From the Research
The ICD-10 code for propranolol use in anxiety is F41.9 (Anxiety disorder, unspecified) combined with Z79.899 (Other long term (current) drug therapy). Propranolol is a beta-blocker commonly prescribed off-label for situational or performance anxiety at doses ranging from 10-40mg taken 30-60 minutes before anxiety-provoking events. For ongoing anxiety management, dosing typically ranges from 10-20mg two to three times daily. When documenting this treatment, it's essential to note both the underlying anxiety condition and the medication being used. Propranolol works by blocking the physical symptoms of anxiety (such as rapid heartbeat, trembling, and sweating) by preventing adrenaline from binding to beta receptors. While not FDA-approved specifically for anxiety disorders, propranolol is particularly effective for performance anxiety where physical symptoms are prominent.
Key Considerations
- Patients should be monitored for potential side effects including fatigue, dizziness, and bradycardia, and the medication should be used cautiously in patients with asthma, diabetes, or certain heart conditions.
- The most recent and highest quality study, 1, found no evidence for a beneficial effect of beta-blockers compared with either placebo or benzodiazepines in patients with social phobia or panic disorder with/without agoraphobia.
- Despite the lack of robust evidence, propranolol may still be prescribed off-label for anxiety, particularly for performance anxiety, as noted in 2 and 3.
- It is crucial to weigh the potential benefits and risks of propranolol use in anxiety disorders, considering the limited evidence and potential side effects, as discussed in 4 and 3.