Propranolol
Steady nerves for the big moments. A beta blocker that blunts adrenaline’s effects, the racing heart, shaking hands and unsteady voice, taken about an hour before a presentation, interview, performance or flight. It isn’t a sedative, and for performance anxiety it’s prescribed off-label.
- FDA-approved generic, not compounded
- Taken only when you need it, about an hour before
- Eases the physical side of nerves, not a sedative
As-needed tablet · from $29/mo. Prices are preliminary.
How to use it
- Take your dose about an hour before the event, with water. Your provider tells you whether that’s one tablet or two, and how often you can take it.
- Try a dose at home on an ordinary day first, so you know how it feels before it matters.
- Stand up slowly if you feel light-headed, and go easy on alcohol, which adds to it. Get emergency help for wheezing, trouble breathing, fainting or a very slow pulse.
- Form
- Immediate-release tablet, 15 per bottle
- Strength
- 10 mg tablets; your provider sets whether you take one or two
- Typical use
- About an hour before a stressful event, only when you need it
- Dispensed as
- FDA-approved generic from a licensed pharmacy, not compounded
- Who it’s for
- Adults whose nerves show up physically at predictable moments (an off-label use), if a provider decides it’s appropriate
One active, an FDA-approved generic.
- Propranolol hydrochloride (10 mg tablet): A non-selective beta blocker, one of the most widely used heart medicines. It stops adrenaline from acting on the beta receptors in your heart, blood vessels, airways and muscles, so your heart doesn’t race and your hands and voice stay steadier. It doesn’t act on worry itself, and it isn’t habit-forming or a controlled substance.
What the research does and doesn’t show
Performance anxiety: small trials from the 1970s and 1980s, mostly in musicians, found that a beta blocker taken before a performance eased the physical side of stage fright. In one of the best known, 29 musicians took propranolol or a placebo before performing: propranolol relieved symptoms like a racing heart and dry mouth without sedation, and critics who didn’t know who took what rated the performances better.
Anxiety disorders: a 2016 review of eight trials found the evidence too weak to support using propranolol routinely for panic disorder, phobias, social anxiety disorder or PTSD.
So the evidence supports occasional use for predictable, physical nerves, from studies that were small and old, and not daily use for ongoing anxiety. This use is off-label.
Studies: Brantigan, Brantigan & Joseph, Am J Med 1982 (two double-blind trials, 29 musicians; beta blockade relieved the physical symptoms of stage fright and improved critic-rated performance without tranquilization; PMID 6120650); Steenen et al., J Psychopharmacol 2016 (systematic review and meta-analysis, 8 randomized trials in panic disorder, specific phobia, social phobia and PTSD; evidence insufficient to support routine use; PMID 26487439); propranolol hydrochloride tablets prescribing information (DailyMed).
What to expect
- About an hour after
- When nerves kick in, your heart stays calmer and your hands and voice steadier. Your thoughts stay your own; it isn’t a sedative.
- The next few hours
- The effect fades over a few hours. Some people feel a little tired or light-headed, or have cold hands.
- Ongoing
- Refills ship monthly, or order once. Your provider checks in on how it’s working and whether the dose is right.
Important safety information
Before you start
Your provider reviews your health history, medicines and allergies before prescribing, and prescribes only if it’s right for you. Tell your care team about any side effect, and get emergency care for chest pain, trouble breathing, or swelling of the face, lips or throat.
Side effects, and when to get help
At the low doses used for nerves, side effects are usually mild: tiredness, light-headedness, cold hands and feet, and sometimes nausea or vivid dreams. A slower pulse is expected. Standing up slowly helps with light-headedness, and alcohol adds to it. Get emergency help for wheezing or trouble breathing, fainting, a very slow pulse, chest pain, or swelling of your face, lips or throat.
Rules that keep it safe
Propranolol isn’t used with asthma, a very slow heart rate or heart block. Heart failure, low blood pressure, COPD and poor circulation need a provider’s review first. If you have diabetes, it can hide the warning signs of low blood sugar, and it can hide the signs of an overactive thyroid. If you have severe allergies, beta blockers can make a reaction harder to treat and epinephrine less effective. Tell your provider about every medicine you take, especially verapamil, diltiazem, clonidine, other blood-pressure or heart-rhythm medicines, fluoxetine, paroxetine and rizatriptan. If you also take propranolol every day for another reason, don’t stop it suddenly; that can bring on chest pain or a fast heartbeat. Tell the team before any surgery.
Is it FDA-approved?
Yes, for high blood pressure, chest pain from heart disease, atrial fibrillation, after a heart attack, migraine prevention, essential tremor and a few rarer conditions. Propranolol here is an FDA-approved generic, dispensed by a licensed pharmacy as the manufacturer makes it; it isn’t compounded. Using it for performance or situational anxiety is off-label: a provider can prescribe it that way, but the FDA hasn’t reviewed it for that use.
About Propranolol
Is propranolol FDA-approved?
Yes, for high blood pressure, chest pain from heart disease, some irregular heart rhythms, after a heart attack, migraine prevention and essential tremor, among others. Using it for performance or situational anxiety is off-label, meaning a provider prescribes it for a use the FDA hasn’t specifically approved. Your provider decides whether it’s appropriate for you.
Is this compounded?
No. Your prescription is filled with FDA-approved generic propranolol by a licensed pharmacy, the same medicine you’d get at a retail pharmacy.
What kind of anxiety is it for?
Predictable, situational nerves where the physical side gets in the way: a presentation, a performance, an interview, a flight or a big conversation. It isn’t a treatment for everyday anxiety, panic disorder or depression. If anxiety is part of most days, a provider can talk with you about care that fits that better.
Will it make me drowsy or foggy?
It isn’t a sedative and doesn’t change how you think. Some people feel a little tired or light-headed, which is why it’s worth trying a dose at home before the day it matters.
How is it different from Xanax?
Benzodiazepines such as alprazolam (Xanax) act on the brain, can make you drowsy and can be habit-forming; they’re controlled substances. Propranolol works on your body’s response to adrenaline, isn’t habit-forming and isn’t a controlled substance. They aren’t interchangeable.
Who shouldn’t take it?
People with asthma, a very slow heart rate or heart block shouldn’t take it. Heart failure, low blood pressure, COPD, diabetes treated with insulin, severe allergies, an overactive thyroid and some medicines need a provider’s review first.
What if I’m having a hard time?
Propranolol isn’t an emergency treatment. If you’re thinking about harming yourself, call or text 988 (the Suicide & Crisis Lifeline) or call 911 right away.