Propranolol Dosing for Stage Fright in a 24-Year-Old Male
For stage fright in a 24-year-old male, the recommended dose of propranolol is 10-40 mg taken 30-60 minutes before the anxiety-provoking event. 1, 2
Dosing Guidelines
- Initial dosing typically ranges from 30-60 mg daily in divided doses, or as a single dose with long-acting formulations 2
- For performance anxiety (stage fright), a single dose of 10-40 mg taken 30-60 minutes before the performance is typically effective 1
- Propranolol levels above 20 ng/ml are required to induce significant beta blockade, which is typically achieved with doses of 40 mg or higher 3
- For occasional use (such as before performances), the immediate-release formulation is preferred over long-acting propranolol 4
Administration Considerations
- Administer propranolol with food to reduce the risk of hypoglycemia 2
- The American College of Cardiology recommends checking for contraindications before initiating propranolol, including:
- Heart block
- Asthma or obstructive airway disease
- Decompensated heart failure
- Hypotension 2
- Baseline cardiovascular assessment (heart rate and blood pressure) is recommended before starting propranolol 2
Monitoring and Safety
- Monitor for potential adverse effects, including:
- Hypotension
- Bradycardia
- Bronchospasm 2
- Common side effects include gastrointestinal problems, tiredness, and cold hands and feet 5
- Propranolol may mask symptoms of hypoglycemia in susceptible patients 2
- No routine monitoring is required for most patients using propranolol occasionally for stage fright 2
Important Considerations for Stage Fright
- Propranolol is one of the few medications successfully used for stage fright, though this is considered an off-label use in most countries 1
- The medication works primarily by blocking the peripheral manifestations of anxiety (tremor, tachycardia, sweating) rather than affecting the psychological experience of anxiety 1
- For infrequent use (such as occasional performances), there is no need for daily dosing or dose titration 1, 4
- Avoid abrupt discontinuation if used regularly, as this can cause rebound hypertension or tachycardia 2