
Taking medication for anxiety is a personal choice, and it’s not the only way to treat anxiety. But many people have found relief from their symptoms with anxiety medication, especially if they have more severe or long-lasting symptoms. If you are considering medication for anxiety, then it can help to know the options that are available to you. Propranolol (Inderal) is one medication that’s often used off-label to treat anxiety.
Highlights
- Though not FDA-approved for anxiety, propranolol is commonly prescribed off-label to manage its physical symptoms — particularly in situational anxiety such as public speaking.
- Propranolol doesn’t target anxious thoughts or emotional distress; it helps reduce the physical sensations that can intensify anxiety.
- Since propranolol isn’t FDA-approved for anxiety, dosing varies based on symptoms, body weight, and prior experience with anxiety medications, and is individually determined by a healthcare provider.
Propranolol isn’t FDA-approved specifically for anxiety, but many people have found that it brings relief from anxiety symptoms, especially physical ones like a racing heart. It can be especially helpful for when you need relief from acute anxiety symptoms.
In this article, we’ll explain how, exactly, propranolol works for anxiety.
What Is Propranolol (Inderal)?
Propranolol belongs to a category of medications called
Beta-blockers work by affecting receptors in your body (called beta-1 and beta-2 receptors). These receptors are located in your heart, muscles, and other tissues. Beta-blockers change the way these nerve receptors respond to adrenaline and noradrenaline (stress hormones that put your body into fight-or-flight mode). As a result, you experience a slower heart rate and lower blood pressure, which helps get more oxygen and blood to your heart.
On top of high blood pressure, propranolol is
- Angina pectoris due to coronary atherosclerosis (chest pain)
- Atrial fibrillation
- Myocardial infarction
- Migraine
- Tremors
- Hypertrophic Subaortic Stenosis
- Pheochromocytoma
How Does Propranolol Help With Anxiety?
It’s important to note that the
Unlike other anxiety medications that target your thoughts or emotions, propranolol works on your body. It doesn’t stop racing thoughts or worry, but it may help if you’re dealing with symptoms like a racing heart, trembling hands, or flushing.
If you live with anxiety, then you’ve probably experienced its physical effects. For example, you might notice that your heart beats faster and harder, or you start sweating or flushing when you’re having an anxiety attack.
Sometimes, those physical symptoms can make anxiety worse. If you’re already feeling nervous and you start sweating or shaking, you might feel even more anxious. Propranolol can interrupt that cycle — by calming your body, it may help calm your mind, too.
When Propranolol May Be Helpful?
One of the advantages of propranolol is that it usually starts to work within a few hours. This is in contrast to other types of medications that are used for anxiety, like SSRIs, which can take weeks to fully kick in. So propranolol may be most helpful when you need a relatively fast relief from your anxiety symptoms (especially physical symptoms).
Some examples of when propranolol might be most helpful include:
- During a Panic Attack. Panic attacks often come with a sudden rush of physical symptoms — your heart might start pounding, you might feel flushed or shaky, or like you can’t catch your breath. These symptoms are caused by a surge of adrenaline, and propranolol can blunt that response so the panic feels less intense and doesn’t last as long. However,
studies have shown no significant difference [3*] between propranolol and other anti-anxiety medications like benzodiazepines when it comes to reducing panic. - For Social Anxiety. If you live with social anxiety, then just anticipating a conversation or social event can trigger a flood of physical symptoms.
A small older study [4*] found that propranolol may help ease these symptoms, but it’s important to note that this medication is not considered a first-line treatment for social anxiety disorder. You can learn more about the medication for social anxiety in this article. - Before a Performance or Presentation. Research shows that
propranolol can significantly reduce stage fright [5*] and anxiety that comes up before performances, public speaking, and test anxiety. If your anxiety shows up as a racing heart, shaky voice, or sweating, then propranolol may help calm your body so you can stay focused on what you’re doing. - For Specific Phobia. If you have a specific phobia — like a fear of flying — then propranolol
may help ease your physical symptoms [6*] when you know you’re going to be in that situation. It won’t erase the fear, but it might make it more manageable in the moment.
While propranolol can be helpful for these kinds of scenarios, it’s not a long-term solution on its own. It’s not considered a first-line treatment for anxiety disorders, and it doesn’t address the emotional or cognitive parts of anxiety.
For things like social anxiety or phobias, it’s still important to gradually expose yourself to the situations you fear, ideally with support from a therapist. Propranolol can be one tool, but therapy can help you work through the underlying fears so you don’t always have to rely on medication.
Propranolol Dosage for Anxiety
The dose of propranolol you take will depend on several different factors, including your weight, how severe your symptoms are, and whether you’ve taken beta-blockers before.
Dosage isn’t something you’ll make decisions on. Your medical provider will ask you questions to determine the best dose for you. It’s possible that they’ll start you on a lower dose, and increase it as necessary. Always take the exact dosage that’s been prescribed to you. It can be dangerous to take more or less without talking to your provider first.
How Quickly Does Propranolol Work for Anxiety?
Propranolol kicks in fairly quickly compared to some other anxiety medications. If you’re taking an immediate-release version, it usually reaches peak levels in your system within one to four hours. The long-acting version takes a bit longer — closer to six hours.
Never exceed the prescribed dosage even if you don’t see its effects right away. Consult with your healthcare provider on when you may notice the effects and what steps to take if the medication doesn’t seem to be working for you. At MEDvidi, you can have online anxiety treatment and ongoing support, so you get all your questions answered.
How Long Do the Effects of Propranolol Last?
The effects of propranolol usually last for about three to four hours if you’re taking the immediate-release version. Long-acting or extended-release versions may last much longer, sometimes up to a full day.
How long it works can also depend on things like your metabolism, dosage, and overall health. If you’re not sure whether the effects are lasting long enough — or if they’re lasting too long — your provider can help adjust the dose or formulation to better meet your needs.
What Is the Best Time to Take Propranolol?
The optimal time to take propranolol depends on why you’re taking it.
- Situational Anxiety: If you’re taking propranolol for situational anxiety, like before a performance or public speaking, it is usually recommended to take the medication 30 to 60 minutes before the event.
- Daily Management: If you’re taking propranolol for daily anxiety management, it is best to take the medication at the same time every day. If using an immediate-release formulation, you might take a couple of doses throughout the day. Extended-release propranolol for anxiety is typically taken once daily, often in the morning.
Consult your healthcare provider to know how to take propranolol in your particular situation.
How Long Is Propranolol Usually Taken for Anxiety?
How long you’ll stay on propranolol depends on why you’re taking it and what kind of anxiety you’re dealing with. Some people only use it occasionally — for example, before a public speaking event, flight, or big interview. In those cases, it’s taken PRN (as-needed), not every day.
Others might take propranolol more regularly as part of a long-term plan to manage ongoing anxiety symptoms. If that’s the case, you could be on it for several months or even years, depending on how well it’s working and whether you’re experiencing any side effects. Either way, your healthcare provider should check in with you regularly to see how things are going and make any necessary adjustments.
If you do decide to stop taking propranolol, don’t quit cold turkey. Suddenly stopping can lead to withdrawal symptoms or a rebound in anxiety. Always work with your provider to taper off safely.
Side Effects of Propranolol (Inderal)
Just like most medications, propranolol can come with side effects that can range from mild to severe. Not everyone experiences side effects, but it’s important to know what to look out for. Tell your doctor if you experience any of these side effects, especially if they’re getting in the way of your ability or desire to keep taking your medication as prescribed.
Mild and Common Side Effects
These side effects are often temporary and may improve as your body adjusts to the medication:
- Fatigue or feeling light-headed
- Slower heart rate (bradycardia)
- Cold hands or feet
- Nausea, diarrhea, or stomach cramps
- Diarrhea or constipation
- Vivid dreams or sleep disturbances (especially with higher doses)
- Mild depression or emotional flatness
- Blurry vision or other visual changes
- Fatigue and lethargy
- Low blood pressure (which might cause dizziness)
- Dry eyes
- Alopecia (hair loss)
Serious Side Effects
Some people may experience more severe side effects. These are less common but can be serious and may require medical attention.
- Heart-Related Issues: Congestive heart failure, hypotension (low blood pressure), worsening AV block (a type of heart rhythm issue), or arterial insufficiency (especially Raynaud-type symptoms).
- Neurological Symptoms: Disorientation, short-term memory loss, mental fog, catatonia, hallucinations, or decreased cognitive performance.
- Respiratory Issues: Bronchospasm, especially for people with asthma or other breathing conditions.
- Severe Gastrointestinal Effects: Vomiting, mesenteric artery thrombosis, or ischemic colitis.
- Mood Changes: Depression or emotional lability (sudden mood swings).
- Skin Issues: Toxic epidermal necrolysis or Stevens-Johnson Syndrome (both are rare but life-threatening skin reactions).
- Sexual Side Effects: Male impotence or Peyronie’s disease.
Rare Blood and Autoimmune Reactions
While rare, propranolol can affect your blood or immune system in serious ways:
- Agranulocytosis (low white blood cells).
- Thrombocytopenic purpura or non-thrombocytopenic purpura (conditions that affect blood clotting).
- Systemic lupus erythematosus (SLE) or SLE-like symptoms.
Allergic Reactions
Propranolol can also cause rare but serious allergic reactions for some people. These require immediate medical attention.
- Severe anaphylaxis (life-threatening allergic response).
- Tightened throat or airways; difficulty breathing.
- Rash, fever, and sore throat (may signal a more systemic allergic response).
- Sore or inflamed throat.
- Swelling, itching, or flushing.
If you experience difficulty breathing, swelling of the face or throat, or a sudden rash, stop taking the medication and seek emergency help right away.
Cautions and Interactions With Other Medicines
Some people are prescribed propranolol alongside other medications — for example, benzodiazepines — to improve treatment outcomes for anxiety. But in other cases, combining propranolol with certain medications can lead to harmful interactions. That’s why it’s essential to tell your healthcare provider about everything you’re taking, including prescriptions, over-the-counter medications, “natural” supplements, and recreational drugs.
Here are some of the medications and substances that can interact with propranolol:
- Heart rhythm medications (antiarrhythmics).
- Digitalis glycosides and calcium channel blockers.
- ACE inhibitors and alpha-blockers.
- Reserpine.
- Epinephrine (adrenaline).
- NSAIDs (like ibuprofen or indomethacin).
- Antidepressants (SSRIs, MAOIs, and TCAs).
- Anesthesia drugs.
- Blood thinners like warfarin.
- Antipsychotic medications (neuroleptics).
- Thyroid medications.
- Alcohol.
- Herbal supplements, including St. John’s Wort and goldenseal.
This doesn’t necessarily mean that you absolutely can’t take propranolol if you take these medications. Your healthcare provider can help explain these interactions and make safe decisions about your treatment.
When Not to Use Propranolol
Propranolol isn’t safe or appropriate for everyone. You should not take propranolol if you:
- Are experiencing cardiogenic shock.
- Have sinus bradycardia or any heart block beyond first-degree.
- Live with bronchial asthma or other serious breathing issues.
- Have a known allergy or hypersensitivity to propranolol.
Propranolol may also not be recommended during pregnancy or breastfeeding. It’s classified as a Pregnancy Category C drug, which means there may be risk to the fetus based on animal studies. In human cases, it’s been linked to low birth weight, small placentas, and possible complications during birth. The medication can also pass into breast milk, so if you’re pregnant or nursing, your healthcare provider will help weigh the risks and benefits.
Propranolol may also need to be used more cautiously in:
- Older adults, especially those with age-related changes in kidney, liver, or heart function.
- Children, since its safety and effectiveness haven’t been firmly established in pediatric patients.
Bottom Line
Propranolol isn’t the first-choice treatment for anxiety, and there are other FDA-approved medications that might be more helpful. But many people have found that propranolol works for them, especially for things like public speaking or flights.
Even if propranolol isn’t for you, there are so many ways to successfully treat anxiety. You don’t need to live under the control of anxiety forever. By getting an appointment with one of our medical providers, you can learn more about the treatment options that are available and get on the path to managing anxiety symptoms.
FAQ
Is propranolol a form of Xanax?
No, propranolol and Xanax are not the same. Xanax (alprazolam) is a benzodiazepine specifically designed to treat anxiety and panic disorders. In contrast, propranolol is a beta-blocker primarily used to treat heart conditions, and it’s sometimes used off-label to treat anxiety. They work differently in the body and have different side effects and interactions.
Can propranolol help with panic attacks?
Yes, beta-blockers like propranolol can help with the physical symptoms of panic attacks, such as rapid heartbeat and trembling. It is sometimes prescribed off-label for this purpose. However, propranolol is not the first-line medication for panic disorder, and it’s important to consult with a healthcare professional to determine the best treatment.
What kind of anxiety does propranolol help with?
Doctors may prescribe propranolol off-label to help with the physical symptoms of anxiety, panic attacks, and social anxiety. Always consult with a healthcare professional for appropriate recommendations.
Will propranolol affect my sleep?
Propranolol can potentially affect sleep in some individuals, including insomnia or vivid dreams while taking the medication. However, reactions can vary from person to person. If you notice any changes in your sleep patterns while taking propranolol for anxiety, discuss them with your healthcare provider.
Is propranolol or Xanax better for anxiety?
Different things work for different people. But it’s worth mentioning that Xanax is FDA-approved to specifically treat anxiety, while propranolol isn’t. Consult with your healthcare provider to have a detailed assessment of your symptoms and health history and receive a personalized treatment plan.
