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Propranolol for anxiety: What to know

Propranolol for anxiety: What to know

Reviewed by:
Austin Lin, MD
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May 7, 2024
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Key takeaways

Medications are often part of an effective anxiety treatment plan. Choosing the right medication for you is an important decision for you and your healthcare team to make together. One anxiety treatment is propranolol, the generic name for Inderal and others.  Whether you’re considering propranolol or already taking it, we’ll cover everything you need to know about the medication in this article.  


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Propranolol 101: History and dosage

Propranolol was invented in the 1960s by Sir James Black to treat heart conditions. Since then, it has been used to treat a variety of conditions, including heart problems, high blood pressure, migraines, and anxiety.  

Like many other medications, propranolol goes by various brand names, including Hemangeol, Inderal, Inderal LA, Inderal XL, InnoPran XL, and Propranolol HCl Intensol. It’s available as a capsule, an extended-release capsule, a tablet, or a liquid solution. Those who take propranolol for anxiety may be prescribed 10mg to take 30-60 minutes before an event, and the dosage can be gradually increased by 10mg to as high as 60mg a day.  This dose may change depending on the form of propranolol you’re taking, and your doctor’s advice.

Propranolol may be prescribed to teens and adults over age 12. However, it may not be suitable for those who have low blood pressure, kidney or liver problems, or are pregnant—among others. You can work with your doctor to determine if this medication is right for you.

How does propranolol work?

Propranolol is a beta-blocker that works by blocking the effects of certain hormones, including adrenaline and noradrenaline (also called norepinephrine). Both of these hormones contribute to your body’s fight-or-flight response by increasing your heart rate and blood pressure. Propranolol restricts these hormones from causing the fight-or-flight response, and slows your heart rate, therefore reducing physical symptoms of anxiety.  

Beta-blockers like propranolol, are an ‘off-label’ anxiety treatment. This means that their intended and approved use isn’t technically to treat anxiety. However, there is evidence that beta-blockers are an effective way to relieve anxiety symptoms, hence why many doctors prescribe them. The main benefit to propranolol is that it works quickly and so it can be effective in short-term situations as needed, such as before an anxiety-inducing performance or event.

Propranolol side effects

Most medications have some side effects and propranolol is no exception. However, the most common side effects are temporary and mild.

It’s important to remember that just because you take propranolol doesn’t mean you’ll experience any of these side effects. However, if you do experience negative side effects or have specific concerns, speak with a licensed mental health professional or your primary healthcare provider.

Common side effects

  • Cold hands or feet
  • Chest tightness
  • Cough
  • Difficulty sleeping and/or intense dreams
  • Dizziness
  • Fatigue
  • Headaches
  • Nausea and vomiting

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More severe side effects

  • Bradycardia  
  • Hypotension  
  • Lightheadedness  
  • Weakness
  • Anxiety or nervousness
  • Blood in urine or stool
  • Cracking or itchy skin
  • Discolored urine or stool
  • Irregular heartbeat
  • Mood swings
  • Nose bleeds
  • Shortness of breath
  • Stomach pain
  • Yellowing eyes or skin

This is not a comprehensive list of side effects. If you notice anything unusual after taking propranolol, contact a healthcare professional.

When not to take propranolol

When developing a treatment plan, your doctor will ask a variety of questions about your symptoms, medications, and medical history. This is because some medications are better or worse for individuals with certain conditions.  

Propranolol may not be suitable for children under 12 years old or people with breathing disorders, including asthma and emphysema. It also may not be suitable for you if you take other medications. Be sure to disclose any medications to your doctor.

Your doctor may or may not recommend propranolol if you’re pregnant, breastfeeding, or trying to get pregnant.  

Make sure to disclose any other medical conditions to your doctor, including:

  • Allergies
  • Circulation problems, including low blood pressure
  • Diabetes
  • Heart problems, including heart failure and angina (chest pain)
  • Liver or kidney disease
  • Muscular or thyroid disorders
  • Other mental health conditions, including depression

FAQs

Here’s what else to know about taking propranolol for anxiety.

How quickly does propranolol work for anxiety?

Propranolol is a fast-acting medication that starts working to relieve anxiety within an hour. Some people may feel the effects as quickly as 30 minutes after taking it.  

Is propranolol a form of Xanax?

The short answer is no. Although they are both used to treat anxiety, Xanax (alprazolam) is a different type of medication than propranolol. Propranolol is a beta-blocker that reduces the physical symptoms of anxiety, like a racing heart rate.Xanax is a benzodiazepine. Benzodiazepines work by increasing the amount of chloride ions to cause hyperpolarization of a neuron, and thus reducing the excitable state. signaling your brain to release more GABA—a neurotransmitter that makes your nervous system less active. Learn more about alternatives to Xanax.

Does propranolol stop panic attacks?

Since treating anxiety with propranolol is an “off-label” use, it’s technically not intended to treat panic attacks. However, some research has found that it is effective, and doctors may prescribe it for patients who experience panic attacks.  

The information in this article is for education and informational purposes only and should never be substituted for medical advice, diagnoses, or treatment. If you or someone you know may be in danger, call 911 or the National Suicide and Crisis Lifeline at 988 right away.

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Call the number on your insurance card and ask about your plan’s coverage for outpatient psychiatric services.

How does Talkiatry compare to face-to-face treatment?

For most patients, Talkiatry treatment is just as effective as in-person psychiatry (American Psychiatric Association, 2021), and much more convenient. That said, we don’t currently provide treatment for schizophrenia, primary eating disorder treatment, or Medication Assisted Treatment for substance use disorders.

What kind of treatment does Talkiatry provide?

At Talkiatry, we specialize in psychiatry, meaning the diagnosis and treatment of mental health conditions. Your psychiatrist will meet with you virtually on a schedule you set together, devise a treatment plan tailored to your specific needs and preferences, and work with you to adjust your plan as you meet your goals.

If your treatment plan includes medication, your psychiatrist will prescribe and manage it. If needed, your psychiatrist can also refer you to a Talkiatry therapist.

What's the difference between a therapist and psychiatrist?

Psychiatrists are doctors who have specialized training in diagnosing and treating complex mental health conditions through medication management. If you are experiencing symptoms of a mental health condition such as depression, anxiety, bipolar disorder, PTSD, or similar, a psychiatrist may be a good place to start.  

Other signs that you should see a psychiatrist include:  

  • Your primary care doctor or another doctor thinks you may benefit from the services of a psychiatrist and provides a referral    
  • You are interested in taking medication to treat a mental health condition  
  • Your symptoms are severe enough to regularly interfere with your everyday life

The term “therapist” can apply to a range of professionals including social workers, mental health counselors, psychologists, professional counselors, marriage and family therapists, and psychoanalysts. Working with a therapist generally involves regular talk therapy sessions where you discuss your feelings, problem-solving strategies, and coping mechanisms to help with your condition.

Who can prescribe medication?

All our psychiatrists (and all psychiatrists in general) are medical doctors with additional training in mental health. They can prescribe any medication they think can help their patients. In order to find out which medications might be appropriate, they need to conduct a full evaluation. At Talkiatry, first visits are generally scheduled for 60 minutes or more to give your psychiatrist time to learn about you, work on a treatment plan, and discuss any medications that might be included.

About
Austin Lin, MD

Dr. Austin Lin is a double board-certified adult and addiction psychiatrist who has been in practice for over 9 years. At the center of Dr. Lin’s clinical approach is a strong emphasis on establishing trust and using a collaborative approach to help patients develop an individualized and cohesive plan so that they are able to achieve their goals.

Dr. Lin's practice focuses on medication management. Typically, he offers this in conjunction with supportive therapy, motivational interviewing, and/or cognitive behavioral therapy in 30-minute follow-up visits. Occasionally, Dr. Lin may recommend that additional therapy is needed and ask that you bring a therapist into your care team in order to provide the best outcome.

Dr. Lin received his medical degree from St. George’s University School of Medicine. He went on to complete his residency in psychiatry at Harvard South Shore, an affiliate of Harvard Medical School, where he served as Chief Resident and earned his 360° Professionalism award. He then had additional training in Addiction Psychiatry through his fellowship at the University of Texas Southwestern Medical Center. After completing training, Dr. Lin has worked as an Addiction Psychiatrist and Director of Adult Services in the Trauma and Resilience Center (TRC) at the University of Texas Health Science Center at Houston (UTHealth). He specialized in treating patients with a history of depression, anxiety, trauma, and substance use disorders.

Dr. Lin has held an academic appointment at UTHealth, and he has spent his professional career supervising and teaching medical students and psychiatry residents.



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