From the Guidelines
Propranolol for anxiety is typically prescribed at 10-40 mg taken 30-60 minutes before anxiety-provoking situations or 10-40 mg taken 2-3 times daily for ongoing anxiety symptoms. For situational anxiety (like public speaking or performance anxiety), a single dose of 10-20 mg is often sufficient, while chronic anxiety may require regular dosing of 40-80 mg total per day, divided into multiple doses. Start with the lowest effective dose to minimize side effects. Propranolol works by blocking beta-adrenergic receptors, reducing physical symptoms of anxiety such as rapid heartbeat, trembling, and sweating, though it doesn't directly affect psychological anxiety. It's essential to note that propranolol should not be stopped abruptly as this can cause rebound symptoms; dosage should be tapered gradually under medical supervision. This medication is contraindicated in patients with asthma, certain heart conditions, and diabetes, so a thorough medical evaluation is necessary before starting treatment 1.
Some key points to consider when prescribing propranolol for anxiety include:
- Starting with a low dose and gradually increasing as needed to minimize side effects
- Monitoring for potential side effects such as hypotension, bradycardia, and bronchospasm
- Avoiding use in patients with certain medical conditions, such as asthma, heart failure, and diabetes
- Tapering the dosage gradually when discontinuing the medication to avoid rebound symptoms
- Considering alternative treatments for patients who may not be suitable candidates for propranolol, such as those with certain medical conditions or taking certain medications 1.
It's also important to note that propranolol is not a first-line treatment for anxiety and should only be used under the guidance of a healthcare professional. Other treatments, such as selective serotonin reuptake inhibitors (SSRIs) and cognitive-behavioral therapy (CBT), may be more effective and have a more favorable side effect profile for many patients 1.
In terms of dosing, the most recent and highest quality study recommends starting with a low dose of 10-20 mg and gradually increasing as needed, with a maximum daily dose of 80-120 mg 1. However, the optimal dosing strategy may vary depending on the individual patient and their specific needs, and should be determined in consultation with a healthcare professional.
From the Research
Propranolol Dosing for Anxiety
The recommended dosing of propranolol for anxiety varies depending on the specific condition and individual response.
- Average therapeutic doses range from 20 to 40 mg, once to three times a day 2
- For peri-operative anxiolysis, a dose of 20 mg is recommended as it provides significant reduction in anxiety with minimal side-effects 3
- A single dose of 40 mg of propranolol has been shown to be effective in improving performance in students prone to cognitive dysfunction due to test anxiety 4
- Higher doses, such as 80 mg, have also been used for preoperative anxiolysis, but may not offer additional benefits over lower doses 5
Factors Influencing Dosing
The dosing of propranolol for anxiety may be influenced by several factors, including:
- Severity of symptoms: Propranolol may be more effective for mild to moderate anxiety symptoms 2, 6
- Individual response: Patients may respond differently to propranolol, and dosing may need to be adjusted accordingly 3, 4
- Specific condition: Propranolol may be used for various types of anxiety, including performance anxiety, test anxiety, and preoperative anxiolysis 2, 6, 3, 4, 5
Comparison with Other Medications
Propranolol has been compared to other medications, such as diazepam, for preoperative anxiolysis.