From the Guidelines
Propranolol plays a role in the management of anxiety disorders, specifically in treating symptoms of panic disorder and performance anxiety.
Key Points
- Propranolol, a beta-blocker, is commonly prescribed for symptom relief in panic disorder, often in combination with cognitive behavior therapy and/or selective serotonin reuptake inhibitors and/or benzodiazepines 1.
- The use of beta-blockers like propranolol is also extended to treating performance anxiety as a psychiatric comorbidity 1.
- While propranolol is not the primary treatment for social anxiety disorder, beta-blockers are listed as one of the potential interventions for this condition, although SSRIs and SNRIs are considered safer and more effective therapeutic options 1.
- The efficacy of propranolol in anxiety disorders is based on its ability to alleviate physical symptoms of anxiety, such as tremors and palpitations, rather than addressing the underlying psychological causes.
Treatment Considerations
- Propranolol is typically used off-label for anxiety disorders, and its use should be individualized based on the patient's medical comorbidities and response to treatment.
- The dosage of propranolol for anxiety disorders is usually lower than that used for cardiovascular indications, and it is often started at a low dose and gradually increased as needed and tolerated.
The FDA Drug Labels for propranolol (PO) do not address this question.
From the Research
Role of Propranolol in Anxiety Disorders
- Propranolol's efficacy in anxiety disorders is not clearly established, with some studies suggesting it may be useful in patients with physical symptoms of anxiety that have not responded to benzodiazepine therapy 2.
- Beta-blockers, including propranolol, may have a role in the treatment of anxiety disorders, particularly in patients with physical symptoms such as palpitations and tachycardia 3, 4.
- Propranolol may be effective in reducing anxiety in certain patients, especially those with cardiovascular complaints, when combined with benzodiazepines or as an alternative to traditional antipsychotic therapy 2, 4.
- A recent study found that propranolol had a beneficial effect on anxiety in children and young adults with autism spectrum disorder, but did not impact social interaction measures or language 5.
Study Design and Limitations
- Many studies on the use of propranolol in anxiety disorders have methodological limitations, including poor study design and small sample sizes 2, 4.
- Further research is needed to determine the exact role of propranolol in the treatment of anxiety disorders and to identify the characteristics of patients who are most likely to respond to treatment 2, 4, 5.
- The use of propranolol in anxiety disorders should be approached with caution, particularly in patients with concurrent depressive illness, as beta-blockers may induce depression 4.