Propranolol Dosage for Mild Anxiety
For mild anxiety, propranolol is typically dosed at 10-40 mg, taken 1-3 times daily as needed, with a total daily dose not exceeding 120 mg. 1, 2
Dosing Recommendations
- Initial dose should be 10-20 mg taken approximately 1-2 hours before anticipated anxiety-provoking situations 1, 3
- For ongoing mild anxiety symptoms, a regimen of 20-40 mg once to three times daily is effective 1, 2
- The clinical efficacy of propranolol for anxiety beyond 4 weeks of continuous use has not been well established 1
- Lower doses (20 mg) are effective for pre-operative anxiolysis with fewer side effects compared to higher doses (40 mg) 3
Indications for Propranolol in Anxiety
- Most effective for anxiety characterized by somatic symptoms related to increased adrenergic tone (tremor, palpitations, sweating) 1, 2
- Particularly useful for performance anxiety and specific social situations (public speaking, musical performances) 1, 2
- Better suited for moderate intensity anxiety and/or anxiety seen in general practice settings 1
- More effective for recent-onset anxiety rather than chronic anxiety disorders 1
Administration Guidelines
- Take propranolol with food or after eating to reduce the risk of side effects 4
- For situational anxiety (like performance anxiety), take 20-40 mg approximately 1-2 hours before the anxiety-provoking event 1, 2
- If used for ongoing anxiety, divide the daily dose into 2-3 administrations for more consistent effect 1, 2
Monitoring and Precautions
- Monitor heart rate and blood pressure during initial treatment period 4
- Avoid in patients with asthma, obstructive airway disease, decompensated heart failure, and certain cardiac conditions 4
- Use with caution in patients with a history of depression as beta-blockers may potentially exacerbate depressive symptoms 1
- Discontinue gradually over several weeks if used for extended periods 5
Potential Side Effects
- Common: bradycardia, hypotension, fatigue, sleep disturbances 4, 3
- Less common: bronchospasm, cold extremities, gastrointestinal disturbances 4
- High doses (>160 mg/day) may increase risk of side effects without providing additional anxiolytic benefit 1, 2
Comparison to Other Treatments
- Propranolol may be considered as a first-line alternative to benzodiazepines for anxiety, particularly when somatic symptoms predominate 6
- Unlike benzodiazepines, propranolol has minimal risk of dependence or psychomotor impairment 1
- Propranolol and oxprenolol have the most established efficacy among beta-blockers for anxiety treatment 6