Can I combine 100mg of labetalol (beta blocker) and 10mg of propranolol (beta blocker) to help with anxiety?

From the Guidelines

You should not combine 100mg of labetalol and 10mg of propranolol for anxiety without medical supervision. Taking two beta blockers simultaneously can lead to dangerous additive effects, including excessive lowering of blood pressure and heart rate, as beta blockers competitively block the effects of catecholamines on cell membrane beta receptors, reducing myocardial contractility, sinus node rate, and AV node conduction velocity 1. This combination could cause dizziness, fainting, severe fatigue, or even more serious cardiovascular complications.

According to the acc/aha 2007 guidelines, beta blockers, such as propranolol and labetalol, are primarily used to manage conditions like unstable angina and non-st-elevation myocardial infarction, with their benefits due to inhibition of beta-1 adrenergic receptors, resulting in a decrease in cardiac work and myocardial oxygen demand 1. While propranolol is sometimes used off-label for anxiety symptoms, labetalol is primarily prescribed for hypertension and is not typically used for anxiety management.

Key points to consider:

• The properties of beta blockers, including selectivity, partial agonist activity, and usual dose for angina, vary among different medications, as outlined in Table 15 of the acc/aha 2007 guidelines 1.
• Labetalol and carvedilol are combined alpha and beta blockers, which may have different effects and interactions compared to selective beta blockers 1.
• If you're experiencing anxiety, it's essential to consult with your healthcare provider, who can recommend appropriate treatment options, which might include a single beta blocker at the right dose, other medications specifically designed for anxiety, or non-medication approaches like therapy 1. Your doctor needs to evaluate your complete medical history and current medications to provide safe and effective anxiety treatment.

From the Research

Combination of Labetalol and Propranolol for Anxiety

• The combination of 100mg of labetalol and 10mg of propranolol for anxiety is not a standard treatment approach, and there is limited research on the efficacy and safety of this specific combination 2, 3.
• Beta-blockers, such as labetalol and propranolol, are not typically used as a first-line treatment for anxiety disorders, but they may be useful in certain situations, such as performance anxiety or anxiety accompanied by physical symptoms like palpitations and tachycardia 4, 5.
• Propranolol has been shown to be effective in reducing somatic symptoms of anxiety, such as tremors and palpitations, but its efficacy in treating other forms of anxiety is less clear 6.
• The use of beta-blockers, including labetalol and propranolol, may be associated with side effects like depression, and they should be used cautiously in patients with a history of depressive illness 2.

Dosage and Efficacy

• The dosage of propranolol used in studies for anxiety typically ranges from 20 to 40 mg, once to three times a day, but the efficacy of higher doses or longer treatment durations is not well established 4, 6.
• Labetalol is not commonly used for anxiety, but it may be used in hypertensive emergencies or urgencies, and its efficacy in treating anxiety symptoms is not well studied 3.

Mechanism of Action

• The mechanism of action of beta-blockers in treating anxiety is thought to be primarily through peripheral blockade of beta-mediated symptoms, rather than a central effect on the brain 5.
• The use of beta-blockers may be preferred in certain situations due to their lack of risk of pharmacological dependence, compared to other anti-anxiety medications like benzodiazepines 5, 6.