- Propranolol FAQs: 25 Common Propranolol Questions Answered
- What is Propranolol?
- What is Propranolol Used For?
- Is Propranolol Available Over the Counter?
- How Does Propranolol Make You Feel?
- Does Propranolol Affect Mental Function?
- How Long Does it Take for Propranolol to Work?
- Is it Okay to Take Propranolol With Food?
- How Long Does Propranolol Last?
- How Much Propranolol Should You Take for Anxiety?
- Can Propranolol be Taken as Needed?
- What are Propranolol Side Effects?
- Is Propranolol Safe?
- Does Propranolol Cause Weight Gain?
- Can Propranolol Make it Harder to Fall Asleep?
- How Much Does Propranolol Lower Blood Pressure?
- Does Propranolol Have any Effects on Exercise?
- Is Propranolol Addictive?
- Is Propranolol a Benzodiazepine?
- Is it Safe to Drink Alcohol While Taking Propranolol?
- Is Propranolol a Selective or Nonselective Beta Blocker?
- Is it Safe for People With Diabetes to Use Propranolol?
- Is it Safe to Use Propranolol for Public Speaking?
- Can Propranolol Interact With Other Medications?
- What Brand Names is Propranolol Sold Under?
- What Forms of Propranolol are Available?
- How long does Propranolol last for anxiety?
- How long does it take Propranolol to leave your system?
- What You Need to Know About Propranolol for Anxiety
- How Can Propranolol Help Me?
- Brand and Generic Names
- Before Taking Propranolol
- Allergy Information
- Common Interactions
- Adult Dosing
- Black Box Warnings
- Side Effects
- How Should I Take Propranolol for Anxiety?
- What Do I Do If I Miss a Dose?
- What Happens If I Overdose?
- Efficacy Concerns
- Other Uses
- Single-dose propranolol tied to ‘selective erasure’ of anxiety disorders
- how long does it take to adjust to inderal
- Propranolol for Performance Anxiety: How it Works, Studies & Dosages
- How Does Propranolol Treat Performance Anxiety?
- How to Use Propranolol for Performance Anxiety
- Propranolol vs. Benzodiazepines for Performance Anxiety
- Does Propranolol Have Side Effects?
- Learn More About Propranolol
Propranolol FAQs: 25 Common Propranolol Questions Answered
Searching for information about propranolol? Prescribed to millions of Americans in the United States alone, propranolol is a commonly used beta blocker used to treat heart conditions, anxiety, headaches and more.
Below, we’ve answered 25 of the most frequently asked questions about propranolol, covering everything from common propranolol dosage to propranolol’s primary effects, potential side effects, uses, half-life and more.
What is Propranolol?
Propranolol is a beta blocker medication. It works by blocking the action of stress hormones like adrenaline (epinephrine) and noradrenaline (norepinephrine) on the beta receptors of the heart, lungs and other tissue.
Developed in the 1960s, propranolol is a commonly used beta blocker that has been on the market for decades. Our guide to beta blockers goes into more detail on how propranolol and other beta blocker medications work.
What is Propranolol Used For?
Like other beta blockers, propranolol is primarily used to treat cardiovascular conditions such as arrhythmia (irregular heartbeat) and hypertension. By blocking the action of stress hormones on the heart, propranolol can reduce a person’s heart rate and blood pressure.
Propranolol is also used to relieve angina (chest pain) and to improve heart function after heart attacks. Along with other beta blockers, propranolol is used to treat benign essential tremor—a disorder that can cause uncontrollable shaking in the hands, arms, head, neck and torso.
Propranolol is also prescribed off-label as an effective treatment for certain types of anxiety. Our guide to propranolol and anxiety goes into more detail on how propranolol can treat the symptoms of performance anxiety, social anxiety and other anxiety disorders.
Is Propranolol Available Over the Counter?
Propranolol is a prescription medication, meaning it isn’t available over the counter. To purchase propranolol, you’ll need to get a prescription from your doctor or complete an online consultation to receive a valid prescription.
How Does Propranolol Make You Feel?
Propranolol blocks the physical effects of anxiety, meaning you won’t experience an increased heart rate, sweating and shakiness when you feel nervous. By blocking the physical symptoms of anxiety, propranolol can help you feel calmer, less nervous and more composed.
Does Propranolol Affect Mental Function?
Propranolol primarily affects your body’s physical response to stress, with few major effects on your cognitive function. A 2000 study found that people who used propranolol performed almost exactly the same on 11 tests of cognitive function after three or 12 months of use.
It’s worth noting that this study was carried out on people who received a significant propranolol dosage daily (80 to 400mg every day) to treat hypertension, instead of the smaller, as-needed dose used to treat social anxiety and performance anxiety.
How Long Does it Take for Propranolol to Work?
It takes 30-60 minutes for the effects of propranolol to become noticeable. Most people who take propranolol to treat performance anxiety use the medication about one hour before any stress-inducing events.
Is it Okay to Take Propranolol With Food?
Propranolol can be taken with food or on an empty stomach. Food does not seem to have a significant effect on the body’s absorption of propranolol, meaning you shouldn’t notice any difference in effectiveness if you take this medication after a meal.
How Long Does Propranolol Last?
Propranolol has a half-life of eight to 10 hours, meaning about half of the dose will still be active in your body after eight to 10 hours. However, the noticeable effects of the drug last for about 12 hours—slightly longer than propranolol’s half-life.
How Much Propranolol Should You Take for Anxiety?
Propranolol comes in 10mg, 40mg, 80mg and 160mg tablets. The standard propranolol dosage for treating performance or social anxiety ranges from 10 to 80mg, depending on the severity of your symptoms and response to the medication.
As with other medications, there’s no “perfect” dose of propranolol for everyone. Depending on your symptoms, bodyweight and response to the medication, your doctor might recommend a mild or higher propranolol dosage before anxiety-inducing events.
Can Propranolol be Taken as Needed?
Yes. When used for performance anxiety and social anxiety, propranolol can be taken only when it’s needed. Many people use propranolol as needed before public speaking events, meetings or other stressful, anxiety-inducing situations.
If you’re prescribed propranolol for a heart condition, follow your doctor’s exact instructions and only use propranolol as prescribed.
What are Propranolol Side Effects?
Propranolol has several potential side effects. Most propranolol side effects are minor, with fatigue, a reduced heart rate and difficulty falling asleep being the most common side effects at a normal dose.
In rare cases, propranolol can cause more serious side effects. Our Propranolol 101 guide lists all of the common and uncommon side effects of this medication, with information on what to do if you experience propranolol side effects.
Is Propranolol Safe?
Used according to your doctor’s instructions, propranolol is a very safe medication. It’s been in use since the 1960s and is prescribed to millions of people in the United States alone, with a long record of safety.
Like all medications, propranolol needs to be used responsibly. If you use propranolol at doses above those recommended by your doctor or more frequently than prescribed, you may have an increased risk of experiencing side effects.
Does Propranolol Cause Weight Gain?
Propranolol can cause weight gain, although it’s more likely to cause extra fluid retention than an increase in body fat. Any weight gained from propranolol and other beta blockers is usually temporary, with most people’s weight stabilizing after the first few months of treatment.
Can Propranolol Make it Harder to Fall Asleep?
A small percentage of people who use propranolol for heart conditions and anxiety experience difficulty falling—and staying—asleep. This is often a temporary side effect that goes away after a few weeks or months of using propranolol.
Sleep supplements such as melatonin can reduce the negative effects of propranolol on your ability to sleep and make it easier to maintain normal, healthy sleep habits.
How Much Does Propranolol Lower Blood Pressure?
Propranolol can cause a significant decrease in blood pressure, especially when used at a high dose.
In a 1983 study, researchers found that an 80mg daily dose of propranolol caused an average drop in systolic blood pressure of 11 +/- 4 mm Hg, while a 160mg daily dose caused a fall of 16 +/- 4 mm Hg. Higher doses of propranolol did not cause any further measurable decrease.
Does Propranolol Have any Effects on Exercise?
Because propranolol can reduce your heart rate, it can have several effects on your ability to exercise. After you take propranolol, you might feel fatigued and exhausted more easily after intense exercise.
If you do frequent cardiovascular exercise, it’s important to account for propranolol’s effect on your heart rate if you use a heart rate monitor to track your workout intensity.
Is Propranolol Addictive?
Propranolol is not a physically addictive, habit-forming medication. However, it is possible to become accustomed to the feeling of relaxation propranolol provides, especially if you often experience performance or social anxiety.
Is Propranolol a Benzodiazepine?
No. Although propranolol is used to treat certain types of anxiety, it is not a benzodiazepine like alprazolam (Xanax) or diazepam (Valium). Propranolol belongs to a class of medications called beta blockers.
Is it Safe to Drink Alcohol While Taking Propranolol?
You should not drink alcohol while taking propranolol. Alcohol can interact with propranolol and cause you to feel excessively drowsy and fatigued. It’s also possible for alcohol and propranolol to reduce your heart rate and blood pressure, causing potentially serious side effects.
Is Propranolol a Selective or Nonselective Beta Blocker?
Propranolol is a nonselective beta blocker, meaning it can block the effects of stress hormones on beta-1, beta-2 and beta-3 receptors. Because of this, the effects of propranolol can occur in tissue outside the heart, such as the airways.
Is it Safe for People With Diabetes to Use Propranolol?
Propranolol is not recommended for people with diabetes. As a nonselective beta blocker, it’s possible for propranolol to cause hypoglycemia. If you have diabetes and anxiety, you should speak to your doctor about safe treatment options before considering any medications.
Is it Safe to Use Propranolol for Public Speaking?
Yes. Many people experience performance anxiety before giving speeches or performing in front of others. Propranolol is widely used as a performance anxiety treatment by people who perform in public, from event presenters to musicians.
Can Propranolol Interact With Other Medications?
Propranolol can interact with a range of medications, including more than 70 major interactions with other drugs. If you use other prescription medications, it’s important to let your doctor know before considering propranolol or any other beta blockers.
What Brand Names is Propranolol Sold Under?
Today, propranolol is mostly sold as a generic without a specific brand name. It’s also been sold under the brand names Inderal (the first name for propranolol, by ICI Pharmaceuticals), Deralin, Inderalici, Dociton, Avlocardyl, InnoPran XL, Anaprilin, Sumial and others.
What Forms of Propranolol are Available?
Propranolol is available in four different forms. The most common is a tablet, which contains 10 to 160mg of propranolol. Propranolol is also available as an extended-release capsule, which is designed primarily for treating heart conditions.
There’s also an oral liquid version of propranolol that provides the same effects as the common, tablet-based form, as well as a propranolol IV injection that’s mainly used in hospitals and other medical settings.
We’ve all experienced moments of performance anxiety.
That realization that we’re about to face a room full of people who will, inevitably, wind up staring at us, expecting us to say something profound, or clever, or at the very least informative.
Performance anxiety can push our biological panic button, which floods our system with adrenaline. Our heart rate increases, our breathing becomes difficult, and we start sweating like we’re in a Bikram yoga studio.
We all have different strategies for coping with that anxious response.
We try to breathe through it. We try to focus on our notes. We try to imagine our audience or interviewers naked (I’m not sure why, as it never seems to help).
Even more frustrating is the fact that as soon as we notice those physical symptoms, they cause even more anxiety, creating a downward spiral.
Propranolol can help prevent the physical response to performance anxiety that reacts to a room full of people the same way it does to mortal peril.
A 10-20mg dose of Propranolol one hour before a stress-inducing event can keep your heart rate level, your breathing steady, and your trembling (and sweating) subdued for several hours.
How long does Propranolol last for anxiety?
For most patients, Propranolol’s half-life is around 4 hours.
A medication’s half-life is the time it takes for the medication in our bodies to be reduced by 50%. So, Propranolol should give you at least 3-4 hours of relief from the physical symptoms of performance anxiety.
As Propranolol’s effects are most potent within the first 4 hours, you’ll want to time your dosage correctly. If you take it too close to your event, it may not have kicked in yet. Too early, though, and the effects might wear off by the time you get up on stage.
Taking your prescribed dosage one hour before your pivotal moment is the general recommendation from doctors to ensure you get the most benefit from your beta-blockers.
How long does it take Propranolol to leave your system?
Once Propranolol is in your system, it takes roughly 1-2 days for your body to completely clear it. Propranolol’s half-life is short, so it metabolizes quickly, and the Propranolol dosage for anxiety (10-20mg) is fairly low.
In order to lower the risk of interactions or side effects, you should wait until Propranolol exits your system completely before taking another medication. And always check with your doctor about possible interactions and side effects before taking Propranolol.
Propranolol is a prescription medication and may not be right for everyone. A consultation with one of our board-certified doctors can help you decide if it is the right choice to treat your performance anxiety.
Reviewed by Dr. Alex Dimitriu
Dr. Alex Dimitriu is a Stanford-trained physician with dual board certification in psychiatry and sleep medicine. The included content is not intended to replace medical advice. Always be sure to discuss any prescription medications with your doctor.
What You Need to Know About Propranolol for Anxiety
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.
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.
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.
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.
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.
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.
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.
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.
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.
Propranolol has been used for many different indications over the years.
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.
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.
Single-dose propranolol tied to ‘selective erasure’ of anxiety disorders
BARCELONA – 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, Marieke Soeter, PhD, said at the annual congress of the European College of Neuropsychopharmacology.
Dr. Marieke Soeter
The concept here is that the beta-blocker, when given with a brief therapist-led reactivation of a fear memory, blocks beta-adrenergic receptors in the brain so as to interfere with the specific proteins required for reconsolidation of that memory, thereby disrupting the reconsolidation process and neutralizing subsequent expression of that memory in its toxic form. In effect, timely administration of one dose of propranolol, a drug that readily crosses the blood/brain barrier, achieves pharmacologically induced amnesia regarding the learned fear, explained Dr. Soeter, a clinical psychologist at TNO, the Netherlands Organization for Scientific Research, an independent nonprofit translational research organization.
“It looks like permanent fear erasure. You can never say that something is erased, but we have not been able to get it back,” she said. “Propranolol achieves selective erasure: It targets the emotional component, but knowledge is intact. They know what happened, but they aren’t scared anymore. The fear association is affected, but not the innate fear response to a threat stimulus, so it doesn’t alter reactions to potentially dangerous situations, which is important. If there is a bomb, they still know to run away from it.”
This single-session therapy addressing what psychologists call fear memory reconsolidation is totally outside the box relative to contemporary psychotherapy for anxiety disorders, which typically entails gradual fear extinction learning requiring multiple treatment sessions. But contemporary psychotherapy for anxiety disorders leaves much room for improvement, given that up to 60% of patients experience relapse. That’s probably because the original fear memory remains intact and resurfaces at some point despite initial treatment success, according to Dr. Soeter.
Nearly 2 decades ago, other investigators showed in animal studies that fear memories are not necessarily permanent. Rather, they are modifiable, and even erasable, during the vulnerable period that occurs when the memories are reactivated and become labile.
Later, Dr. Soeter – then at the University of Amsterdam – and her colleagues demonstrated the same phenomenon using Pavlovian fear-conditioning techniques involving pictures and electric shocks in healthy human volunteers. They showed that a dose of propranolol given before memory reactivation blocked the fear response, while nadolol, a beta-blocker that does not cross the blood/brain barrier, did not.
However, since the fear memories they could ethically induce in the psychology laboratory are far less intense than those experienced by patients with anxiety disorders, the researchers next conducted a randomized, double-blind clinical trial in 45 individuals with arachnophobia. Fifteen received 40 mg of propranolol after spending 2 minutes in proximity to a large tarantula, 15 got placebo, and another 15 received propranolol without exposure to a tarantula. One week later, all patients who received propranolol with spider exposure were able to approach and actually pet the tarantula. Pharmacologic disruption of reconsolidation and storage of their fear memory had turned avoidance behavior into approach behavior. This benefit was maintained for at least a year after the brief treatment session (Biol Psychiatry. 2015 Dec 15;78:880-6).
“Interestingly, there was no direct effect of propranolol on spider beliefs. Therefore, do we need treatment that targets the cognitive level? These findings challenge one of the fundamental tenets of cognitive-behavioral therapy that emphasizes changes in cognition as central to behavioral modification,” Dr. Soeter said.
Most recently, she and a coinvestigator have been working to pin down the precise conditions under which memory reconsolidation can be targeted to extinguish fear memories. They have shown in a 30-subject study that the process is both time- and sleep-dependent. The propranolol must be given within roughly an hour before to 1 hour after therapeutic reactivation of the fear memory to be effective. And sleep is an absolute necessity: When subjects were rechallenged 12 hours after memory reactivation and administration of propranolol earlier on the same day, with no opportunity for sleep, there was no therapeutic effect: The disturbing fear memory was elicited. However, when subjects were rechallenged 12 hours after taking propranolol the previous day – that is, after a night’s sleep – the fear memory was gone (Nat Commun. 2018 Apr 3;9:1316. doi: 10.1038/s41467-018-03659-1).
“Postretrieval amnesia requires sleep to happen. Sleep may be the final and necessary link to prevent the process of reconsolidation,” Dr. Soeter said. It’s still unclear, however, how much sleep is required. Perhaps a nap will turn out to be sufficient, she said.
Colleagues at the University of Amsterdam are now using single-dose propranolol-based therapy in patients with a wide range of phobias.
“The effects are pretty amazing,” Dr. Soeter said. “Everything is treatable. It’s almost too good to be true, but these are our findings.”
Based upon her favorable anecdotal experience in treating a Dutch military veteran with severe combat-related PTSD of 10 years’ duration which had proved resistant to multiple conventional and unconventional interventions, a pilot study of single-dose propranolol with traumatic memory reactivation is now being planned in patients with war-related PTSD.
“After one pill and a 20-minute session, this veteran with severe chronic PTSD has no more nightmares, insomnia, or alcohol problems, and he now travels the world,” she said.
Her research met with an enthusiastic reception from other speakers at the ECNP session on PTSD. Eric Vermetten, MD, PhD, welcomed the concept that pharmacologic therapy upon reexposure to fearful cues can impede the molecular and cellular cascade required to reestablish fearful memories. This also is the basis for the extremely encouraging, albeit preliminary, clinical data on ketamine, an N-methyl-D-aspartate receptor antagonist, as well as 3,4-Methylenedioxymethamphetamine (MDMA) for therapeutic manipulation of trauma memories.
Dr. Eric Vermetten
“Targeting reconsolidation of existing fear memories is worthy of looking into further,” declared Dr. Vermetten, professor of psychiatry at Leiden (the Netherlands) University and a military mental health researcher for the Dutch Ministry of Defense.
New thinking regarding pharmacotherapy for PTSD is sorely needed, he added. He endorsed a consensus statement by the PTSD Psychopharmacology Working Group that decried what was termed a crisis in pharmacotherapy of PTSD (Biol Psychiatry. 2017 Oct 1;82:e51-e59. doi: 10.1016/j.biopsych.2017.03.007. Epub 2017 Mar 14).
“We only have two -approved medications for PTSD – sertraline and paroxetine – and they were approved back in 2001,” Dr. Vermetten noted. “Research has stalled, and there is a void in new drug development.”
Dr. Soeter’s study of the time- and sleep-dependent nature of propranolol-induced amnesia was supported by the Netherlands Organization for Scientific Research, where she is employed.
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Propranolol 2020-01-04 Person 4 5 0 Written by a patient 4th January 2020
I’m in my 30’s and have only really had mild, manageable anxiety before. I started a new job 3 months ago and it’s just gone into overdrive to the extent that I ended up having full blown panic attacks, couldn’t sleep, would be thinking about work constantly, even first thing at a weekend when I wasn’t working. I’m having counselling (which helps to a degree) but have also been given propranolol. It works really, really well for me. Within an hour of taking a 40mg tablet I will go from thinking my job is completely beyond me and I’ll never be able to be successful, to thinking it’s entirely possible and positive about the future. Back, neck and shoulder pain that is had for years also went, which made me think I’ve been living with anxiety far longer than I actually realised. The effects only last about 6 or 7 hours, so I’m currently taking 1 X 40mg tablet 3 times a day. For people also taking it, if you’re only taking 1 tablet (and unless you’re only taking it to be able to sleep) I wouldn’t recommend taking it in the evenings because the effects will likely have worn off by the morning. I had mild headaches initially, and the odd period of nausea but all very manageable side effects. I don’t think propranolol is necessarily the “long term” answer and I’m speaking to my doctor about going onto a course of anti-depressants but for the time being these tablets are a life saver. I’ve also struggled with public speaking / being centre of attention most of my life. I’d go red, get a sweaty forehead, dry mouth etc. This tablet also stops all that – it won’t turn you into a polished speaker, but it make it much easier for you to get your point across as you won’t be displaying physical symptoms of anxiety. I’m really pleased I found this tablet, and even if/when I come off it in the future I think it’s something I’ll use periodically for the rest of my life, when I have things that are causing me anxiety. For anyone struggling with anxiety, please don’t struggle alone, or in silence. We are fortunate enough to be alive at a time when there are all sorts of medical solutions available and they really do work. There’s still a stigma associated with people that have anxiety / depression and some people think they’ve somehow failed because they’re taking medicine. Please give it a go, the worst that can happen is it does nothing. Good luck.
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Propranolol for Performance Anxiety: How it Works, Studies & Dosages
Feeling anxious before a speech, event or social engagement? Originally designed to treat heart conditions, propranolol is also a highly effective medication for treating for the physical symptoms of social and performance anxiety.
Below, we’ve explained what propranolol is, how it works and how you can use it to manage most performance anxiety symptoms. We’ve also explained how propranolol differs from the other drugs used to treat anxiety, such as alprazolam (Xanax) and diazepam (Valium).
Propranolol is a beta blocker — a type of medication that works by blocking the beta receptors found in your heart, lungs and arteries.
Developed in the 1960s, propranolol is one of the oldest and most widely used beta blockers in existence. There are more than 15 million prescriptions for propranolol in the US alone, making it an incredibly popular medication.
Propranolol is available in a variety of forms, from an oral tablet to an injection. The majority of people who use propranolol are prescribed the oral version of the medication.
Like other beta blockers, propranolol was originally designed as a treatment for heart conditions, such as irregular heart rate or high blood pressure. Most people who are prescribed propranolol use it for this purpose.
In addition to treating certain heart conditions, propranolol also works as a treatment for some of the effects of anxiety. Today, it’s commonly prescribed off-label to treat performance anxiety and social anxiety.
How Does Propranolol Treat Performance Anxiety?
First off, it’s important to understand that propranolol technically isn’t an antianxiety medication like Xanax (alprazolam, a benzodiazepine) or Zoloft (sertraline, an SSRI).
These drugs work by targeting specific parts of your brain and central nervous system, causing you to feel relaxed and calm. Although the specifics are complicated, they essentially work by stopping you from feeling the physical and psychological effects of anxiety.
Medications like Xanax and Zoloft are usually prescribed to treat long-term, persistent anxiety disorders such as panic disorder and generalized anxiety disorder (GAD).
Instead, propranolol works by specifically targeting the receptors in your heart to block some of the physical effects of anxiety. It’s prescribed off-label as a treatment for specific types of anxiety that occur in certain situations, such as social anxiety or performance anxiety.
Social anxiety usually occurs when you’re around other people. Many people feel anxiety about being judged by others or by doing or saying something embarrassing in a social environment.
Performance anxiety is a type of anxiety that can occur when you’re required to perform in front of others. It can strike when you need to perform in public, such as giving a speech, as well as in private, such as before having sex.
When you feel anxiety, such as before meeting a new person or performing in front of others, it can trigger certain physical symptoms. These include:
- A dry mouth, taut throat and difficulty speaking
- A faster pulse and rapid breathing
- Nausea, discomfort and dizziness
- Shakiness in your hands, jaw and lips
- Sweating, especially from your hands
When performance anxiety strikes before sex, it can even cause erectile dysfunction. This often creates a vicious circle of anxiety, with each episode of performance anxiety causing the next to become even worse.
These symptoms don’t just develop out of nowhere. Instead, they’re a physical reaction caused by the presence of specific stress hormones in your body, particularly the hormones adrenaline (epinephrine) and noradrenaline (norepinephrine).
When you feel nervous and stressed, such as before delivering a speech, your body ramps up its production of these stress hormones. These hormones work by attaching to beta receptors, specifically the β1, β2 and β3 receptors throughout your body.
Once these hormones attach to your beta receptors, they trigger the anxiety symptoms listed above, from shaky hands to sweating, nausea and a rapid heartbeat.
Propranolol works by blocking these receptors. With these receptors blocked, stress hormones like adrenaline don’t have their normal effects on your heart and other tissue. This means you’re less likely to experience physical symptoms like shaking, sweating or a rapid pulse.
Since propranolol only blocks beta receptors, it doesn’t actually stop the psychological effects of anxiety. You might still feel nervous before delivering a speech or meeting someone, but it’s less likely to result in any kind of physical reaction.
Interestingly, although propranolol doesn’t directly affect your brain, it can help to make you feel less nervous. Without the shaking, rapid heartbeat and sweating that usually happens when you feel anxious, it can become easier to relax, perform and stay focused.
Studies show that propranolol works best as a short-term treatment for specific types of anxiety, such as performance anxiety, social anxiety and specific phobias. Propranolol isn’t used to treat other types of anxiety, such as generalized anxiety disorder.
How to Use Propranolol for Performance Anxiety
Propranolol is a prescription medication, meaning you’ll need to talk to your doctor before you can buy and use it.
Using propranolol to treat performance or social anxiety is a simple process. Most people take 10 to 80mg of propranolol approximately one hour before the event that’s likely to cause stress, depending on the severity of their anxiety.
Propranolol has a duration of action of approximately 12 hours, meaning its effects can last for significantly longer than most stressful events. Using a lower dose of propranolol (such as 10 or 20mg) can reduce the drug’s effects and provide shorter-acting relief from anxiety symptoms.
Like with other medications for anxiety, it can take time to work out the right dose of propranolol for you. Most doctors recommend starting with a low to moderate dose and adjusting your dose based on your results and side effects.
Propranolol vs. Benzodiazepines for Performance Anxiety
Benzodiazepines such as alprazolam (Xanax) and diazepam (Valium) are also commonly used to treat anxiety. Although they might seem similar, beta blockers such as propranolol differ from benzodiazepines in several ways:
- Propranolol is not physically addictive. Although it’s possible to abuse propranolol and other beta blockers, these drugs aren’t physically addictive. Benzodiazepines such as Valium and Xanax, on the other hand, have a high risk of causing physical addiction.
- Propranolol is designed for short-term, event-based anxiety. Benzodiazepines are normally prescribes for long-term, generalized anxiety, whereas propranolol works best as a treatment for short-term, event-based anxiety.
- Propranolol primarily affects the body, not the brain. Benzodiazepines like Xanax reduce anxiety by targeting parts of the brain and central nervous system. Propranolol primarily works by targeting the heart and other tissue with beta receptors.
In general, propranolol works best as a treatment for event-based anxiety, whereas drugs like benzodiazepines and SSRIs are normally used to treat recurrent, persistent anxiety disorders that aren’t triggered by specific events or settings.
Does Propranolol Have Side Effects?
Used responsibly at a normal dose, propranolol is a safe, effective treatment for performance and social anxiety. However, like other beta blockers, it can result in some side effects.
Our guide to beta blockers goes into more detail on the side effects you might experience after taking propranolol, as well as potential drug interactions you should be aware of before taking propranolol or any other beta blockers.
Learn More About Propranolol
Whether you need something to calm your nerves before performances or need help reducing the effects of social anxiety, propranolol’s effects on the physical symptoms of anxiety make it an effective treatment.
Our guide to propranolol goes into more detail on how propranolol works, as well as its main potential side effects.