Propranolol Vs. Xanax: Drug Comparison

Propranolol is the active ingredient in the brand-name medication Inderal XL^®. The information below is about brand name Inderal XL. According to the FDA, “Generic medicines use the same active ingredients as brand-name medicines and work the same way, so they have the same risks and benefits as the brand-name medicines.”

Inderal XL (propranolol extended-release) is a beta-blocker that works by blocking the effects of adrenaline on beta receptors, which slows the heart rate and reduces blood pressure. It is FDA-approved for the treatment of high blood pressure, chest pain, and to reduce the risk of heart attacks, as well as for managing certain types of tremors and preventing migraines. Off-label uses include managing performance anxiety and treating symptoms of hyperthyroidism. Inderal XL is available in extended-release capsule form, typically taken once daily. Common side effects include dizziness, fatigue, and constipation, and it can interact with other medications that lower blood pressure or heart rate. Abrupt discontinuation of propranolol can lead to serious heart-related issues, so it should be tapered off gradually under medical supervision.

Xanax^® (alprazolam) is a benzodiazepine medication used to treat anxiety and panic disorders by enhancing the activity of GABA, a neurotransmitter that calms the nervous system. Its FDA-approved indications include the treatment of generalized anxiety disorder (GAD) and panic disorder with or without agoraphobia. Xanax is available in tablet, extended-release tablet, and oral solution forms, typically taken once to multiple times daily depending on the dose. Common side effects include impaired coordination, low blood pressure, difficulty speaking, and increased libido. Serious risks include dependence, withdrawal, and respiratory depression, especially when combined with opioids or alcohol. Xanax carries a boxed warning for the risk of abuse, dependence, and potentially fatal respiratory depression when used with other central nervous system (CNS) depressants.

Beta adrenergic blocker

Benzodiazepine

Inderal XL (propranolol hydrochloride) is indicated:

• For the treatment of hypertension, to lower blood pressure. Lowering blood pressure reduces the risk of fatal and nonfatal cardiovascular events, primarily strokes and myocardial infarctions

Xanax (alprazolam) is indicated for the:

• Acute treatment of generalized anxiety disorder in adults

• Treatment of panic disorder with or without agoraphobia in adults

• Typically taken orally once daily

• Comes in 80 mg and 120 mg capsules

• Typically taken orally three times daily

• Comes in 0.25 mg, 0.5 mg, 1 mg, and 2 mg tablets

The most commonly reported adverse reactions (≥3% and greater than placebo) included the following:

• Fatigue

• Dizziness

• Constipation

The most common adverse reactions reported in clinical trials for generalized anxiety disorder and panic disorder (incidence >5% and at least twice that of placebo) include:

• Impaired coordination

• Low blood pressure

• Difficulty forming or pronouncing words

• Increased libido

• Cardiogenic shock and decompensated heart failure

• Sinus bradycardia, sick sinus syndrome, and greater than first-degree block unless a permanent pacemaker is in place

• Bronchial asthma

• Hypersensitivity to propranolol or any of the components of Inderal XL

• Drug interactions: CYP2D6, 1A2, and 2C19 enzyme inhibitors, CYP1A2 and 2C19 inducers, warfarin

• Known hypersensitivity to alprazolam or other benzodiazepines

• Concomitant use with strong cytochrome P450 3A (CYP3A) inhibitors, except ritonavir

• Drug interactions: Opioids, other central nervous system (CNS) depressants, digoxin, CYP3A inhibitors (except ritonavir), CYP3A inducers

• Abrupt cessation may exacerbate myocardial ischemia

• May worsen congestive heart failure

• Avoid discontinuing therapy prior to major surgery

• Diabetes: May mask symptoms of low blood sugar and alter glucose levels

• Slow heart beat

• Pregnancy: Monitor neonates whose mothers received propranolol near the time of delivery for bradycardia, hypoglycemia, and/or respiratory depression and manage accordingly

• Effects on driving and operating machinery

• Patients with depression: Exercise caution in patients with signs or symptoms of depression

• Neonatal sedation and withdrawal syndrome

• Breastfeeding: Breastfeeding not recommended

WARNING: RISKS FROM CONCOMITANT USE WITH OPIOIDS; ABUSE, MISUSE, AND ADDICTION; and DEPENDENCE AND WITHDRAWAL REACTIONS

Concomitant use of benzodiazepines and opioids may result in profound sedation, respiratory depression, coma, and death. Reserve concomitant prescribing for use in patients for whom alternative treatment options are inadequate. Limit dosages and durations to the minimum required. Follow patients for signs and symptoms of respiratory depression and sedation.

The use of benzodiazepines, including Xanax, exposes users to risks of abuse, misuse, and addiction, which can lead to overdose or death. Before prescribing Xanax and throughout treatment, assess each patient’s risk for abuse, misuse, and addiction.

• Abrupt discontinuation or rapid dosage reduction of Xanax after continued use may precipitate acute withdrawal reactions, which can be life-threatening. To reduce the risk of withdrawal reactions, use a gradual taper to discontinue Xanax or reduce the dosage.

*This information is from the label for brand name Inderal XL^®. See the Full Prescribing Information for more complete information. Propranolol, the active ingredient in Inderal XL, may also be the active ingredient in other medications, and this information may not be accurate for all medications that include the active ingredient propranolol.

*This information is from the label for brand name Xanax^®. See the Full Prescribing Information for more complete information. Alprazolam, the active ingredient in Xanax, may also be the active ingredient in other medications, and this information may not be accurate for all medications that include the active ingredient alprazolam.