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

Propranolol Dosing for Anxiety

For anxiety management, propranolol is typically prescribed at doses of 10-40 mg, taken 1-3 times daily as needed. 1

Dosing Guidelines

• The effective dose range for anxiety is typically 20-40 mg per dose, administered 1-3 times daily depending on symptom severity and duration 1, 2
• For situational or performance anxiety (such as public speaking), a single dose of 20-40 mg taken 30-60 minutes before the anxiety-provoking event is usually effective 3
• For ongoing anxiety symptoms, divided doses throughout the day (typically 10-40 mg per dose) provide more consistent symptom control 2
• Lower doses (20 mg) may be sufficient for mild anxiety symptoms while minimizing side effects such as bradycardia and hypotension 4

Administration Considerations

• Propranolol can be taken with or without food, but consistent administration relative to meals helps maintain predictable blood levels 5
• For performance anxiety, a single 20 mg dose has been shown to effectively reduce observable anxiety symptoms and physiological responses (increased heart rate) 3, 4
• Higher doses (40 mg) may provide slightly more anxiolytic effect but come with increased risk of side effects including bradycardia (25%) and hypotension (10%) 4

Monitoring and Adjustments

• Heart rate and blood pressure should be monitored, especially when initiating therapy or adjusting doses 5
• Dose adjustments should be made gradually to avoid abrupt changes in cardiovascular parameters 6
• The dose may need to be reduced in patients with:
  • Cardiovascular comorbidities 5
  • Asthma or obstructive airway disease 5
  • Concomitant use of other medications that affect heart rate or blood pressure 5

Precautions and Contraindications

• Propranolol should be avoided in patients with:
  • Uncontrolled heart failure 5
  • Severe bradycardia or heart block 5
  • Asthma or severe COPD 5
  • Hypotension 5
• Use caution when prescribing to patients with diabetes, as propranolol may mask symptoms of hypoglycemia 5

Duration of Treatment

• For situational anxiety, propranolol can be used as needed before anxiety-provoking events 3
• For chronic anxiety, treatment duration should be reassessed periodically, as efficacy beyond 4 weeks has not been well established in clinical trials 1
• Some patients may experience lasting remissions after successful treatment, allowing for dose reduction over time 2

Practical Considerations

• Propranolol primarily addresses the physical symptoms of anxiety (tremor, tachycardia, sweating) by blocking peripheral beta-adrenergic receptors 1, 3
• It may be particularly effective for patients whose anxiety is predominantly characterized by somatic symptoms 1
• Unlike benzodiazepines, propranolol does not cause sedation, cognitive impairment, or dependence when used appropriately 1