Propranolol for Night Terrors
Propranolol is the beta-blocker used to treat night terrors and PTSD-related nightmares, with typical dosing starting at 1 mg at bedtime and titrating by 1-2 mg every few days until clinical response is achieved. 1
Primary Beta-Blocker for Night Terrors
While prazosin (an alpha-1 blocker, not a beta-blocker) is actually the first-line pharmacologic agent for nightmare disorder 2, propranolol is the specific beta-adrenergic blocking agent that has been studied for trauma-related nightmares and night terrors.
Propranolol Evidence and Mechanism
Propranolol is a nonselective beta-blocker that has been studied for reducing consolidation of emotional memory when administered after psychic trauma 2
Recent evidence shows propranolol combined with re-exposure psychotherapy reduced nightmare severity from "severe" to "mild" in PTSD patients, with 85% reporting nightmares at baseline decreasing to only 50% after treatment 3
The mechanism involves correcting excessive epinephrine release, which is hypothesized to be central in the development and maintenance of PTSD-related nightmares 2
Propranolol is commonly prescribed for panic disorder and performance anxiety, conditions that share features with night terror presentations 2
Dosing Considerations for Propranolol
For anxiety and night terror symptoms, typical doses range from 20 to 40 mg, administered once to three times daily 4
For memory reconsolidation therapy targeting nightmares, propranolol is administered orally 60 to 75 minutes prior to psychotherapeutic sessions 3
The therapy was generally well tolerated and did not increase nightmare severity in any patient studied 3
Important Clinical Caveat
You should be aware that prazosin (an alpha-blocker, not a beta-blocker) is actually the recommended first-line pharmacologic treatment for nightmare disorder 2, 1. The distinction matters because:
Prazosin has Level A evidence for PTSD-associated nightmares, while propranolol has more limited evidence 2
If the question specifically requires a beta-blocker, propranolol is the answer, but prazosin would be the superior clinical choice for nightmare disorder 2, 1
Side Effects to Monitor
Central nervous system effects including nightmares can paradoxically occur with beta-blockers, particularly with improper dosing or timing 5, 6
Monitor for depression in predisposed patients, as propranolol may induce depressive states 4
Cognitive impairment remains controversial but should be monitored 4
Cardiovascular effects including bradycardia and hypotension require monitoring, especially in elderly patients 2