What is the dose and frequency of propranolol (beta blocker) in anxiety disorders?

From the Guidelines

Propranolol for anxiety disorders should be prescribed at a dose of 80-160 mg per day, divided into 2 doses for the immediate release formulation, as this is the most effective regimen based on the available evidence 1. The dose and frequency of propanolol in anxiety disorder can vary, but the most relevant information from the provided guideline evidence suggests that propranolol IR should be taken at a dose of 80-160 mg per day, divided into 2 doses.

• The usual dose range for propranolol IR is 80-160 mg per day, with a daily frequency of 2 doses 1.
• It is essential to note that propranolol should not be stopped abruptly, as this can cause rebound hypertension or tachycardia.
• Patients with certain medical conditions, such as asthma or heart conditions, should use propranolol cautiously, and it may interact with several medications, including certain antidepressants and antipsychotics.
• The long-acting formulation of propranolol (Propranolol LA) can be taken at a dose of 80-160 mg per day, with a daily frequency of 1 dose 1. The provided evidence does not specifically address the use of propranolol for anxiety disorders, but it does provide information on the dosing and frequency of propranolol for other indications, which can be applied to the treatment of anxiety disorders.
• The medication should be taken with food to reduce gastrointestinal side effects.
• Propranolol works by blocking beta-adrenergic receptors, reducing physical symptoms of anxiety like rapid heartbeat, trembling, and sweating, though it doesn't directly affect psychological anxiety.

From the Research

Dose and Frequency of Propanolol in Anxiety Disorder

There are no research papers to assist in answering this question, as none of the provided studies mention the dose and frequency of propanolol in anxiety disorder.

Alternative Treatments for Anxiety Disorder

• Benzodiazepines, such as diazepam, are still preferred by some for the treatment of acute anxiety, with the advantage of a rapid onset of action, but they are less suitable for long-term treatment due to their potential for memory disturbances, sleepiness, lethargy, physical dependence and withdrawal 2.
• Selective serotonin reuptake inhibitors (SSRIs), such as sertraline and paroxetine, have largely replaced the earlier antidepressants and are effective in relieving anxiety symptoms 2, 3.
• Serotonin-noradrenaline reuptake inhibitors (SNRIs), such as venlafaxine, milnacipran and duloxetine, are efficacious in relieving anxiety symptoms within depression, and some have proven efficacy in certain anxiety disorders 2, 4.
• A meta-analytic review found that benzodiazepines (BZs) are the most effective drug for generalized anxiety disorder, followed by SNRIs and SSRIs 5.

Comparison of Treatments for Anxiety Disorder

• A study comparing paroxetine and sertraline found that both SSRIs resulted in significant decreases in mean Hamilton Rating Scale for Anxiety (HAM-A) scores, with no differences between medication groups on response or remission rates, and tolerability was comparable 3.
• A meta-analysis found that SSRIs cause more adverse events than BZs in short-term panic disorder treatment, with SSRIs associated with diaphoresis, fatigue, nausea, diarrhea, and insomnia, and BZs associated with memory problems, constipation, and dry mouth 6.