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What You Need to Know About Propranolol for Anxiety

ThriveTalk Staff ∙ Updated: 03/22/2020 Medically Reviewed 

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Anxiety impacts millions of people across the world every day. It comes in different forms and impacts each person to a different degree. For some, anxiety can be overwhelming and prevent them from doing things they love to do. Fortunately, there are a variety of medications available to help those who suffer from anxiety. Depending on the diagnosis and symptoms each person experiences, medications may benefit them to different degrees. Working closely with your mental health provider and primary care provider, you can find a medication regimen that will work best for you to manage your anxiety symptoms.

THIS ARTICLE IS FOR INFORMATIONAL PURPOSES ONLY AND SHOULD NOT BE TAKEN AS MEDICAL ADVICE. ALWAYS FOLLOW THE DIRECTIONS GIVEN BY YOUR DOCTOR WHEN TAKING ANY MEDICATION.

Overview

Anxiety is a complex mental health condition that impacts many people in the United States. It is complicated and can present differently in each person it affects. Some people who suffer from anxiety experience symptoms throughout the day, while others have certain triggers that cause them to experience anxiety. Because this condition impacts so many people, there have been many medications discovered and used to help those who are suffering. These medications can help decrease anxiety symptoms and improve each person’s quality of life.

Propranolol has been around for a long time and has many different uses. It belongs to a class of medications called beta-blockers. This class of medications decreases the body’s response to some stimulating chemicals. Most of these medications are used for heart health or blood pressure management. Propranolol is also one of the many different types of medications that have been used to help those who suffer from anxiety.

How Can Propranolol Help Me?

Propranolol has been prescribed for anxiety for many years. It can be useful for different forms of anxiety, and its benefits depend on the symptoms you are trying to manage.

Calms Physical Symptoms of Anxiety

When you experience anxiety, you may start to feel short of breath, your heart might start racing, and your hands might start shaking. You may experience other symptoms as well. Propranolol can help reduce these automatic responses your body has during anxiety-inducing situations. It does not treat the cause of your anxiety during these experiences. Instead, it reduces these symptoms to help you physically feel calmer.

Helps With Peripheral Autonomic Responses

Propranolol reduces many physical symptoms of anxiety by decreasing the body’s response to chemicals released during times you are stressed or anxious. These chemicals or signals are released by your body when you feel stressed or worried because it is your body’s attempt to get you ready to take on the challenge in front of you or run away from that obstacle. When your body releases signals that cause shaking hands, sweating, or a racing heart, propranolol blocks some of those signals from reaching their target. This leads to fewer physical symptoms of anxiety, which can also help keep your mind feeling calmer.

Brand and Generic Names

Propranolol has been around for a long time and is available as a tablet, capsule, liquid, long-acting capsules, and injectable forms. It is currently available as a generic medication in the form of propranolol hydrochloride. There are also different brand names available. Inderal is the brand name of the short-acting version of propranolol. Inderal LA, Inderal XL, and InnoPran XL are brand names for the longer-acting versions of propranolol. Hemangeol is the liquid form of propranolol.

Before Taking Propranolol

Before taking propranolol for anxiety, it is important you talk about the medication with your physician and your mental health provider. They can help you determine if this medication is appropriate for you. For some medical conditions, propranolol is not a good medication to take. There are also some forms of anxiety that do not benefit from using propranolol.

Allergy Information

Before taking any medication, including propranolol, you should consider your allergies. By discussing your allergies with your medical providers or pharmacist, you can determine if propranolol is a safe medication for you to use.

If you are allergic to propranolol, there are a variety of symptoms you could experience. The most serious is an anaphylactic reaction during which you throat could swell; this reaction is rare. Some people who are allergic to propranolol can get a rash, fever, sore throat, or shortness of breath. If you have had an allergic reaction to another beta-blocker, you may also experience an allergic reaction to propranolol.

If you have had severe allergic reactions to other substances before, taking a beta-blocker can make you more reactive to those substances. It can also reduce your response to the treatment for these severe reactions. If you have experienced these serious types of allergies before, please talk to your primary care provider before starting a beta-blocker medication, such as propranolol.

Common Interactions

Propranolol can interact with some medications or substances you may already be taking or using. These include:

  • Alcohol: Drinking alcohol can increase the levels of propranolol in your body, which could cause side effects of the medication.
  • Blood pressure medications: Propranolol can decrease blood pressure, so if you are already on blood pressure lowering medications this can lead to low blood pressure. Talk to your provider about the medications your taking to make sure you safely add or stop this and other blood pressure medications. Some blood pressure medications can also affect the levels of propranolol in your body.
  • Diazepam: Diazepam is a benzodiazepine that might be used to help treat anxiety symptoms as well. When taken with propranolol, the levels of diazepam in your body can go up causing you to experience more side effects, such as drowsiness.

Adult Dosing

The dosing for propranolol differs for each indication it is used for. When used for anxiety, propranolol doses are typically 10mg to 40mg. Some people use these medications as needed for certain events that cause them anxiety. When this is the case, they might just take propranolol 30 minutes to one hour before the event. Other people take propranolol for more generalized anxiety. These people may benefit from scheduled dosing, such as propranolol twice daily, every day.

Black Box Warnings

Black box warnings are issued by the FDA to describe serious side effects or adverse reactions that can occur from using a medication. For propranolol, there is a black box warning regarding any abrupt discontinuation of the medication. This is especially true for those patients who also suffer from various forms of cardiac disease. If propranolol is stopped abruptly, these patients may experience chest pain and, in some cases, myocardial infarction, or a heart attack. To prevent this, it is recommended to slowly decrease the dose of propranolol if you have been on it for some time instead of just quitting the medication suddenly.

Side Effects

Propranolol is usually well tolerated by those who take it, especially when used at lower doses for anxiety. However, there are some side effects people may experience. Some people who start propranolol feel tired or lightheaded when they first start taking it. They may also experience cold hands or feet.

Propranolol for Anxiety

Some side effects are specifically related to other medical conditions. In patients with diabetes, propranolol can cause your blood sugar to be lower. It can also mask the symptoms of hypoglycemia or low blood sugar. Patients with asthma or breathing conditions can also be impacted by propranolol and other beta-blockers. In these patients, beta-blockers can increase the risk of bronchospasm, which is a contraction of the airway that makes it difficult to breathe. If you have other medical conditions, talk to your medical provider before starting propranolol to ensure it is safe for you to use.

How Should I Take Propranolol for Anxiety?

The directions for taking propranolol for anxiety can vary depending on the reason you are taking it. Some people take propranolol to prevent symptoms during certain events, such as public speaking. In those instances, propranolol is typically taken 30 minutes to 1 hour before the event. In other cases, patients need help managing symptoms throughout the day. These patients might benefit from a scheduled dosing regimen; this means they take the medication every single day no matter if they anticipate an anxiety-inducing event or not.

What Do I Do If I Miss a Dose?

If you are taking propranolol every day, there might be a time when you forget to take your dose. If you miss a dose of propranolol and you are taking the short-acting form, you should take this dose as soon as you remember unless it is within about 4 hours of your next dose. If you are taking the long-acting version of propranolol and you forget your dose, you should take it as soon as you remember unless it is within about 12 hours of your next dose.  You should not take double your dose the next day if you forgot to take your dose the day before.

What Happens If I Overdose?

If you overdose on propranolol you should seek emergency care as soon as possible. The poison control center can also give you advice on what to do if you are unable to seek emergency care right away.

If you have taken too much propranolol, you might experience a slow heart rate or abnormal heart rate. You might also feel lightheaded or dizzy, or you could faint.

Efficacy Concerns

Propranolol has been used for anxiety for a long time. There are many people who feel that this medication really helps them manage their anxiety symptoms. That being said, there is some research that has not shown propranolol to be more effective than placebo or other anxiety medications for certain types of anxiety.

In an evaluation of the research available, it was found that propranolol was no better than benzodiazepines for anxiety or panic attacks. There is also more evidence for SSRI use in panic disorder than propranolol. This review also showed that propranolol was not proven to be effective for PTSD. However, there has been some recent research that has suggested propranolol can reduce memory consolidation in patients with PTSD, so this evidence is currently conflicting.

While propranolol may not demonstrate consistent efficacy in research, it is a well-tolerated medication. If it benefits you and helps manage your symptoms, it can be an effective choice. It can also help with symptom management in specific situations or while you are waiting for longer-term treatment options, such as SSRIs, to kick in.

Pregnancy

Propranolol is listed as a pregnancy category C. While there are no well-controlled studies that have been done in pregnant women, there have been some deficits reported in mothers who were on propranolol during pregnancy. If you are on propranolol and become pregnant or are considering starting propranolol during pregnancy, discuss this with your medical provider. Together you can determine if the benefits outweigh the risks in your situation.

After giving birth, propranolol is excreted in breast milk and should be used with caution in nursing mothers.

Other Uses

Propranolol has been used for many different indications over the years.

Typical Uses

Propranolol is most widely used for heart conditions. It is one of the medications approved to lower blood pressure. It can control heart rate in people who have fast heart rhythms, such as atrial fibrillation or ventricular tachycardia. Many people also use propranolol to prevent migraines or reduce symptoms of tremors. The liquid formulation is also approved for infants who have proliferating infantile hemangioma.

Off-Label Uses

Propranolol has been used off-label for a variety of indications over time, as well. An off-label indication is the use of a medication for a reason not specifically approved by the FDA but often widely accepted by doctors. Some of these indications for propranolol include controlling symptoms of chest pain in patients with coronary artery disease, managing symptoms of high thyroid levels, and reducing the risk of a variceal bleed in patients with liver failure. It has also been used to treat aggression in some cases.

Resources

  1. https://www.healthline.com/health/propranolol-oral-tablet
  2. https://www.statnews.com/2017/10/25/anxiety-performance-propranolol/
  3. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4724794/
  4. https://www.medicalnewstoday.com/articles/316061.php
  5. https://www.pdr.net/drug-summary/Propranolol-Hydrochloride-Oral-Solution-propranolol-hydrochloride-2656#topPage
  6. https://www.accessdata.fda.gov/drugsatfda_docs/label/2010/021438s013s014lbl.pdf
  7. https://www.anxieties.com/159/panic_medication_Betas#.W8EYdi-ZP-Y
  8. https://www.drugs.com/propranolol.html
  9. https://ww2.mc.vanderbilt.edu/adc/38888

About the author 

ThriveTalk Staff


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