Metoprolol, a selective beta blocker commonly prescribed to help with cardiovascular health conditions, is used by many people to help with performance anxiety (more often referred to as ‘stage fright‘) symptoms.

As with any drug, there are some side effects with Metoprolol that you should be aware of. In this article, we are going to look at how Metoprolol works, what the side effects of Metoprolol are when using the drug specifically for treating performance anxiety symptoms and, finally, we’ll share some natural alternatives to Metoprolol that are less likely to have undesirable side effects and/or dangers while still offering the same anxiety-fighting qualities.

What is Metoprolol?

The brand name, over-the-counter version of Metoprolol is Lopressor. Sometime during the year 1978, the FDA approved the use of Metoprolol under the name Lopressor ^[1].

A video all about Metoprolol beta blocker and how it works for anxiety

Is Metoprolol a Beta Blocker?

As mentioned, Metoprolol (chemical name ‘Metoprolol tartrate’) falls under the drug class of Cardioselective beta blockers and is a β1 receptor blocker or “beta1-adrenoreceptor blocking agent”. In short: yes Metoprolol is a beta blocker.

As with other popular beta-blocker medications such as Propranolol and Carvedilol, Metoprolol requires a prescription from a doctor to acquire. Metoprolol is a widely used medication, and is prescribed around 27 million times each year in the United States.

Although Metoprolol is frequently used to treat high blood pressure and similar cardiovascular conditions, beta-blockers typically aren’t the first medications doctors would prescribe for such health conditions. They might start with other drugs, like diuretics, and only move on to beta-blockers if other treatments are ineffective. Beta-blockers are also often used in combination with other medications to treat hypertension ^[2].

Doctors may also prescribe Metoprolol to treat irregular heartbeats and to increase someone’s chances of survival after a heart attack or heart failure.

Metoprolol/Lopressor and other beta-blockers have also been shown to be useful when it comes to migraines, and for certain types of tremors caused by drugs used to treat mental disorders.

How Does Metoprolol work for Anxiety?

Metoprolol, and beta-blockers in general, work by reducing the stress on your cardiovascular system. They lower the force with which your heart has to pump blood, causing a relaxing effect.

Beta-adrenergic blocking agents (beta-blockers) block the effects of adrenaline, a hormone that binds to adrenergic receptors in your body ^[3]. There are adrenergic receptors in the heart called beta receptors and adrenaline, which is a stress-related hormone, binds to these beta receptors in the heart to make it pump harder and faster ^[4].

By blocking the release of these stress hormones, beta-blockers are preventing your heart from going into overdrive, which can keep your blood pressure low, lower stress on your cardiovascular systems and even (critically, for most people suffering from stage fright) keep your performance anxiety symptoms at bay ^[5].

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Fight-or-Flight Response

The reason you might be experiencing performance anxiety symptoms might be due to the effects of the adrenaline hormone. If your fight-or-flight response gets activated in a stressful situation (like before a speaking engagement, for example), then your adrenaline levels can spike, causing you to experience performance anxiety symptoms.

As we now know, Metoprolol works by blocking the effects of the adrenaline hormone ^[3]. Metoprolol is preventing adrenaline from binding with beta-receptors in your heart ^[4], which reduces the force with which your heart has to pump blood. Overall, this has a relaxing effect on your cardiovascular system.

So, when you take Metoprolol before a performance, exam, audition or date, you are effectively blocking the physical symptoms of performance anxiety from showing up. In the absence of the physical symptoms, you may find yourself in a more relaxed state, which then allows you to get through the high-anxiety scenario.

What are the Metoprolol side-effects?

Beta-blockers, in general, are pretty safe. But here are some of the potential, albeit rare, side effects of Metoprolol ^[1]:

• Irritability or mood swings
• Dry mouth
• Gut issues like gas, bloating, constipation
• Heartburn
• Nausea

Severe side effects are quite rare with Metoprolol, but if you experience any of the following symptoms after taking the beta-blocker, be sure to contact your doctor immediately:

• Shortness of breath
• Unexplained swelling of hands, feet, or ankles
• Fainting

What are the downsides of Metoprolol?

There are several known limitations that come with beta-blockers like Metoprolol when it comes to dealing with anxiety & stage fright ^[6]:

1. Metoprolol will always be a temporary solution for stage fright as it does nothing to address the root causes of your performance anxiety & stage fright. You’re applying a quick-fix to stop the physical symptoms (which may be all you need!).
2. You will need a prescription for Lopressor/Metoprolol, at least in the United States. So, you may need to visit your doctor every time you run out of Lopressor, which can become an inconvenience if you use the drug frequently.
3. In rare cases, beta-blockers like Metoprolol can cause dependency and if you make it a habit of using Metoprolol frequently, then you shouldn’t stop taking it too suddenly. Stopping abruptly might cause your blood pressure to spike, which can have negative consequences, so talk to your doctor if you want to stop the medication.

Prescription alternatives to Metoprolol for Anxiety

There are several other beta-blockers medications that perform the same role as Metoprolol, in regards to slowing down the release of adrenaline and lessening the physiological symptoms of anxiety and stage fright. The main alternatives include:

• Coreg/Carvedilol
• Propranolol/Inderal
• Atenolol/Tenormin
• Bisoprolol/Zebeta
• Acebutolol/Sectral
• Clonidine/Catapres

There’s also Valproic Acid (Depakote) but it’s not, technically, a beta-blocker although some have experienced similar results from it.

You may have better luck with the side-effects of these drugs. But, as they all fall under the same ‘beta-blocker’ umbrella, it is likely that any problems you have with Metoprolol will persist with another beta-blocker.

Natural Metoprolol Alternatives for Anxiety

With the potential risks and downsides of Metoprolol, as well as the risk of dependence when you take any drug habitually, it may be best to consider which natural alternatives to Metoprolol can provide the same benefits for performance anxiety.

Many foods, minerals and dietary supplements have similar properties as beta-blockers like Metoprolol, in terms of lowering the negative effects of stress and anxiety.

The major difference is that natural beta-blockers are less likely to have detrimental side-effects, and carry a lower risk of dependence or addiction. They’re also more widely available, as you do not need a prescription, and almost all are beneficial to your health in more areas than one ^[7].

Here are some notable natural Metoprolol alternatives that you can consider trying:

GABA

Gamma-Aminobutyric Acid, shortened to GABA, is a naturally-occurring amino acid that acts as a neurotransmitter within the body. GABA has been shown in numerous studies to have a calming effect, and GABA deficiency is believed to play a part in several anxiety disorders ^[8].

Studies that used GABA supplementation have found it may have a positive effect on stress and anxiety ^[9], which would help block the symptoms associated with performance anxiety.

L-theanine

L-theanine is an amino acid well known for its relaxing properties ^[10]. Studies have shown that L-theanine may decrease the severity of stress-related symptoms in test subjects, while also increasing cognitive performance ^[11].

Taking L-theanine, therefore, may help people counteract the nerves that come with performance anxiety, while also providing better focus during their performance.

L-theanine can be taken in supplement form, and is also present in green, black and oolong teas, as well as some mushrooms.

L-arginine

Another natural amino acid, L-arginine effectively lowers blood pressure, and may provide relief from the symptoms of hypertension and even some forms of heart disease ^[12][13]. L-arginine increases the release of nitric oxide in the blood, causing blood vessels to open which allows blood to flow more freely.

More research is necessary to show whether or not L-arginine also proves effective for nerves and anxiety the same way beta-blockers like Metoprolol do.

L-arginine can be found in supplement form, as well as found in red meat, dairy, poultry and fish.

Garlic

Garlic can be a natural alternative to Metoprolol, providing many of the same positive effects to cardiovascular health and blood pressure.

Studies have shown garlic extracts having significant beneficial effects on hypertension ^[14]. Garlic works in much the same way as L-arginine, stimulating the production of nitric oxide and relaxing blood vessels ^[15].

Whether the anti-hypertensive benefits of garlic provide benefits for performance anxiety is unproven. However, garlic’s ability to replicate the effects of prescription beta-blockers is very promising.

Natural Anxiety Supplements

Some dietary supplements contain a mix of ingredients that support focus, calm and cognition, which may counteract the negative side-effects of performance anxiety and stage fright.

One example that I personally like and recommend to clients is PerformZen, which contains GABA, L-theanine and Magnesium, as well as cognitive-enhancing ingredients Ginkgo Biloba, Vitamin B6 and Theacrine. These ingredients have been shown to help induce a calming effect on the body, as well as keeping the brain as sharp as it needs to be during your performance. I even interviewed the founder of PerformZen and secured a limited-time discount for PerformanceAnxiety.com readers. Check that out here.

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Does a Natural alternative to Metoprolol exist?

Performance anxiety, stage fright, and similar conditions are not fun to deal with. It’s even worse when you’re commonly asked to perform in high-pressure situations, especially when this is your profession.

While many people are using Metoprolol off-script to help with their performance anxiety, there are many natural ways to treat those same symptoms, or even to prevent the cause of performance anxiety itself. With amino acids like GABA and L-theanine, cognitive-enhancing supplements like PerformZen or physical relaxation techniques, you can have a go-to technique to fight off nerves and perform without anxiety.