From the Guidelines
Propranolol is a recommended treatment for anxiety, particularly for symptom relief in panic disorder, as evidenced by its common prescription for this condition. According to a 2022 study published in Hypertension 1, beta-blockers like propranolol are prescribed for symptom relief in panic disorder, often in combination with cognitive behavior therapy and/or selective serotonin reuptake inhibitors and/or a benzodiazepine. The medication works by blocking beta-adrenergic receptors, preventing adrenaline from increasing heart rate and blood pressure during anxiety responses.
Key points to consider when prescribing propranolol for anxiety include:
- Typical dosage ranges from 10-40mg taken 30-60 minutes before anxiety-provoking situations for situational anxiety, or 40-80mg daily for ongoing anxiety management
- Side effects may include fatigue, dizziness, and cold extremities
- Propranolol should be avoided by people with asthma, certain heart conditions, or diabetes
- It's essential to start with a lower dose and adjust as needed under medical supervision
The benefits of propranolol for anxiety management, as supported by the 2022 study 1, make it a valuable treatment option, especially when combined with therapy or other anxiety management strategies. Unlike benzodiazepines, propranolol is not addictive and doesn't cause sedation, making it suitable for daytime use when mental alertness is required.
From the Research
Propranolol and Anxiety
- The use of propranolol, a beta-blocker, in the treatment of anxiety disorders has been studied in several research papers 2, 3.
- A systematic review and meta-analysis published in 2025 found that there is no evidence for a beneficial effect of beta-blockers, including propranolol, compared with either placebo or benzodiazepines in patients with social phobia or panic disorder with/without agoraphobia 2.
- Another study published in 2016 found that the quality of evidence for the efficacy of propranolol in the treatment of anxiety disorders is insufficient to support its routine use 3.
- The 2016 study also found no statistically significant differences between the efficacy of propranolol and benzodiazepines regarding the short-term treatment of panic disorder with or without agoraphobia 3.
- Both studies highlight the need for more research to understand the effectiveness of propranolol in the treatment of anxiety disorders 2, 3.
Limitations of Current Research
- Many of the included studies had small sample sizes, missing data, and high or unclear risk of bias 2.
- The lack of robust evidence of effectiveness has led to a call for a large randomized controlled trial to provide definitive evidence of whether beta-blockers, including propranolol, are an effective and safe treatment for anxiety 2.