Is propranolol (a beta blocker) effective as a treatment for Attention Deficit Hyperactivity Disorder (ADHD)?

Propranolol is Not Recommended for ADHD Treatment

Propranolol (a beta blocker) is not recommended as a treatment for Attention Deficit Hyperactivity Disorder (ADHD) as it is not supported by current clinical guidelines and lacks evidence of efficacy for ADHD core symptoms. 1

Evidence-Based ADHD Treatments

First-Line Pharmacological Treatments

The American Academy of Pediatrics and other clinical guidelines clearly establish that the following medications have proven efficacy for ADHD:

1. Stimulant Medications (strongest evidence):

   • Methylphenidate and amphetamine preparations
   • Effect size of approximately 1.0 (very strong)
   • FDA-approved for ADHD
   • First-line treatment for most patients 1, 2

2. Non-Stimulant Medications (sufficient but less strong evidence):

   • Atomoxetine (selective norepinephrine reuptake inhibitor)
   • Extended-release guanfacine (α-2 adrenergic agonist)
   • Extended-release clonidine (α-2 adrenergic agonist)
   • Effect size of approximately 0.7 1, 2

Non-Pharmacological Approaches

Several non-pharmacological interventions have established evidence:

• Behavioral therapy (particularly parent training in behavior management)
• School-based interventions
• Cognitive-behavioral therapy (particularly for adults) 1, 2, 3

Propranolol and ADHD

Propranolol is a non-selective beta-blocker that has established efficacy for conditions like infantile hemangiomas 1, but there is no substantial evidence supporting its use for ADHD:

• Not mentioned in any ADHD treatment guidelines as a recommended treatment 1, 2
• Not FDA-approved for ADHD
• Not included in the list of established medications with proven efficacy for ADHD core symptoms
• Only mentioned in passing in some research literature about alternative agents, without supporting evidence 4

Treatments Specifically Not Recommended for ADHD

The American Academy of Pediatrics specifically states that several treatments have "either too little evidence to recommend them or have been found to have little or no benefit" for ADHD, including:

• Mindfulness (as standalone treatment)
• Cognitive training
• Diet modification
• EEG biofeedback
• Supportive counseling
• Cannabidiol oil
• External trigeminal nerve stimulation (limited evidence) 1

Beta-blockers like propranolol are not even mentioned in this list, suggesting they are not considered standard or alternative treatments for ADHD.

Clinical Decision-Making Algorithm

1. Assess for ADHD using validated diagnostic criteria
2. First-line treatment options:
   • For children and adults: FDA-approved stimulant medications (methylphenidate or amphetamine preparations)
   • If stimulants are contraindicated: Consider FDA-approved non-stimulants (atomoxetine, extended-release guanfacine, or extended-release clonidine)
3. If first-line treatments are ineffective or poorly tolerated:
   • Try an alternative stimulant class (switch between methylphenidate and amphetamine)
   • Try an FDA-approved non-stimulant medication
4. Adjunctive treatments:
   • Evidence-based behavioral interventions
   • School/workplace accommodations

Important Considerations

• Medication adherence is a significant challenge in ADHD treatment, with many discontinuing due to perceived burden or adverse effects 5
• The combination of pharmacological and non-pharmacological treatments often yields the best outcomes 2, 6
• Beta-blockers like propranolol may have a role in treating specific comorbidities (such as performance anxiety) that can co-occur with ADHD, but they are not treatments for the core ADHD symptoms themselves

Conclusion

When treating ADHD, clinicians should rely on evidence-based approaches with established efficacy. Propranolol is not supported by current guidelines or evidence for treating ADHD and should not be considered as a treatment option for this condition.