Propranolol FAQs: 29 Common Questions Answered

Searching for information about propranolol? Approved by the FDA for more than 40 years and prescribed to millions of American adults, propranolol is one of the most common beta blockers used to treat heart conditions, anxiety, headaches and other health issues.

Below, we’ve answered 29 of the most frequently asked questions about propranolol, covering everything from propranolol’s common dosages to primary effects, potential side effects, using propranolol for anxiety and more.

Propranolol is a beta blocker medication. It works by blocking the effects of stress hormones, such as adrenaline (epinephrine) and noradrenaline (norepinephrine) on beta receptors in the heart, lungs and other tissue.

Originally developed in the 1960s, propranolol was initially approved by the FDA in the 1970s and has been on the market for decades as a treatment for several conditions.

Our guide to beta blockers goes into more detail on how propranolol and similar beta blocker medications work.

Propranolol is used to treat several medical conditions, including those that affect the vascular system and heart. 

Currently, propranolol is used to treat hypertension (high blood pressure), heart arrhythmia (an irregular heartbeat), hypertrophic subaortic stenosis (heart muscle disease) and angina (a form of chest pain caused by poor blood flow to the heart).

Propranolol is also prescribed to improve general health in people who’ve suffered myocardial infarction, or heart attack.

In some cases, propranolol is used to treat benign essential tremor -- a disorder that can cause uncontrollable shaking in the hands, arms, head, neck and torso -- and restless leg syndrome.

Like many other medications, propranolol is also sometimes prescribed off-label for uses other than those approved by the FDA.

For example, propranolol is often prescribed as an off-label treatment for some forms of anxiety, such as performance anxiety. When used as an anxiety medication, propranolol can reduce the severity of some physical anxiety symptoms, such as sweating and an elevated heart rate. 

Our guide to propranolol and performance anxiety goes into more detail about how propranolol can work as an off-label anxiety treatment. 

No. Propranolol is a prescription medication, meaning it can’t be purchased over the counter in a drug store. To purchase propranolol, you’ll need to talk to your primary care provider or take part in an online consultation using our telehealth service. 

Propranolol works by blocking the physical effects of anxiety on your heart. This means that you won’t experience the usual physical symptoms of anxiety, such as sweating, shaking or a faster heart rate when you feel nervous.

Unlike other medications for anxiety, propranolol doesn’t promote mental relaxation or calm your mind. However, by reducing the physical symptoms of anxiety, propranolol might help you to feel calmer, less nervous and more composed.

Some medications used to treat anxiety, such as benzodiazepines and antidepressants, work by “slowing down” certain aspects of your brain and causing you to feel tired.

Propranolol primarily affects your body’s physical response to stress, with few significant effects on your cognitive function.

In a 2000 study, researchers found that people who used propranolol to treat hypertension (high blood pressure) performed almost exactly the same on 11 tests of cognitive function after using their medication for three or 12 months.

It’s worth noting that this study was carried out on people who received a significant propranolol dosage of 80 to 400mg per day. This dosage, which is used to treat hypertension, is higher than the as-needed dose that’s typically used to treat social anxiety and performance anxiety. 

Propranolol typically reaches its peak concentration in one to four hours. It may take 30 to 60 minutes for the physical effects of propranolol, such as reduced shaking or a slower heart rate, to become noticeable.

If you’re prescribed propranolol for performance anxiety, your healthcare provider may suggest a specific time to take your medication before specific events.

Propranolol can typically be taken with or without food. Taking propranolol with protein-rich food may increase its bioavailability, although this does not seem to make the medication work faster or increase its duration of action.

If you’re prescribed an extended-release form of propranolol, such as Innopran XL® or Inderal XL®, it should be consistently taken either with food or without food every time.

If you’re prescribed propranolol for a cardiovascular health condition, it’s important to follow your healthcare provider’s instructions and take it as prescribed.

Oral propranolol comes in several forms. The extended-release tablet of propranolol is generally taken one time each day. Your healthcare provider may instruct you to take propranolol before going to bed or during the daytime.

If you’re prescribed a shorter-acting propranolol tablet or solution, you may need to take it two to four times each day. Make sure to closely follow the instructions provided with your medication and ask your healthcare provider if you have any questions about using propranolol.

Propranolol has a half-life of three to six hours, meaning approximately half of each dose will be active in your body three to six hours after using the medication. Some long-acting versions of propranolol have a half-life of eight to 11 hours. 

Research suggests that propranolol might last for longer in elderly people due to aging-related changes in the body’s oxidation capacity. The effects of propranolol are usually noticeable for several hours after each dose. 

Because propranolol is used off-label to treat anxiety, there’s no standard recommended dosage provided by the FDA. 

Most research suggests that a propranolol dosage of 40 to 120mg per day is effective at treating several forms of anxiety. 

When used for other health conditions, propranolol is prescribed at dosages ranging from 40mg to 640mg per day:

• For hypertension, propranolol is prescribed at an initial dosage of 40mg taken two times per day, which may be increased to a maintenance dose of 120 to 240mg per day. The maximum dosage of propranolol for hypertension is 640mg per day.

• For atrial fibrillation (irregular, abnormally fast heart rate), propranolol is prescribed at a recommended dose of 10 to 30mg, taken three to four times per day.

• To improve heart function after a heart attack, propranolol is prescribed at a dosage of 180 to 240mg per day, taken in divided doses.

• For angina pectoris (chest pain), propranolol is typically prescribed at a total daily dose of 80 to 320mg, split into one to four separate doses per day.

• For migraine, propranolol is usually prescribed at a range of 80 to 240mg per day, taken in divided doses.

• For essential tremor, propranolol is usually prescribed at an initial dosage of 80mg a day, taken in two separate doses. This dosage may be adjusted to a maximum of 320mg per day over time. 

As with other medications, there’s no “perfect” dose of propranolol for everyone. Based on your symptoms, bodyweight and response to the medication, your healthcare provider may prescribe propranolol at a moderate or high dosage for use before anxiety-inducing events.

If you’re prescribed propranolol for a cardiovascular health issue, tremor or other condition that requires you to use your medication on a regular schedule, you should take the missed dose as soon as you remember it.

If it’s almost time for your next propranolol dose, you should skip the missed dose of propranolol and continue using your medication as prescribed. Do not double your dose of propranolol after a missed dose. 

It’s possible to overdose on propranolol. Taking too much propranolol may cause a severe drop in blood pressure, reduced heart rate and abnormal heart function. Overdosing on propranolol can potentially cause death.

If you’ve taken too much propranolol, you should contact emergency services on 911 or call the poison control helpline on 1-800-222-1222. 

Yes. When used for performance anxiety and social anxiety, propranolol can be taken only when it’s needed. Many people use propranolol as needed before public speaking events, meetings or other stressful, anxiety-inducing situations.

If you’re prescribed propranolol for a heart condition or other reason, it’s important to follow your healthcare provider’s exact instructions and only use your medication as prescribed. 

Like other medications used to treat cardiovascular health issues and anxiety, propranolol can potentially cause side effects. 

Propranolol can cause several potential side effects. Most side effects of propranolol are minor, with dizziness, lightheadedness, tiredness, diarrhea and constipation some of the most common adverse effects.

If these symptoms are severe or persistent, it’s best to tell your healthcare provider. They might suggest adjusting your dosage of propranolol or making other changes to the way you use your medication.

Propranolol can also cause more severe side effects, including the following:

• Rash

• Blistering or peeling of the skin

• Itching

• Hives

• Swelling that affects the throat, lips, tongue and/or face

• Difficulty breathing and/or swallowing

• Faintness

• Irregular heartbeat

• Weight gain 

It’s important to contact your healthcare provider or seek medical treatment if you develop any severe side effects from propranolol or other beta blockers.

Used as prescribed, propranolol is a safe medication with a low risk of side effects. It’s been in use since the 1960s and is prescribed to millions of people of all ages and backgrounds in the United States alone, with a long and reliable safety record.

Like all medications, propranolol needs to be used responsibly. If you use propranolol at doses above those directed by your healthcare provider or more frequently than prescribed, you may have an increased risk of experiencing side effects. 

Like other medications, propranolol may cause or contribute to weight gain. In a study published in the BMJ, researchers found that people who used propranolol over the long term put on more weight than those given a non-therapeutic placebo.

It’s worth noting that most research on beta blockers and weight gain involves medications used to treat hypertension and other cardiovascular health issues, not performance anxiety.

If you notice your weight increasing after you begin treatment with propranolol, it’s best to talk to your healthcare provider. 

Propranolol may cause sleep issues, including difficulty falling asleep or staying asleep. In one study published in the journal International Clinical Psychopharmacology, experts found that a typical dose of propranolol increased insomnia in people prone to difficulty sleeping.

However, research also suggests over-the-counter supplements containing melatonin may help to curb this side effect. Melatonin is an active ingredient in our Sleep Gummy Vitamins.

Propranolol can cause a significant decrease in blood pressure, especially when used at a high dosage. 

In a study published in the Journal of Clinical Hypertension, researchers tested propranolol on a group of more than 400 patients with mild to moderate hypertension. They found that the use of propranolol was associated with a 10.1 to 11 mmHg reduction in diastolic blood pressure.

The researchers also found that the decrease in blood pressure was significant in all propranolol doses after eight weeks of treatment.

Symptoms of low blood pressure include dizziness, lightheadedness, nausea, dehydration and unusual thirst, fatigue, difficulty concentrating, blurred vision, rapid breathing, chilled, pale skin, depression and an increase in sweating.

It’s important to inform your healthcare provider if you start to feel any symptoms of low blood pressure after using propranolol. 

Because propranolol and other beta blockers reduce your heart rate and blood pressure, they may reduce your maximal and submaximal exercise capacity.

While taking propranolol, you may notice that your heart rate is lower while running, cycling or during other forms of cardiovascular exercise. 

If you typically train for a target heart rate (for example, by monitoring your heart rate while you work out in order to improve your heart function or burn a certain number of calories), you may need to modify your target heart rate range while using beta blockers.

Propranolol is not a physically addictive, habit-forming medication. However, when propranolol is used to treat anxiety, it’s possible to become used to the feeling of relaxation that it provides, especially if you often experience performance or social anxiety.

If you feel like you’re overusing propranolol or relying on it unnecessarily, it’s important to inform your healthcare provider. 

No. Although propranolol is used to treat certain types of anxiety, it is not a benzodiazepine like alprazolam (Xanax®), diazepam (Valium®) and other anti-anxiety medications. 

You should not drink alcohol while taking propranolol. Drinking alcohol may increase the amount of propranolol in your body. This may increase your risk of experiencing side effects.

Propranolol is a nonselective beta blocker, meaning it can block the effects of stress hormones on beta-1, beta-2 and beta-3 receptors. Because of this lack of receptor selectivity, the effects of propranolol may also target tissues outside the heart. 

Propranolol may not be suitable for people with diabetes. As a type of nonselective beta blocker, it’s possible for propranolol to prevent the appearance of certain symptoms of hypoglycemia and potentially contribute to hypoglycemia during fasting.

If you have diabetes, it’s important to tell your healthcare provider before considering any type of beta blocker or other medication for anxiety. 

Yes. Many people experience performance anxiety before giving speeches or performing in front of others. Propranolol is widely used as a performance anxiety treatment by people who perform in public, from event presenters to musicians.

When it’s used as prescribed, propranolol is generally a safe and effective medication. However, like with any medication, it’s important to avoid using propranolol in a way that could affect your health and wellbeing. 

Before using propranolol, it’s important to inform your healthcare provider if:

• You have any preexisting health conditions, including asthma, heart disease, diabetes, liver disease, thyroid issues, severe allergies or any other medical condition.

• You use any other medications or supplements, including prescription medications or drugs available over-the-counter.

• You have heart failure, or have previously experienced a cardiovascular event such as a heart attack or stroke.

• You smoke cigarettes or use other products that contain tobacco and/or nicotine.

Yes. Propranolol can interact with a range of medications, including medications used to treat heart disease, depression, migraines, anxiety, ulcers and other conditions. These medications may increase or reduce the effects of propranolol, or contribute to dangerous side effects.

If you use other over-the-counter or prescription medications, it’s important to fully inform your healthcare provider before considering propranolol or any other beta blockers.

Since propranolol is no longer under patent protection, it’s mostly sold as a generic medication without a specific brand name.

It’s also been sold under the brand names Inderal® (the first name for propranolol), Deralin®, Inderalici®, Dociton®, Avlocardyl®, InnoPran XL®, Sumial® and others.

Propranolol is available as a tablet, an extended-release capsule and as a liquid solution. Each form of propranolol comes in several strengths. Make sure to check the type of propranolol you have before using this medication.

In clinical settings, propranolol may be used intravenously to treat atrial fibrillation. This form of propranolol is not typically prescribed for use at home. 

As a beta blocker, propranolol can help you to deal with the symptoms of performance anxiety and feel more comfortable on stage or in front of others.

We offer propranolol for anxiety online, following a consultation with a healthcare provider who will determine if a prescription is appropriate. 

You can also take action to overcome your anxiety and improve your mental wellbeing with our range of online mental health services, including psychiatry and individual therapy.