Several medications and therapies are available to treat anxiety. But, in some specific cases, a health professional may use an off-label drug.

Anxiety involves both physical and mental symptoms, and in most instances, they feed off each other.

Blocking the physical effects of anxiety can sometimes help you calm down, and drugs like propranolol may be useful for this.

Yes. Propranolol can reduce your body’s physiological response to anxiety under some circumstances. In other words, it interferes with the stress response.

Some of the physical anxiety symptoms that propranolol can help reduce include:

  • racing heart
  • shaking
  • chills
  • sweating
  • lightheadedness

Because some of these physical reactions to anxiety can increase your psychological response, reducing these symptoms can help you calm down and relax during anxiety-inducing events.

Research has shown that short-term treatment with propranolol can have similar therapeutic effects to the use of benzodiazepines, but without some of their known side effects. Benzodiazepines, like Xanax and Valium, are effective medications for anxiety.

There are also different types of anxiety disorders, and propranolol may not work for all of them. The same research suggests the drug may help in cases of:

  • anticipatory anxiety
  • performance anxiety
  • social anxiety disorder
  • specific phobias

However, scientific research in general on propranolol’s efficacy in treating anxiety is quite scarce and inconclusive.

The Food and Drug Administration (FDA) hasn’t approved propranolol to treat anxiety disorders. This is why we say the use of propranolol and other beta-blockers for anxiety is “off-label.”

Propranolol is a prescription medication and only a health professional may recommend you use it for anxiety, depending on the specifics of your situation.

Propranolol is a medication originally developed in the 1960s to treat heart disease.

Today, some healthcare professionals use it to treat other ailments as well, including mental health conditions.

Propranolol is typically prescribed for:

  • hypertension (high blood pressure)
  • angina pectoris (pectoris pain) caused by coronary atherosclerosis
  • atrial fibrillation
  • myocardial infarction
  • migraines
  • essential tremors
  • hypertrophic subaortic stenosis
  • pheochromocytoma

Some off-label uses of propranolol include:

  • portal hypertension
  • anxiety
  • hyperthyroidism
  • neuroleptic-induced akathisia

What type of drug is propranolol?

Propranolol is in a class of drugs known as beta-blockers. These drugs stop neurotransmitters (chemical messengers) in your body from attaching to their receptors.

The neurotransmitters that propranolol blocks are known as beta-adrenergic agents.

The word “adrenergic” refers to versions of the hormone adrenaline — for example, epinephrine and norepinephrine. These are all naturally made by your body.

Known as the fight-or-flight hormone, adrenaline is useful in the right doses.

Think about a time you were watching a scary movie and something jumped out at the screen, startling you. You probably experienced an adrenaline rush.

When adrenaline is released into your system, your body does several things:

  • It makes your heart beat faster.
  • It increases blood flow to your brain and muscles.
  • It breaks down sugar for fuel.

This is useful when you need to be on alert for a real threat, but it may be harmful when you live in an adrenaline-fueled state long-term.

Living with anxiety may mean you have a chronic stress response. Propranolol may help block this response and the physical sensations that come with it.

How does propranolol work?

Beta-blockers like propranolol are prescribed because they can attach to adrenaline receptors instead. If the neurotransmitter can’t attach to the receptor, it can’t signal the body to produce adrenaline.

Propranolol causes what’s known as an “antihypertensive effect.” In other words, it lowers high blood pressure.

It does this by causing your blood vessels to relax and expand, allowing for improved blood flow throughout your body.

How do you use propranolol?

You can only get propranolol with a prescription from a healthcare professional.

Also known by generic names like Hemangeol and Inderal, propranolol is available in three forms: a tablet, a liquid solution, and an extended-release pill.

The tablet and solution start working immediately and can be taken every 3 to 4 hours, depending on your health team’s recommendation.

The extended-release pill acts over time, so it should only be taken once per day. Since it works better for short-term anxiety, an immediate release option like a tablet or liquid solution may be a doctor’s preferred choice.

Propranolol is best taken as a short-term treatment for occasional anxiety.

When propranolol is used to treat other conditions, like angina or migraines, the starting dose is 80 milligrams taken once per day. Your doctor will decide what a safe dose is for you depending on your symptoms and your health profile.

Who can take propranolol?

Only adults (18 years and older) are approved to take propranolol. The medication has not been proven safe and effective for treating anxiety in children (ages 0 to 17 years old).

If a medication has the potential to cause a serious or life-threatening reaction, the FDA will put a warning label on the medication box, called a black box warning.

Propranolol’s black box warning states:

“Do not abruptly stop taking propranolol without talking to your healthcare provider. Suddenly stopping propranolol may cause chest pain or a heart attack.”

Just like with other medications, taking propranolol may cause some side effects.

Common side effects of propranolol include:

  • drowsiness
  • slow heart rate
  • nausea or diarrhea
  • fatigue
  • dizziness

Rare, but serious side effects include:

  • trouble breathing or swallowing
  • rashes or hives
  • weight changes
  • irregular heart beat

These are just a few side effects of propranolol. If you experience a strong reaction, it’s highly advisable that you receive medical attention.

Research on the link between beta-blockers, including propranolol, and depression is limited and inconclusive.

If you have concerns about past or current symptoms of depression and the use of propranolol, it may be a good idea to discuss them with your health professional.

Propranolol is a prescription medication that blocks neurotransmitters from creating an adrenaline response in your body. This is why it’s sometimes used off-label to treat certain anxiety disorders.

Some research suggests propranolol is best used as a short-term therapy. Like all medications, it has some side effects, including fatigue and dizziness.

Only a medical professional can prescribe propranolol for anxiety.