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Propranolol (Inderal) for Anxiety: Mechanism of Action, Dosage, and Side Effects

Anxiety medicine propranolol
Written by:

Rabia Khaliq

MSc in Applied Psychology

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Medical Disclaimer
The medications listed on this website are provided for informational purposes only. Their inclusion does not guarantee that they will be prescribed to any individual, as treatment decisions are ultimately at the discretion of healthcare providers. This list is not exhaustive, and healthcare providers may prescribe other medications, including non-stimulant options, based on the patient’s unique health circumstances and needs.Read more
The medications listed on this website are provided for informational purposes only. Their inclusion does not guarantee that they will be prescribed to any individual, as treatment decisions are ultimately at the discretion of healthcare providers. This list is not exhaustive, and healthcare providers may prescribe other medications, including non-stimulant options, based on the patient’s unique health circumstances and needs.

Anxiety is a pervasive mental health condition but many therapeutic approaches can help manage it; one of them is medication. Some anti-anxiety medications work directly on the central nervous system to alter mood and emotion. However, others have a different target, for example, beta-blockers reduce the effects of adrenalin.

One beta-blocker prescribed for anxiety is propranolol (brand name Inderal). It is primarily used to treat conditions like hypertension, chronic angina, and tremor but its properties have found it a place in the treatment of anxiety and panic attacks. In this article, we explore how propranolol functions, its dosage, and potential side effects.

Discover the ins and outs of anxiety medicine propranolol. Talk to a certified healthcare professional to get a personalized treatment plan.

What Is Propranolol (Inderal)?

Propranolol hydrochloride is a non-selective beta-blocker that affects both beta-1 and beta-2 receptors. These receptors are located in the heart and various tissues and muscles, respectively, and interact with adrenaline, a key stress hormone. As a result, propranolol helps to reduce blood pressure and heart rate and promote relaxation.

It is important to note that the Food and Drug Administration (FDA) [1*] has not approved propranolol specifically to treat anxiety disorders. This is why the usage of propranolol is referred to as “off-label,” even though anxiety and panic attacks are mentioned in the Inderal’s indications.

How Does Propranolol Help With Anxiety?

While propranolol does not directly impact the emotional or cognitive aspects of anxiety, it has a significant effect on the physical symptoms [2*] . By preventing adrenaline from influencing the heart and blood vessels, it can help reduce palpitations, sweating, shaking, and an increased heart rate. This tends to make anxiety less physically overwhelming.

Physical symptoms of anxiety can sometimes exacerbate the emotional and cognitive manifestations. So, by reducing the above-mentioned reactions, Inderal may help transform the perception of anxiety overall, creating a calmer feedback loop.

How propranolol works for anxiety

When Propranolol May Be Helpful?

Anxiety comes in various forms, and many of them are accompanied by physical symptoms that can be distressing. These include:

  • Panic or anxiety attacks. The abrupt and intense physical symptoms during a panic attack are often fueled by a surge in adrenaline. When patients take propranolol for anxiety attacks or panic attacks, they may expect a reduction in the severity and duration of these symptoms due to blunting the effects of adrenaline.
  • Social anxiety. Social interactions (or even the anticipation of them) can be overwhelming for someone with social anxiety, triggering a host of physical symptoms. When used for social anxiety, medication propranolol can aid in managing these reactions, enabling a more comfortable and less stressful social experience.
  • Performance or situational anxiety. Propranolol can be beneficial for those who have intense physical symptoms of anxiety during public speaking or performing. However, medication is not the only solution, and for long-term results in managing performance anxiety, a person can also refer to talk therapy and various self-help techniques.

While propranolol can be an effective tool in managing the physical aspects of anxiety, it is crucial to pair it with other therapeutic interventions, like counseling or cognitive-behavioral therapy. Such a comprehensive approach helps to also address the emotional and cognitive components of anxiety.

Propranolol Dosage for Anxiety

Inderal dosage for anxiety [3*] will vary depending on individual factors, including the severity of symptoms, body weight, and tolerance to medications. Always consult a medical professional before starting or adjusting any medication.

For situational or performance anxiety, a dose of 10-40 mg taken approximately one hour before the anticipated event is common. For generalized anxiety disorder, a sustained-release dosage form may be prescribed to be taken once daily. Regular monitoring is essential to adjust the dose as needed.

How Quickly Does Propranolol Work for Anxiety?

Like many other anti-anxiety medications, Inderal (propranolol) has a relatively rapid onset of action. The period of reaching its peak concentration depends on the type. It takes 1 to 4 hours for immediate-release formulation and about 6 hours for long-acting medicine.

How Long Do the Effects of Propranolol Last?

The duration of action for propranolol depends on its formulation and individual health features. Typically the effects last for 3 to 4 hours but the effects of extended-release versions can provide therapeutic effects for a longer period of time. It’s essential to consult with your healthcare provider if you have any concerns about the efficacy and effects of the prescribed medication to adjust your treatment if necessary.

Connect with a medical professional to know what treatment options for anxiety can help you best.

What Is the Best Time to Take Propranolol?

The optimal time to take propranolol depends on the purpose of its administration:

  • Situational anxiety. For those taking propranolol for situational anxiety, like before a performance or public speaking, it is usually recommended to take the medication 30-60 minutes before the event.
  • Daily management. For individuals using propranolol for depression and anxiety management as a long-term solution, it is best to take the medication at the same time every day. If using an immediate-release formulation, the doses may be spread out over 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.
Peak effects of propranolol for generalized anxiety disorder

How Long Is Propranolol Usually Taken for Anxiety?

The duration for which a person may need propranolol varies significantly based on individual factors and the nature of their anxiety:

  • Short-term use. Some people may only require propranolol for specific events, such as performances, exams, or interviews. In such cases, propranolol is used on an as-needed basis.
  • Chronic anxiety management. Others may need to get propranolol for anxiety as a part of a longer-term management plan. In these instances, the duration of treatment can range from several months to years. Regular check-ups with a healthcare professional are crucial to determine the ongoing need for the medication, potential dose adjustments, and monitoring for side effects.

Regardless of the intended duration, remember that stopping propranolol suddenly can cause rebound effects or withdrawal symptoms. Consult a healthcare professional before stopping or adjusting any medication.

Side Effects of Propranolol (Inderal)

Like most medications, propranolol can cause side effects that may range from mild to severe. While not everyone experiences them, it is important to be informed. Common side effects include:

  • Fatigue or dizziness. This can often be one of the first side effects noticed and might decrease as the body gets used to the medication.
  • Slower heart rate. As a beta-blocker, it is expected for propranolol to reduce the heart rate. However, if the heart rate becomes too slow, it can be concerning.
  • Cold hands or feet. Reduced circulation might lead to these symptoms.
  • Gastrointestinal disturbances. These include nausea, diarrhea, or an upset stomach.
  • Sleep disturbances. Some people might experience insomnia or nightmares.

Rare but serious side effects might include:

  • Shortness of breath. Any respiratory issues should be reported immediately.
  • Sudden weight gain. This could be a sign of fluid retention.
  • Swelling. Especially in hands, ankles, or feet.
  • Depression or mood changes. Any significant mood shifts should be noted and discussed with a healthcare provider.

Be aware of these potential side effects and inform a healthcare provider of any unusual or severe reactions. Monitoring and regular medical check-ups can help manage and address any concerns that arise during treatment.

Cautions and Interactions With Other Medicines

According to research, when patients are prescribed propranolol for generalized anxiety disorder or panic disorder,  it can be combined with benzodiazepines [4*] for higher effectiveness of treatment. However, combining it with some other medicines may cause interactions. That is why it is crucial to inform the doctor of any other medicines you might be taking. 

Some interactions to be aware of include:

  • Blood pressure medications. Combining propranolol with other substances that lower blood pressure, such as ACE inhibitors or diuretics, can lead to an excessive drop in blood pressure. This may result in symptoms like dizziness or lightheadedness.
  • Diabetes medications. Propranolol can mask the symptoms of low blood sugar (hypoglycemia) and may also alter blood sugar levels. Diabetic patients should monitor their blood sugar closely and discuss any changes in their medications with their doctor.
  • Asthma medications. Beta-blockers, including propranolol, can potentially worsen the symptoms of asthma or obstructive pulmonary conditions. They can interfere with bronchodilators, which are used to open up airways.
  • Antidepressants. Certain antidepressants, when taken with propranolol, can increase the levels of propranolol in the body, leading to increased risks of side effects. Examples include fluoxetine and paroxetine.
  • Warfarin. Propranolol can increase the blood levels of warfarin, which is an anticoagulant. This could increase the risk of bleeding. Regular monitoring of the INR (a measure of blood clotting) is advised when these drugs are co-administered.
  • Over-the-counter medications. Even non-prescription drugs, such as cold or flu medicines, antihistamines, and pain relievers, can interact with propranolol. Always check with a pharmacist or doctor before combining them.
  • Alcohol. It can intensify the blood pressure-lowering effects of propranolol, leading to increased dizziness or a risk of fainting.
  • Herbal supplements. Some herbal products, like St. John’s Wort or goldenseal, might interfere with propranolol. It’s always best to consult with a healthcare provider before adding any herbal remedies to your regimen.

Keep your healthcare provider informed about all the medications, supplements, and over-the-counter products you are taking. Regularly updating them allows for adjustments in dosages or changes in medications to ensure optimal therapeutic results and reduce the risk of interactions.

Receive personalized mental health care from home: our medical providers will guide you every step of the way.

Bottom Line

Propranolol, though primarily a medication for heart conditions, has found its place in the management of anxiety. While it can be beneficial in treating the physical symptoms of anxiety, it may also cause side effects and drug interactions. Being aware of these and keeping in touch with a healthcare provider allows for safer and more effective use.

Always consult with your clinician about starting an anti-anxiety medication propranolol or adjusting its dose.

FAQ

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.
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.
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.
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.

Sources

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+4 sources
  1. https://www.accessdata.fda.gov/drugsatfda_docs/label/2011/016418s080,016762s017,017683s008lbl.pdf
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  2. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6327687/?report=reader
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  3. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9456064/
    Source link
  4. https://www.sciencedirect.com/science/article/abs/pii/0165032787900176
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Written by:

Rabia Khaliq

MSc in Applied Psychology
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