From the Guidelines
Propranolol is a good option for managing physical symptoms of anxiety, particularly for situational or performance anxiety, as it works by blocking the effects of adrenaline and reducing physical symptoms like rapid heartbeat, trembling, and sweating. This beta-blocker is especially effective for people whose anxiety manifests primarily as physical symptoms and for those who experience performance anxiety, such as before public speaking or performances. However, it primarily addresses physical symptoms rather than psychological aspects of anxiety. Side effects may include fatigue, dizziness, and cold extremities. Propranolol should be avoided by people with certain conditions including asthma, certain heart conditions, and diabetes. It's essential to start with a low dose and consult with a healthcare provider before beginning treatment, as they can determine if propranolol is appropriate based on your specific health history and medication regimen, as suggested by the study published in Hypertension in 2022 1.
Some key points to consider when using propranolol for anxiety include:
- Typical dosing ranges from 10-40 mg taken 30-60 minutes before an anxiety-provoking situation, or 10-40 mg taken 2-3 times daily for ongoing symptoms.
- Propranolol is not suitable for everyone, especially those with certain medical conditions, and its use should be carefully evaluated by a healthcare provider.
- The medication can be used in conjunction with other treatments, such as cognitive behavior therapy and/or selective serotonin reuptake inhibitors, for comprehensive management of anxiety symptoms, as mentioned in the study published in Journal of the National Comprehensive Cancer Network in 2010 1.
Overall, propranolol can be a useful treatment option for managing physical symptoms of anxiety, but its use should be carefully considered and monitored by a healthcare provider to ensure safe and effective treatment.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Efficacy of Propranolol for Physical Symptoms of Anxiety
- Propranolol, a beta-blocker, has been studied for its effectiveness in managing physical symptoms of anxiety, with mixed results 2, 3, 4, 5, 6.
- A 1988 study found that propranolol was effective in the symptomatic treatment of generalized anxiety, particularly for physical symptoms such as tremors and palpitations 2.
- However, a 2025 systematic review and meta-analysis found no evidence for a beneficial effect of beta-blockers, including propranolol, compared to placebo or benzodiazepines in patients with social phobia or panic disorder 3.
- Another study from 2022 highlighted the application of propranolol in the treatment of stage fright and post-traumatic stress disorder (PTSD), suggesting its potential benefits in specific types of anxiety 4.
- A 2006 review of pharmacotherapy for social anxiety disorder noted that beta-blockers, including propranolol, may be beneficial for performance anxiety, but their benefits are limited to this specific context 5.
- A 2016 systematic review and meta-analysis found insufficient evidence to support the routine use of propranolol in the treatment of anxiety disorders, including panic disorder, specific phobia, social phobia, and PTSD 6.
Limitations and Considerations
- Many studies on propranolol and anxiety have small sample sizes, missing data, and high or unclear risk of bias, which can limit the interpretation of results 3.
- The use of propranolol for anxiety is often considered off-label, and more research is needed to fully understand its efficacy and safety in this context 4.
- Propranolol may be beneficial for specific types of anxiety, such as performance anxiety or stage fright, but its effectiveness for other types of anxiety disorders is less clear 2, 5.