Propranolol: Uses, Side Effects, Dosage

Updated 03/21/24 

Propranolol is a medication that’s in the beta-blocker class of drugs. It works by relaxing blood vessels to reduce heart rate and blood pressure. Propranolol is used to treat high blood pressure, chest pain, tremors, fast heartbeat, migraine, irregular heartbeat, anxiety disorders, and other health conditions.

If you’re considering taking Propranolol for anxiety or another condition, keep reading. We’re covering everything you need to know about Propranolol uses, side effects, dosage, and more.

What is Propranolol?

Propranolol is an FDA-approved beta-blocker used to treat hypertension, angina, arrhythmias, and more. It also can be used off-label to treat anxiety and social phobia. Like any medication, Propranolol has possible side effects that range from mild fatigue to depression. It’s important to always seek medical advice from your health care provider before starting a new medication.

How does Propranolol work?

This prescription drug interferes with specific receptors that cause elevated heart rate and blood pressure. As Propranolol works, the medicine reduces some of the physical symptoms related to anxiety and panic attacks.

How does Propranolol make you feel?

When taken orally or intravenously (IV), Propranolol can quickly reduce anxiety symptoms like racing heart and trembling hands. It’s been found to improve performance when taken before an event or activity that causes nervousness or fear. Propranolol can help people who suffer from performance anxiety, such as stage fright or public speaking, by allowing them to feel more relaxed.

Propranolol Uses

What is Propranolol used for? Propranolol is FDA-approved to treat multiple conditions. For example, it’s used for tremors, angina (chest pain), hypertension (high blood pressure), irregular heartbeat disorders, and other heart or circulatory conditions. Propranolol can ward off a heart attack and decrease the strength and recurrence of migraine headaches. As noted, there are also off-label uses for anxiety.

Tremors

Tremors are involuntary muscle contractions that can cause shaking. Propranolol can block certain nerve receptors that control muscle contractions, thus reducing their intensity or stopping them altogether.

Angina

Angina is just another name for chest pain. It can be caused by reduced oxygen supply to the heart from narrowed coronary arteries or increased demand for oxygen from physical activity or stress. By blocking certain receptors on nerves that control blood vessels around the heart, Propranolol helps relax vessels so more oxygen-rich blood can reach them and relieve symptoms like chest tightness or heaviness.

Hypertension

Hypertension is caused by a rise in resistance to blood flow through the major arteries leading away from the heart, resulting in elevated systolic pressure readings. By loosening up muscles around large arteries close to the heart, Propranolol can lower this resistance so that more oxygen-rich blood can reach it and reduce hypertension.

Cardiovascular function

Propranolol’s action on nerve endings controlling cardiovascular function might improve overall cardiac performance, restoring normal sinus rhythm and preventing further arrhythmia-related episodes.

Migraine

A severe migraine headache can cause intense pain that’s often accompanied by light sensitivity, nausea, and vomiting. Studies have found evidence showing that daily use of low-dose Propranolol can reduce the frequency and severity of migraine attacks. It’s not fully understood why or how this works, but the medicine’s ability to modulate vascular response and inflammation around the brain stem area, where most migraines originate, seems to play a part.

Off-label uses for mental health

Off-label Propranolol uses can treat some types of anxiety disorder and panic disorder. It’s important to note that Propranolol doesn’t actually address the underlying causes of anxiety. What it does do is relieve some of the symptoms by blocking the action of hormones that cause increased heart rate and lead to feelings of stress.

“While effective towards symptomatology for heart disease, it’s also shown efficacy in addressing anxiety symptoms including rapid heartbeat, shaking, and other physical symptoms.”

– Talkspace therapist Elizabeth Keohan, LCSW-C, LICSW, LICSW

Pros & Cons of Propranolol

Pros of PropranololCons of PropranololTreats several conditions, including hypertension, anxiety disorders, & migrainesFatigue & dizzinessReduces symptoms & prevents future episodes of certain conditionsCold hands or feetLow risk of adverse reactions compared to other drugsCan cause heart failure in some people

Side Effects of Propranolol

Some of the possible side effects of Propranolol include:

• Lightheadedness or dizziness
• Drowsiness
• Nausea or stomach pain
• Decreased sex drive
• Diarrhea or constipation
• Hair thinning or loss

Less common side effects that could be severe, include:

• Hallucinations
• Memory loss
• Muscle weakness or cramping
• Blood sugar changes
• Shakiness
• Fluid retention
• Insomnia and nightmares
• Allergic reaction
• Cold hands or feet
• Trouble breathing

If you do take Propranolol and want to stop because of side effects, seek medical advice from your health care provider first before stopping. Propranolol withdrawal symptoms can also bring discomfort and sometimes be severe if you take the medication for a long time and suddenly stop.

Propranolol Dosage

Propranolol comes in multiple forms, including tablets, capsules, solution, and injections. The dosage of Propranolol varies based on individual factors and the condition being treated. It’s available in pill form with 10mg – 160mg strengths. Liquid Propranolol is available in 5mg, 40mg, or 50mg doses.

Like any medication, you should talk to your doctor about the best dose for your symptoms and condition. Off-label usage for anxiety disorders or social phobia should be used cautiously and only under the close supervision of an experienced mental health care specialist.

Propranolol for anxiety: 40mg is typically taken one time per day. Dosage can be increased to 40mg and taken 3 times daily with your doctor’s instructions .

How to take Propranolol

Take Propranolol exactly as directed by your doctor. You should take this drug at or around the same time every day. It can be taken with or without food. Do not crush, chew, or break Propranolol capsules — use water to swallow them whole.

Liquid Propranolol should be taken using careful measurements with the dosing instrument the pharmacy provided you. Do NOT use a kitchen spoon to dose Propranolol.

Additional Considerations

When taking Propranolol, it’s important to consult your healthcare provider about any drug interactions and warnings.

Interactions

Propranolol can interact with other medications, supplements, or vitamins you may be taking. Inform your physician of any prescription or over-the-counter drugs you’re already taking before you start Propranolol.

Do not drink alcohol if you’re on Propranolol — it can increase the medication levels in your blood.

Warnings

Tell your doctor if you have a history of any of the following, as it may play a role in how (or if) they prescribe Propranolol:

• Fainting or slow heart rate
• Asthma
• Heart failure
• A severe heart condition
• Adrenal gland tumor
• Raynaud’s syndrome or circulation problems
• Thyroid disorder or condition
• Peripheral vascular disease

Propranolol Alternatives

Although Propranolol is effective in treating certain conditions, that doesn’t necessarily mean it’s right for you. Different medications can be better suited for some people.

• Atenolol: Atenolol is a beta-blocker that’s similar to Propranolol but with a longer half-life. It works by blocking the body’s adrenaline receptors, which helps reduce blood pressure and prevent heart palpitations. It’s often prescribed for those who have difficulty taking Propranolol due to its shorter duration of action. Studies show that Atenolol was effective for 81% of people who took it for anxiety. Side effects can include fatigue, dizziness, and depression.
• Metoprolol: Metoprolol is another beta-blocker. It works similarly to Atenolol but has a longer half-life, making it ideal for some people to treat social phobia anxiety. Common side effects include exhaustion, sleeplessness, and dry mouth/eyes.

“Though Propranolol effectively addresses anxiety, it is still important to stay connected with your providers, prescribers, and clinicians, understanding that it can help with symptoms, but not necessarily address the emotional or stress difficulty often accompanied. Medications can be beneficial in managing symptoms, but they still warrant the important work of processing and navigating the role of stressors in our lives and how they trigger or manifest in our behaviors. Talk therapy and medication management support can be the best comprehensive care practice.”

– Talkspace therapist Elizabeth Keohan, LCSW-C, LICSW, LICSW

Online Propranolol Prescription Through Talkspace Psychiatry

Talkspace provides convenient access to mental healthcare services without having to leave home, giving you more control over your care while still receiving professional guidance from licensed professionals whenever needed. By offering personalized prescriptions for Propranolol online, Talkspace users get reliable information about how best to use this drug safely — ensuring maximum benefit with the least amount of risk.

For anyone looking for an easier way to get Propranolol without leaving home, Talkspace Psychiatry offers online prescriptions with no hassle involved. Reach out today to get started.

Frequently Asked Questions (FAQs) about Propranolol

Is propranolol a form of Xanax?

No, propranolol is not a form of Xanax. Propranolol is a beta-blocker that primarily affects the heart and circulation system, whereas Xanax (alprazolam) is a benzodiazepine that affects chemicals in the brain to reduce anxiety and panic disorders. While both medications can be used to treat anxiety symptoms, they work through different mechanisms in the body.

Will propranolol calm me down?

Yes, propranolol can help calm you down by reducing some of the physical symptoms associated with anxiety, such as a racing heart and trembling. It does this by blocking the action of certain stress hormones on the heart and blood vessels. However, it’s important to note that propranolol is primarily used to manage physical symptoms rather than the psychological aspects of anxiety.

How quickly does propranolol work for anxiety?

Propranolol typically begins to work for anxiety within 30 minutes to 1 hour after taking it. The speed of its effect can depend on several factors, including the dosage and the individual’s metabolism. It is often used on an as-needed basis for situations known to induce anxiety, such as public speaking.

What to avoid when taking propranolol?

When taking propranolol, it’s advised to avoid alcohol as it can intensify its effects, leaving you with strong side effects. You should also avoid other central nervous system depressants and consult with your healthcare provider about any potential drug interactions with over-the-counter medications, prescription drugs, or supplements you are taking.

Why do I feel weird after taking propranolol?

Feeling weird after taking propranolol can be a side effect of the medication. This might include dizziness, lightheadedness, or fatigue as your body adjusts to the drug. If these feelings persist or worsen, it’s important to consult your healthcare provider. In rare cases, propranolol can cause more severe side effects that require medical attention.

Will propranolol stop panic attacks?

Propranolol can help prevent the physical symptoms of panic attacks, such as rapid heartbeat and trembling, but it may not stop a panic attack entirely. It’s more effective in managing the physical symptoms associated with anxiety and panic disorders rather than the psychological symptoms. For comprehensive management of panic attacks, a combination of medication and psychotherapy might be recommended by your healthcare provider.