From the FDA Drug Label
Nebivolol is a β-adrenergic receptor blocking agent. In extensive metabolizers (most of the population) and at doses less than or equal to 10 mg, nebivolol is preferentially β1 selective. The FDA drug label does not answer the question.
From the Research
Propranolol is generally preferred over nebivolol for treating anxiety due to its ability to block both beta-1 and beta-2 receptors, making it more effective for the physical manifestations of anxiety. The most recent and highest quality study on this topic, a systematic review and meta-analysis published in 2025 1, found that there is a lack of robust evidence for the effectiveness of beta-blockers, including propranolol and nebivolol, in treating anxiety disorders. However, propranolol has been shown to be effective in reducing physical symptoms of anxiety, such as trembling, racing heart, and sweating, in situational anxiety 2. Nebivolol, on the other hand, is more selective for beta-1 receptors in the heart and is primarily used for hypertension rather than anxiety.
Some key points to consider when using beta-blockers for anxiety include:
- Propranolol works quickly, typically within 30-60 minutes, to reduce physical symptoms of anxiety
- Propranolol is typically prescribed at 10-40mg as needed before anxiety-provoking situations
- Nebivolol causes fewer side effects like fatigue and sexual dysfunction, but its effectiveness for anxiety is not well established
- Both medications should be used cautiously in people with asthma, diabetes, or certain heart conditions, and should be prescribed under medical supervision
- Neither medication should be stopped abruptly as this can cause rebound effects
It's also important to note that the evidence for the use of beta-blockers in anxiety disorders is limited, and more research is needed to fully understand their effectiveness and potential benefits and risks 1. Additionally, other treatments, such as selective serotonin reuptake inhibitors (SSRIs) and serotonin norepinephrine reuptake inhibitors (SNRIs), may be more effective for treating anxiety disorders, as shown in a systematic review and meta-analysis published in 2019 3.