Propranolol for Anxiety: Dosing and Efficacy
60mg of propranolol twice daily is an appropriate dose for anxiety, falling within the recommended therapeutic range of 80-240mg daily for this indication. 1
Dosing Recommendations for Anxiety
- Starting dose: 20-40mg, 1-3 times daily 2
- Effective maintenance dose: 80-320mg daily (divided doses) 3
- Maximum dose: Up to 240mg daily for most indications 1
Mechanism of Action for Anxiety
Propranolol works primarily by:
- Blocking peripheral beta-adrenergic receptors
- Reducing somatic symptoms of anxiety (tremor, palpitations, tachycardia)
- Providing relief within 1-2 hours of administration 4
Efficacy for Different Types of Anxiety
Propranolol is most effective for:
- Anxiety with prominent somatic symptoms related to increased adrenergic tone
- Moderate intensity anxiety commonly seen in general practice
- Recent-onset anxiety that doesn't meet criteria for chronic anxiety disorders
- Performance anxiety and specific social phobias 2
It is less effective for:
- Generalized anxiety disorder as a primary treatment
- Panic disorder as monotherapy 5
Administration Guidelines
- Take with or after food to reduce gastrointestinal side effects 6
- For sustained effect, divide the daily dose (e.g., 60mg twice daily)
- Dosage may need to be adjusted based on individual response and side effects
Potential Side Effects
- Hypotension
- Bradycardia
- Sleep disturbances
- Fatigue
- Possible worsening of depression in predisposed patients 5
Cautions and Contraindications
- Contraindicated in second/third-degree heart block
- Use with caution in patients with:
- Reactive airway disease (asthma, COPD)
- Heart failure
- Diabetes (may mask hypoglycemia symptoms)
- Avoid combining with non-dihydropyridine calcium channel blockers (diltiazem, verapamil) due to increased risk of bradycardia 1
Comparison to Other Treatments
- Unlike benzodiazepines, propranolol does not cause sedation, cognitive impairment, or dependence
- Some patients may prefer beta-blockers like propranolol over benzodiazepines for anxiety with prominent physical symptoms 2
- In a study comparing atenolol to propranolol, 100% of patients who had previously taken propranolol reported preferring atenolol for anxiety 7
The 60mg twice daily dose you're considering falls within the recommended therapeutic range and represents a moderate dose that balances efficacy with side effect risk for anxiety management.