Propranolol is commonly used for the treatment of anxiety, particularly performance anxiety and situational anxiety. It works by blocking the effects of adrenaline on beta-receptors, which can help reduce the physiological symptoms of anxiety, such as rapid heartbeat, trembling, and sweating.
In clinical settings, propranolol has been found to be effective in managing performance anxiety, helping individuals feel more at ease during stressful situations such as public speaking, presentations, or performance events. By alleviating the physical symptoms associated with anxiety, it allows patients to focus better and feel more confident.
Studies have shown that propranolol can significantly reduce anxiety-related symptoms in various scenarios, contributing to a greater sense of control during anxiety-provoking experiences. While it may not address the psychological aspects of anxiety disorders, many patients find relief from its physiological effects, leading to improved performance and reduced anxiety distress.
For anxiety, particularly performance anxiety, the typical dosage of propranolol according to the British National Formulary (BNF) begins with an initial dose of 40 mg taken orally about 1 hour before the anticipated stressful event, such as public speaking or performing.
Depending on individual response and tolerability, this dose may be adjusted, with a maximum of 40 mg recommended up to three times daily when needed. Propranolol can be used as needed for specific anxiety-provoking situations rather than being taken continuously.
If there are frequent instances requiring management, a healthcare provider may suggest a lower daily dose for chronic anxiety management. It is essential to follow the healthcare provider's guidance regarding dosage, monitor for any side effects, and consider potential interactions with other medications.
Medicines and their possible side effects can affect individual people in different ways. The following are some of the side effects that are known to be associated with this medicine. Just because a side effect is stated here, it does not mean that all people using this medicine will experience that or any side effect.
Propranolol, while generally well-tolerated, can cause a range of side effects. Here are the detailed side effects associated with its use:
Common Side Effects:
1. Fatigue: Many patients report feeling unusually tired or lethargic after starting propranolol.
2. Dizziness: Dose-related dizziness can occur, particularly when standing up quickly, often due to a drop in blood pressure.
3. Cold Extremities: Some individuals may experience coldness in their hands and feet due to reduced blood flow.
4. Gastrointestinal Disturbances: This can include nausea, vomiting, diarrhea, or constipation.
5. Sleep Disturbances: Insomnia or vivid dreams may occur in some users.
Serious Side Effects:
1. Bradycardia: Propranolol can cause a significant decrease in heart rate (bradycardia), which may lead to dizziness or fainting.
2. Hypotension: Blood pressure may drop too low (hypotension), particularly when changing positions, leading to dizziness or fainting.
3. Respiratory Issues: In individuals with asthma or other respiratory conditions, propranolol may exacerbate symptoms due to its non-selective blockade of beta receptors, potentially leading to bronchospasm.
4. Worsening Heart Failure: Propranolol may worsen symptoms in patients with pre-existing heart failure, leading to fluid retention, shortness of breath, or increased fatigue.
5. Severe Allergic Reactions: Although rare, anaphylaxis can occur, characterized by swelling, hives, difficulty breathing, and a rapid heartbeat.
Other Considerations:
1. Mood Changes: Some patients may experience mood changes, including depression or anxiety, particularly with long-term use.
2. Blood Sugar Effects: Propranolol may mask symptoms of hypoglycemia (low blood sugar) in diabetic patients and can alter glucose metabolism.
Monitoring:
Patients taking propranolol are advised to have their blood pressure and heart rate monitored regularly, especially during dose adjustments or if they have existing cardiovascular conditions. For full information on side effects and correct use, see the patient information leaflet. If any side effects concern you, or you are experiencing any of the side effects mentioned in the patient information leaflet whilst taking this medication, please contact our clinical team or speak to your GP.
Cautions
Pulmonary Conditions: Use with caution in patients with asthma, COPD, or other respiratory conditions, as propranolol can induce bronchospasm due to its non-selective beta-blocking effects.
Cardiovascular Issues: Caution is necessary for patients with bradycardia (slow heart rate), heart block, or severe heart failure, as propranolol may exacerbate these conditions or lead to further reduction in heart rate.
Diabetes: Individuals with diabetes should be closely monitored, as propranolol may mask typical symptoms of hypoglycemia (such as tachycardia) and affect blood glucose control.
Thyroid Disorders: Caution is advised in hyperthyroid patients, as propranolol can mask signs of thyroid storm (such as increased heart rate), which is a life-threatening emergency.
Pregnancy and Lactation: Propranolol should only be used during pregnancy if the benefits outweigh the risks, as it can affect fetal development. Caution is also warranted for breastfeeding mothers, as the drug may be excreted in breast milk.
Renal Impairment: Use with caution in patients with renal impairment, as decreased renal function may alter the pharmacokinetics of the drug.
Liver Disease: Hepatic impairment may affect propranolol metabolism, necessitating caution and potential dosage adjustments.
Withdrawal Symptoms: Abrupt discontinuation can result in rebound hypertension or exacerbation of ischemic heart disease; gradual tapering under medical supervision is recommended.
Warnings
Hypotension and Bradycardia: Patients on propranolol should be monitored closely for hypotension (low blood pressure) and bradycardia (slow heart rate), especially if they are also taking other antihypertensive medications.
Depression and Mood Changes: There is a potential for mood alterations, including the development of depression or increased anxiety, particularly in patients with a history of mental health disorders.
Surgical Considerations: Patients should inform their healthcare provider prior to any surgery, as propranolol can influence anesthesia and perioperative blood pressure management.
Pheochromocytoma: In suspected cases of pheochromocytoma (a tumor of the adrenal glands), propranolol should
not be used as monotherapy; it must be administered with an alpha-blocker to avoid severe hypertension.
Interactions with Other Medications: Propranolol may interact with other medications, including certain antidepressants, antihypertensives, and antiarrhythmic drugs, resulting in increased side effects or altered efficacy.
Get emergency medical help if you have signs of an allergic reaction to this medication. These include:
- Hives
- Dizziness
- Fast or pounding heartbeats
- Wheezing
- Difficult breathing
- Swelling of your face, lips, tongue, or throat.
It is important that you let us know which prescription, over-the-counter medicines and recreational drugs you are currently taking. You must also tell us about any other medical conditions that you currently have (or had in the past). This will help us ensure the prescribed medication is safe and appropriate for you to take.
For full information on warnings, medication interactions and contraindications, refer to the Patient Information Leaflet. Please read all packaging and the Patient Information Leaflet before taking any new medicine and inform our clinical team or your GP of medicines you are taking or intend to take.
