Propranolol Dosing for Anxiety
For anxiety, propranolol is typically administered at doses of 20-40 mg, taken 1-3 times daily as needed, with a maximum daily dose of 120-160 mg for most patients.
Dosing Recommendations
Initial Dosing
- Start with 20-40 mg taken 30-60 minutes before anxiety-provoking situations
- For ongoing anxiety management: 20-40 mg 2-3 times daily
Dosage Adjustment
- If initial response is inadequate, dose can be increased gradually
- Maximum daily dose should generally not exceed 160 mg
- Lower doses (10-20 mg) may be sufficient for situational anxiety (e.g., performance anxiety)
Specific Anxiety Scenarios
Performance/Situational Anxiety
- 10-40 mg taken 30-60 minutes before the anxiety-provoking event 1, 2
- Single doses are often sufficient for isolated events
Generalized Anxiety
- 40-80 mg daily in divided doses (typically 20-40 mg 2-3 times daily)
- May require 1-2 weeks of consistent use to achieve optimal effect 2
Somatic Anxiety Symptoms
- Most responsive to propranolol therapy (tremor, palpitations, sweating)
- 20-40 mg doses are particularly effective when somatic symptoms predominate 3
- Patients with predominantly somatic anxiety symptoms show better response than those with primarily psychological anxiety symptoms 3
Administration Considerations
- Take with food to reduce risk of hypoglycemia
- For intermittent use, take 30-60 minutes before anticipated anxiety-provoking situations
- For chronic anxiety, maintain regular dosing schedule
Monitoring and Precautions
Before Starting Treatment
- Cardiovascular and respiratory examination required
- Check baseline heart rate and blood pressure
- Screen for contraindications: asthma, heart block, hypoglycemia risk
Contraindications
- Asthma or obstructive airway disease
- Heart block (second or third degree)
- Hypersensitivity to propranolol
- Uncontrolled heart failure
Common Side Effects
- Fatigue
- Dizziness
- Sleep disturbances
- Bradycardia
- Hypotension
Clinical Pearls
- Propranolol primarily addresses the physical symptoms of anxiety (tremor, palpitations, sweating)
- Lower doses (20 mg) often provide significant anxiety reduction with minimal side effects 4
- Effects typically begin within 1-2 hours of administration 2
- Unlike benzodiazepines, propranolol does not cause sedation, cognitive impairment, or dependency 1
- Most effective for mild to moderate anxiety with prominent somatic symptoms 1, 3
Duration of Treatment
- For situational anxiety: as needed
- For chronic anxiety: efficacy beyond 4 weeks has not been well established 1
- Requirements often diminish over time with continued treatment 5
Remember that propranolol primarily addresses the physical manifestations of anxiety rather than the psychological components, making it particularly useful for performance anxiety and anxiety with prominent somatic symptoms.