Propranolol: Uses, Side Effects, Dosage & More

Want to know a secret from the world of modern medicine? You may or may not know this, but several medications are recommended by healthcare providers for uses other than their Food and Drug Administration (FDA)-approved treatments — something referred to as off-label.

Antidepressants are used for conditions beyond just depression, including eating disorders and premenstrual dysphoric disorder. And beta blockers, a type of blood pressure medication, are sometimes used for anxiety. Ah, the joys of unexpected benefits of modern medications!

If you’ve been recommended beta blockers for anxiety, there’s a good chance the medication propranolol was brought up. But if you hadn’t heard of this commonly prescribed drug before today, “What is propranolol?” probably isn’t your only question.

No shame in asking questions — they help you feel more informed and better able to make decisions about your anxiety treatment.

Fortunately, this guide will answer questions like:

• How long does propranolol last?

• What are the most common side effects of propranolol?

• Do propranolol side effects go away?

Keep reading to learn more about propranolol side effects, dosages and more.

Developed more than 50 years ago, propranolol (or propranolol hydrochloride) is a beta blocker. Also known as beta-adrenergic blocking agents, beta blockers are used to treat a number of conditions, mainly for cardiovascular health (that’s the heart and blood vessels).

Generic propranolol is also sold under the brand names Inderal®, Inderal LA® and InnoPran XL®.

How do propranolol and other beta blockers work, though, especially for anxiety? Beta blockers block the effects of adrenaline — as well as other stress hormones like noradrenaline — on your heart.

Adrenaline and noradrenaline activate your body’s fight-or-flight reaction, the mechanism that protects you in a dangerous situation.

Being in a stressful situation typically increases levels of stress hormones, resulting in an increased heart rate, sweating, feeling lightheaded and other physical symptoms.

Beta blockers reduce the effects of adrenaline and cause a slow heart rate, making it easier to relax when stressed. Instead of a faster heart rate, your heart beats at a normal pace, limiting the physical effects of adrenaline on your body.

Beta blockers can also work to enhance the effects of another class of drugs known as ACE inhibitors, which work by reducing your body’s secretion of angiotensin, a hormone that can restrict blood vessels.

Propranolol has several uses, namely for managing heart disease and other cardiovascular health issues.

So, what is propranolol used for? The medication can help with:

• High blood pressure (hypertension)

• Irregular heartbeat or heart rhythms (arrhythmia)

• Pheochromocytoma (tumor on a small gland near the kidneys)

• Certain types of tremor

• Hypertrophic subaortic stenosis (a heart muscle disease)

• Prevention of angina (chest pain)

• Migraine headaches

• Improving survival after a heart attack

As mentioned, propranolol causes a slow heartbeat and helps you relax in stressful situations — which is why the medication is used off-label for performance anxiety.

A type of social phobia, performance anxiety is intense fear or anxiety that happens specifically when speaking or performing in public. Physical symptoms of anxiety can include a fast heart rate, increased sweating, shaking and dizziness, all of which propranolol can alleviate.

How Long Does It Take Propranolol to Work?

If you’re struggling with performance anxiety and looking for relief, you might be wondering, How long does propranolol take to work?

Don’t hate us, but the short answer is that it depends. How long it takes the medication to work depends not only on your propranolol but also on your dosage frequency and the condition being treated.

Many medications for your mental health vary in how quickly they begin to work, but with beta blockers, the effects are comparatively quick.

Beta blockers are quickly absorbed (unless they’re extended-release tablets), and propranolol typically reaches its peak concentration in one to four hours.

For heart conditions or high blood pressure, propranolol can take up to a week to reach its full effect. For migraines, it can take several weeks for propranolol to start making a real difference.

You may not feel any different at first, but that doesn’t mean it is not working. So it’s crucial to keep taking your medicine.

Like many other medications, propranolol dosages can vary by condition, symptoms and other factors. So a propranolol anxiety dose will be different from a dose of propranolol for someone with heart disease.

The most common form of this medication is propranolol tablets (formally labeled propranolol hydrochloride). But it can also be taken as a liquid solution or an extended-release (long-acting) capsule.

Propranolol hydrochloride tablets (Inderal®) are available in dosages of 10, 20, 40, 60 or 80 milligrams.

A typical propranolol dosage in adults is 60 to 240 milligrams daily, divided up into two doses and one as an extended-release formula.

One question at the top of your mind when starting a new medication might be, What are the most common side effects of propranolol? It’s a fair question to ask, as many medications do have side effects (an unfortunate reality).

Maybe you want to know if there are long-term side effects of propranolol. Does propranolol make you sleepy? Are there different side effects with different propranolol doses? Or perhaps you heard a rumor and are about to look up “propranolol side effects weight gain” to see if it’s true.

We’ll save you the Internet search. Just keep reading to learn about propranolol side effects.

Common Side Effects of Propranolol for Anxiety and Heart Problems

Some common side effects of propranolol for anxiety or heart problems can include:

• Slower than normal heart rate

• Insomnia or trouble sleeping

• Dizziness or lightheadedness

• Low blood pressure (hypotension)

• Diarrhea

• Constipation

• Hair loss

• Dry eyes

Does propranolol make you sleepy? Although one side effect is insomnia, propranolol can also cause fatigue or tiredness.

One more thing to note: While it’s not a specifically listed side effect, those who are breastfeeding should talk to their healthcare provider about taking propranolol, as the medication can transfer to breast milk.

Serious Side Effects

There are also more serious side effects of propranolol, some of which are more severe forms of the common side effects. This includes:

• Reduced or slow heart rate (bradycardia)

• Hypoglycemia (low blood sugar)

• Reduced blood flow to hands or feet, resulting in a cold feeling (known as Raynaud syndrome)

• Severe low blood pressure

• Severe nausea, diarrhea or vomiting

• Shortness of breath

• Hallucinations

• Heart failure

There are also several propranolol warnings to be aware of.

This medication can cause allergic reactions, resulting in hives, skin rash and trouble breathing. And although propranolol is used for many heart conditions, there’s a chance the medication could worsen certain conditions, such as an abnormally slow heart rate, heart block, asthma, severe chest pain or heart failure.

Are There Long-Term Side Effects of Propranolol?

While the hope is that you eventually no longer need to take propranolol for anxiety, you may continually struggle with anxiety symptoms or anxious thoughts.

But is it safe to take propranolol for a long period? And if you do continue to take this medication, what are the long-term side effects of propranolol?

Propranolol is generally considered safe for the long-term treatment of migraine headaches and heart problems. But as noted, there’s a risk of side effects (including more serious side effects) with any medication — propranolol included.

That said, there are ways to alleviate common side effects and avoid adverse reactions, which we’ll cover below.

Though side effects are common with many medications, there are ways to cope with the ones brought on by propranolol.

• Take as directed. Take the drug as it’s prescribed to you. If you forget your daily dose of propranolol, just take the missed dose as soon as you remember. Then take your next dose as regularly scheduled. Don’t double your dosage to try and make up for the missed dose.

• Don’t change your dosage. Changing your propranolol dosage could cause you to experience more side effects while increasing your risk of serious side effects. Your healthcare provider will increase the dosage if needed.

• Be aware of interactions. Medications can have adverse effects from certain drug interactions. Drug interactions with propranolol include other beta blockers, ACE inhibitors, certain antidepressants, calcium channel blockers and nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen. Let your healthcare provider know about any medications or supplements you’re taking — both over-the-counter and prescription drugs — before starting propranolol.

• Take it easy. As your body gets used to the medication, get lots of rest and stay hydrated, especially if you’re experiencing migraine headaches, dizziness or nausea. These side effects may go away within a matter of time.

• Talk to your healthcare provider. Keep your healthcare provider updated, and seek medical advice if your side effects are persistent or if you experience worsening side effects from propranolol.

Dealing with anxiety isn’t fun, especially if physical symptoms come at inopportune times, like before a big speech or presentation. One common treatment your healthcare provider might recommend is propranolol.

Here’s a recap of what we covered:

• A beta blocker medication that reduces heart rate, propranolol is often prescribed for heart conditions and to improve heart health after incidences like a heart attack or heart failure. Propranolol is also used to treat the physical symptoms of performance anxiety.

• Propranolol and other beta blockers are typically fast-acting, making them ideal for performance anxiety. However, for treating migraines and heart disease, they should be taken long-term.

• Some common side effects of propranolol include slow heart rate, tiredness, low blood pressure and trouble sleeping.

• There’s also the risk of more adverse effects such as allergic reaction, severely slow heartbeat, hypoglycemia (low blood sugar), reduced blood flow in the hands or feet (Raynaud syndrome), shortness of breath and heart failure.

• Fortunately, there are ways to cope with propranolol side effects. Getting plenty of rest when you first start taking the medication, being aware of certain drug interactions, taking your prescription as directed and seeking medical advice from your healthcare provider about side effects can help.

While propranolol is one way to treat anxiety, a healthcare provider might also walk you through other ways of treating and managing performance anxiety, including online therapy or lifestyle changes.

You can check out more of our mental health services or consult with a licensed healthcare provider through online psychiatry to find the best treatment for you.