Propranolol: Your Questions Answered

    It’s a drug you’re not quite sure how to pronounce and you’re quite certain comes with a long list of risks and side effects. Aside from that, you may know very little about propranolol. 

    If you’ve heard there’s a chance it could help you with the fear that grips you before a performance or public speaking event, you’re on the right track. Propranolol is generally used to treat high blood pressure, but is a popular medication for the off-label treatment of performance anxiety. 

    Like all prescription drugs, you should learn as much as possible about propranolol before taking it. You’re putting it in your body, for goodness’ sake — you owe it to yourself to know as much about it as possible.

    Luckily, we’ve anticipated your most burning questions about the drug and how it works. 

    What is Propranolol? 

    Propranolol belongs to a class of drugs called beta-blockers. It, like other drugs in this class, is primarily approved for use in the treatment of high blood pressure, a condition that affects 77.9 million U.S. adults. According to the Mayo Clinic, it is also approved for use in treating tremors, irregular heartbeats and tumors of the adrenal glands. 

    Propranolol is also used off-label, or in ways not explicitly approved by the FDA. It is prescribed off-label for the treatment of performance anxiety, also known as “stage fright.”

    How Does Propranolol Work? 

    Beta-blockers such as propranolol work by blocking the effects of adrenaline, also known as epinephrine. Epinephrine is the hormone that rushes into your system when you are scared or excited. Think roller coaster or bungee jumping — does your heartbeat quicken? That’s just a taste of adrenaline. Actually doing those activities causes a dump of the hormone, leading to rapid heart rate, sweating, faster breathing, increased performance, nervousness and decreased ability to feel pain. When confronted with a bear in the woods, it may help you get away faster. When confronted with a presentation at work, however, it could be extremely disruptive. 

    What Is Performance Anxiety?

    Performance anxiety is a subset of social phobia or generalized anxiety, and has symptoms in common with it — fear, restlessness, increased talking, high blood pressure, tremors, sweating, nausea and high heart rate, for example. But unlike general anxiety, performance anxiety only arises in situations where you’ll be “on the spot.” Job interviews, presentations at work, a speech at your best friend’s wedding, a big race — any one of these can cause performance anxiety. 

    You could have diagnosable performance anxiety if you’ve experienced these symptoms consistently for six months or more, it causes extreme distress, and the fear you feel is unrealistic given the circumstances at hand. 

    It’s important to understand that, propranolol dosage for treating performance anxiety and propranolol dosage for treating things like hypertension are going to very drastically. 

    Our guide to dealing with performance anxiety goes into what, exactly, it is, and explores methods by which you can control it — with or without beta blockers. 

    Using Propranolol to Treat Anxiety: The Science

    Several studies have evaluated whether propranolol and other beta blockers are sound treatments for performance anxiety. And many of these studies confirmed the its efficacy. Overall, propranolol has been found to reduce high heart rate, tremors, excessive sweating and feelings of nervousness and fear. 

    For example, one study looked at surgeons while operating on patients and found their average heart rate to be a speedy 120. However, after taking a beta blocker, the average heart rate was about 85 beats per minute.

    In another analysis, study subjects were given a propranolol dosage of 40 mg and asked to give a speech, which was videotaped. Analyzing the video tapes and the speakers self-reported symptoms, the researchers found both physical and verbal signs of anxiety were decreased with propranolol use. 

    Yet another study looked at a beta blocker and its effects on musical performers with anxiety. The musicians were asked to play a solo in front of an audience and were then asked to rate various symptoms of anxiety. After taking the beta blocker, they reported less nervousness and tremors, improved musical performance, and lowered heart rate and blood pressure. 

    Is Propranolol Safe? 

    Propranolol is considered safe by the FDA to treat hypertension and high blood pressure. That doesn’t mean it doesn’t come without risks — all drugs do. Among the risks for this particular drug: Changes in blood sugar level and the concealing of symptoms of low blood sugar, loss of alertness, allergic reactions, skin reactions such as blistering and peeling and heart failure. These risks are rare. 

    Propranolol can also increase the effect of alcohol or other depressants. What this means is you may want to practice restraint if you’re thinking about throwing back cocktails after you’ve taken a propranolol. 

    You may also experience side effects while taking propranolol. Again, all drugs have them, as you’re well aware if you’ve ever heard a prescription drug commercial. Common propranolol side effects include chest tightness and coughing. Less common propranolol side effects may include abdominal pain, black stools, skin problems, blood in urine, bloody stools or nose, blurry vision, body aches, pins and needles feelings, confusion, congestion, constipation and more. Like the serious risks, these propranolol side effects are generally rare, but worth knowing about if you’re considering the medication.

    Is It Safe When Prescribed “Off-Label”?

    When a drug is approved for use in the U.S., the FDA’s label for that drug outlines very specific uses. Performance anxiety is not on the label for propranolol, but that doesn’t mean it’s less safe to take for that condition. 

    Off-label prescribing, as it’s called, is allowed by the FDA. They say, “Once the FDA approves a drug, healthcare providers generally may prescribe the drug for unapproved (off-label) use when they judge it is medically appropriate for their patient.”

    The risks you face for taking propranolol for performance anxiety are likely no different than those you face when taking it for high blood pressure. 

    Will Propranolol Cause Heart Problems? 

    Short answer: Highly unlikely. People take propranolol while in the throes of heart failure. It is designed to treat one of the conditions associated with cardiovascular health (hypertension). It’s highly unlikely it could have a negative effect on your heart health. 

    That being said, it does slow your heart rate. If you have a heart condition or are otherwise concerned about the potential cardiovascular effects of propranolol, it’s best to talk with your doctor. 



    This article is for informational purposes only and does not constitute medical advice. The information contained herein is not a substitute for and should never be relied upon for professional medical advice. Always talk to your doctor about the risks and benefits of any treatment.