Propranolol, also known as Inderal and InnoPran, is a beta-blocker typically used to treat various heart conditions and sometimes prescribed to treat symptoms of anxiety. Always discuss with your doctor or healthcare provider before taking any other medications (prescribed or over the counter) with propranolol, as adverse reactions can occur.

Propranolol brand names

  • Inderal
  • InnoPran

What is propranolol prescribed for?

Propranolol is approved by the US Food and Drug Administration (FDA) to be used to treat several heart conditions, including high blood pressure and irregular heartbeats, glaucoma, migraines, and tremors.

Propranolol is also occasionally prescribed off-label, which means that it is not FDA approved but has been deemed safe for treatment by a medical professional. For example, it can be prescribed off-label for the treatment of symptoms of anxiety, particularly performance anxiety, or for the treatment of post-traumatic stress disorder (PTSD) [1][2][3].

The FDA has not approved propranolol for anxiety treatment as there is not sufficient evidence to support the effectiveness of this use and because there are various other evidence-based treatments available [2][4].

However, it has been used in this way for several decades and has often been found to be effective in relieving symptoms of anxiety, such as shaking, sweating, dry mouth, and increased heart rate [1][4][5].

Scientists continue to research this use, as well as the effectiveness of propranolol in treating PTSD and other trauma-related mental health issues [3][6][7].

How does propranolol work?

Propranolol affects various parts of the brain, including blocking beta receptors, inhibiting protein synthesis, and affecting the sympathetic nervous system. This all results in a decrease in heart rate, blood pressure, and various other symptoms [1].

While propranolol can reduce the physical symptoms of anxiety, allowing people to improve their daily, social, or professional functioning, it does not cure the mental effects or causes of anxiety.

New research suggests that the impact propranolol has on protein synthesis may help to prevent traumatic memories from being stored in the brain, thereby reducing the long-lasting response to traumatic events, as seen in PTSD [3][6][7].

How is propranolol usually taken?

Propranolol is available in tablets and capsules of varying strengths and lengths of action.

Extended-release capsules, or long-acting capsules, tend to be available in higher strengths (60mg, 80mg, 120, 160mg) to be taken once per day as the medication continues to be released into the body throughout the day.

Immediate-release, or short-acting tablets and capsules, are available in lower strengths (10mg, 20mg, 40mg, 60mg, 80mg), to be taken 1-4 times per day, as the medication is released into the body quickly, so can be topped up throughout the day.

The initial dose that your doctor prescribes will depend on your condition, age, response to the medication, and possibly gender, as each of these may impact the effectiveness of the medication [1][9].

Propranolol may initially be prescribed at 40mg twice a day, which can then be increased up to 240mg daily to treat many physical health conditions.

For the treatment of anxiety symptoms and PTSD, research suggests that an effective prescription is 40-80mg doses taken 1-3 times per day [2][3][4][10].

As a PRN (as needed) medication, 10-40mg may be effective at reducing performance anxiety, taken around 1 hour before the event causing anxiety [2][4].

Propranolol may be effective as a short-term treatment for anxiety, so your doctor may suggest a limited treatment plan. They will monitor your physical and mental responses to the medication to evaluate the safety and effectiveness of your propranolol treatment.

Take your prescription exactly as your doctor prescribes, never taking more or less than is prescribed, or intentionally skipping doses, as this could cause adverse effects.

If you miss a dose of propranolol, take the medication as soon as possible, or skip the missed dose if it is close to the next dosage time. Never take double your usual dose in one go, as this may increase the risk of side effects or overdose.

Because of the impact that propranolol has on the heart, suddenly stopping this medication can cause serious heart issues. If your doctor advises that you come off this medication, they will likely reduce your prescription slowly to prevent this. You should never suddenly stop taking propanolol without proper medical advice and supervision.

How long does propranolol stay in your system?

When you start taking propranolol, you may notice an improvement in your symptoms within the first few hours, particularly with immediate-release medication [2][5].

With immediate-release propranolol, you may feel the effects for around 4 hours, while with extended-release, these effects can continue throughout the day.

Propranolol may take several days to leave your system entirely.

Propranolol side effects

When you start taking a new medication, you may experience some common side effects. They will likely reduce within the first week or two, but if they continue or become problematic, consult your doctor, as you may need a reduced daily dose or a medication change.

Common side effects of propranolol include:

  • Stomach upset, including constipation, diarrhea, nausea, or vomiting
  • Slow heartbeat
  • Tiredness and drowsiness
  • Dizziness

Serious side effects of propranolol are less common but may still occur. If you experience any of the following, or any other concerning or intolerable side effects, seek medical attention immediately:

  • Breathing difficulties
  • Muscle weakness or pain
  • Yellowing of the skin or eyes
  • Unexplained bleeding or bruising
  • Hallucinations
  • Allergic reactions, including rash, blisters, swelling of the face or mouth, or tight chest

Propranolol precautions

Your doctor must be aware of any past or present mental health conditions you have experienced to enable safe monitoring of your condition while on this medication or to decide if it is safe for you.

Discuss with your doctor all your past and present physical health conditions, as they may impact your ability to take this medication safely.

Because of the potential for serious side effects, propranolol should not be taken if you have a very low resting heart rate or any lung or breathing issues, such as asthma or COPD [1][9].

While taking this medication, particularly at the beginning of your treatment, your doctor will closely monitor your blood pressure, pulse, and respiratory rate, to ensure your safety and mitigate any potential risks.

Ensure you inform your doctor of any liver or kidney conditions you have experienced. Because of how the body absorbs propranolol, you may need a reduced dose to prevent a buildup of toxic levels of the medication [9].

Propranolol reduces anxiety symptoms such as flushing, sweating, and dizziness, which may also be crucial indicators of hypoglycemia, so it may not be an appropriate medication for you if you have diabetes.

Inform your doctor if you are pregnant or planning to get pregnant. Although the evidence in this area is limited, some research suggests that propranolol may cause harm to the fetus [9]. Your doctor will inform you of these risks so you can make an informed decision about your treatment. It is advised to only use propranolol if the benefits of this treatment outweigh the risks.

Inform your doctor if you are breastfeeding. Propranolol may be excreted in breast milk, so it should be used cautiously if breastfeeding. In addition, it is advised to monitor your baby for any unusual changes in their physical or mental health.

Propranolol interactions

Some medications may interact with propranolol, potentially causing a reduction in the effectiveness of your medication or an increase in the risk of serious side effects.

This includes various heart medications, calcium channel blockers, anti-inflammatory medications, blood thinners, migraine medications, and some mental health medications, such as antidepressant and anti-anxiety medications.

It is advised to avoid or limit the use of alcohol, drugs, or cigarettes while taking propranolol, as they can reduce the effectiveness of the medication or cause an increase in risks [8][9]. You may wish to discuss this with your doctor, as it may vary depending on your dose or treatment plan.

Propranolol storage

Always keep all medications out of reach of children.

Store propranolol in its original packaging, in airtight containers, and at room temperature (never above 86 F).

If you need to dispose of expired medication or those no longer needed, contact a medical professional to ensure it is disposed of appropriately. Never flush medications down the toilet or put them in the trash, as this can create unnecessary risks.

What to do if you overdose on propranolol

If you overdose on propranolol, call a medical professional or Poison Control at 1-800-222-1222, or in case of an emergency, call 9-1-1. For many, over 1g of propranolol in 24 hours is a severe overdose [1].

Symptoms of a propranolol overdose include a slow heart rate, low blood pressure, tight chest, shortness of breath, and sometimes death.

FAQ's

How long does propranolol take to start working?

Propranolol can reduce symptoms of anxiety within 4 hours.

Is propranolol addictive?

Propranolol is not an addictive substance. However, it has the potential to be misused if you begin to feel that you need it to manage anxiety-provoking situations. It may also cause withdrawal symptoms if suddenly stopped. Your doctor will gradually reduce your dose to help prevent misuse and withdrawal symptoms from occurring.

What are the alternatives to propranolol?

For the treatment of anxiety, there are several available medications and treatments. Propranolol is not typically a first-choice medication for anxiety [2], as the FDA has not approved it for this use.

FDA-approved medications for the treatment of anxiety include antidepressant medications, such as selective serotonin reuptake inhibitors (SSRI) and serotonin and norepinephrine reuptake inhibitors (SNRI), many benzodiazepines, an antipsychotic medication called trifluoperazine, and some other medications [2].

You can discuss alternative medications with your doctor, who can advise what is suitable for you, depending on the severity of your medical condition. You may also wish to engage in talking therapies to help manage the cause of your anxiety.

Resources:

  1. Shahrokhi, M. & Gupta, V. Propranolol. (2022). In StatPearls [Internet]. Treasure Island, FL: StatPearls Publishing. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK557801/
  2. Garakani, A., Murrough, J. W., Freire, R. C., Thom, R. P., Larkin, K., Buono, F. D., & Iosifescu, D. V. (2020). Pharmacotherapy of Anxiety Disorders: Current and Emerging Treatment Options. Frontiers in Psychiatry11. Retrieved from https://doi.org/10.3389/fpsyt.2020.595584
  3. Soeter, M., & Kindt, M. (2010). Dissociating Response Systems: Erasing Fear From Memory. Neurobiology of Learning and Memory, 94(1), 30-41. Retrieved from https://doi.org/10.1016/j.nlm.2010.03.004
  4. Steenen, S.A., Van Wijk, A.J., Van der Heijden, G.J., Van Westrhenen, R., de Lange, J., & de Jongh, A. (2015). Propranolol for the Treatment of Anxiety Disorders: Systematic Review and Meta-Analysis. Journal of Psychopharmacology30(2), 128–139. Retrieved from https://doi.org/10.1177/0269881115612236
  5. Propranolol for the Treatment of Acute Stress Disorder. (2008). ClinicalTrials.gov. Retrieved from https://www.clinicaltrials.gov/ct2/show/study/NCT00069355
  6. Johansen, J.P., Cain, C.K., Ostroff, L.E., & LeDoux, J.E. (2011). Molecular Mechanisms of Fear Learning and Memory. Cell147(3), 509–524. Retrieved from https://doi.org/10.1016/j.cell.2011.10.009
  7. Lonergan, M.H., Olivera-Figueroa, L.A., Pitman, R.K., & Brunet, A. (2013). Propranolol's Effects on the Reconsolidation of Long-Term Emotional Memory in Healthy Participants: A Meta-Analysis. Journal of Psychiatry & Neuroscience38(4), 222–231. Retrieved from https://doi.org/10.1503/jpn.120111
  8. Propranolol (Cardiovascular): MedlinePlus Drug Information. (2017, August 15). MedlinePlus. Retrieved from https://medlineplus.gov/druginfo/meds/a682607.html
  9. Akrimax Pharmaceuticals, LLC. (Revised 2010). Inderam (Propranolol Hydrochloride) Medication Guide. Access Data FDA. Retrieved from https://www.accessdata.fda.gov/drugsatfda_docs/label/2011/016418s080,016762s017,017683s008lbl.pdf
  10. Propranolol. (Revised 2021). NHS. Retrieved from https://www.nhs.uk/medicines/propranolol/
  11. Nace, G. S., & Wood, A. J. Pharmacokinetics of Long Acting Propranolol. Implications for Therapeutic Use. (1987). Clinical Pharmacokinetics13(1), 51–64. Retrieved from https://doi.org/10.2165/00003088-198713010-00003