Propranolol has been used off-label to treat issues with anxiety. (Learn More) Research reviews support such use. (Learn More) The medication is typically taken an hour before an anticipated stressful event. (Learn More)
There are both advantages and disadvantages to using propranolol to address issues with anxiety. (Learn More)
While medications can be useful in treating anxiety, they should not be used as long-term solutions. (Learn More)
Inderal (propranolol) belongs to a class of medications referred to as beta blockers. They are often prescribed to treat cardiovascular, or heart-related, conditions that can include high blood pressure, irregular heartbeat, or heart failure.
Propranolol is also prescribed in an off-label fashion to address issues with anxiety. When a drug is used “off-label,” it means it is being used for a purpose other than its approved use. This is a common practice for certain medications, especially when there is research evidence to support the use of the medication for off-label reasons.
How Propranolol Works
Propranolol is a beta-adrenergic blocking drug that prevents adrenaline from interacting with your heart. This prevents adrenaline from making the heart pump faster.
By doing so, it relaxes blood vessels and the heart, and it can reduce blood pressure.
How Propranolol Addresses Anxiety
Propranolol can also reduce some of the physical symptoms of anxiety, but it will not directly address the cause of the anxiety. It does this by reducing the rapid heart rate that often occurs when people become anxious.
It also addresses the following physical symptoms:
- Jitteriness or shakiness
By reducing the physical symptoms associated with anxiety, you may actually feel less anxious.
The justification for using propranolol to address anxiety is that once the body’s reactions have been dampened by the drug, you will feel less anxious. The medication works similarly to many treatments for anxiety, such as stress management, diaphragmatic breathing, and muscle relaxation. By producing a more relaxed state, you will automatically feel less anxious.
Research reviews have found that beta blockers like propranolol can manage short-term anxiety issues. They do not have the significant side effects associated with benzodiazepines (drugs designed to address anxiety).
Propranolol does not appear to be effective in treating long-term issues with anxiety or phobias.
Long-term treatment of anxiety is most often accomplished via behavioral intervention like cognitive behavioral therapy. Medications do not address the underlying issues associated with anxiety. Instead, therapy provides individuals with coping mechanisms to address future events (see below).
Using Propranolol for Anxiety
The effects of propranolol may not occur for a significant period of time after you take it (as long as an hour). Therefore, it will not immediately address severe anxiety, but it can be used to treat anticipatory anxiety (situations you know will cause you anxiety in the near future).
Propranolol is typically taken in pill form. Your physician will tell you how much of the drug you should use, how to use it, and when to take it.
The usual dosage of propranolol to address anxiety is 20 to 40 mg about an hour before a stressful situation. Most often, propranolol is used for people who have social anxiety because they can anticipate when they will be in an anxiety-provoking situation.
Pros & Cons of Using Propranolol for Anxiety
There are several advantages to using propranolol.
- The drug has relatively few side effects.
- It does not produce physical dependence, while benzodiazepines (commonly used anxiety medications) do produce physical dependence.
- Propranolol has very little abuse potential.
- It is safe for most people.
There are also potential disadvantages to its use.
- It may not reduce symptoms of severe anxiety.
- It should not be used by people who have low blood pressure or slow heart rate, other heart conditions, respiratory illnesses like asthma, or diabetes.
Medications Are Not Long-Term Treatments for Anxiety Disorders
Even medications that are designed to treat clinically significant anxiety, like benzodiazepines, should not be considered long-term solutions to treat anxiety disorders. They do not directly address the causes of anxiety, and they do not provide people with mechanisms to address their anxiety over the long term.
When used to address the physical symptoms of anxiety, propranolol should be combined with some form of psychotherapy. It is not a sufficient treatment on its own.
If you think you have an anxiety disorder, you should be assessed by a health care professional. If you are diagnosed with an anxiety disorder, discuss your treatment options with a healthcare professional at that time.
Depending on your situation, you may be prescribed propranolol or some other beta blocker in addition to other medications and psychotherapy. Specific dosages of propranolol will vary according to individual factors.
Everything You Need to Know About Propranolol. (March 2018). Medical News Today.
Can Beta-Blockers Help Your Anxiety? (June 2018). Healthline.
Propranolol for the Treatment of Anxiety Disorders: Systematic Review and Meta-Analysis. (February 2016). Journal of Psychopharmacology.