What is the dose of propranolol (beta blocker) for anxiety?

Propranolol Dosing for Anxiety

For anxiety treatment, propranolol is typically dosed at 10-40 mg taken 1-3 times daily, with total daily doses ranging from 20-120 mg depending on symptom severity and individual response. 1, 2

Dosing Guidelines for Different Anxiety Presentations

Performance/Situational Anxiety

• 10-40 mg taken 30-60 minutes before anxiety-provoking events 1
• Single doses are effective for specific social phobias or performance anxiety (e.g., public speaking) 2

Panic Disorder

• 20-40 mg administered 1-3 times daily 1
• Often used as adjunctive therapy with SSRIs and/or benzodiazepines 1
• Most effective for managing somatic symptoms (palpitations, tremor) 3

Generalized Anxiety

• Starting dose of 20-40 mg 1-3 times daily 2, 4
• Dose can be titrated based on clinical response 4
• Treatment duration beyond 4 weeks requires reassessment of efficacy 2

Dosing Considerations

Patient-Specific Factors

• Higher doses (up to 320 mg daily) may be required for severe symptoms, though this exceeds typical recommendations 4
• Lower starting doses should be considered in patients with:
  • Bradycardia or hypotension 1
  • Hepatic or renal dysfunction 1
  • Elderly patients 1

Monitoring Parameters

• Heart rate and blood pressure should be assessed before initiating therapy 1
• Target sufficient beta-blockade to abolish orthostatic and hyperventilatory tachycardia 4
• Dose adjustments should aim for symptom control while avoiding bradycardia 1

Clinical Pearls

• Propranolol is most effective for anxiety with prominent somatic manifestations (tremor, tachycardia, palpitations) 5
• Patients with predominantly psychological anxiety symptoms may respond better to other medications 5
• Requirements often diminish over time, allowing for dose reduction 4
• Maintenance doses are typically lower than initial therapeutic doses 4

Precautions and Contraindications

• Avoid in patients with:

  • Asthma or reactive airway disease 1
  • Greater than first-degree heart block 1
  • Decompensated heart failure 1
  • Cardiogenic shock 1
  • History of depression (may worsen depressive symptoms) 2, 3

• Use with caution in patients with:

  • Diabetes (may mask hypoglycemic symptoms) 1
  • Concurrent use of other medications with AV nodal blocking properties 1

Treatment Duration

• Short-term use (days to weeks) is appropriate for situational anxiety 2
• Efficacy for treatment periods longer than 4 weeks requires ongoing assessment 2
• Some patients may require intermittent dosing while others benefit from continuous therapy 4