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Nebivolol For Anxiety And Stage Fright – Everything You Need to Know

Last Updated: May 11, 2024

Nebivolol is a prescription beta blocker that is prescribed under the OTC brand name Bystolic in order to treat heart conditions and to assist with cardiovascular conditions like hypertension and irregular heartbeat. Many professional performers like musicians, singers, speakers and actors use beta blockers like Nebivolol ‘off-script’ to help with their performance anxiety and stage fright symptoms before, or during, a performance. In this article we will take a look at the beta blocker Nebivolol, and try to understand why so many celebrities and performers are using the beta blockers to help with their anxiety, see what the recommended dosage is, while also reviewing any downsides and side-effects to the medication. We even take a look at some natural alternatives for those who don’t want to use a prescription medication like Bystolic to help overcome their fears and anxieties.

Nebivolol For Anxiety & Stage Fright

Are you considering using Nebivolol to help with anxiety issues (particularly social anxiety or performance anxiety/stage fright) because you get a bad case of the jitters when its time to jump on stage or on camera and perform in front of an audience?

Perhaps your heart starts racing, your hands tremble, and you start sweating profusely; to the point where it affects your ability to think clearly and perform at an optimal level?

Or maybe you’re not a “professional performer” like a musician, public speaker, or a comedian; but you still experience disturbing jitters in high-pressure situations like job interviews, tests & exams, or in social events like parties or romantic dates.

If any of this sounds familiar, then you should know that you’re not alone. Performance anxiety, also called stage fright, is a (very) common phenomenon that affects millions of people around the world. Performance Anxiety stems from the fear of being judged negatively because of your performance; even if it’s irrational/illogical and there’s no real evidence to justify the fear.

Stage fright is especially prevalent among professional musicians, public speakers, stand-up comedians and even celebs like Adele and Khloé Kardashian. And many of them turn to Nebivolol and beta blocker drugs to help them manage those anxiety issues.

In this article we’re going to investigate what Nebivolol/Bystolic and beta blocker drugs are, uncover how they work, see why performers of all types use Nebivolol, analyze any downsides and side-effects, and see if there are any alternatives that are as good as (or better then) Nebivolol for managing performance anxiety symptoms.

Nebivolol for Anxiety Key Takeaways

If you're looking for a quick, scannable summary of the rest of this article, here are several key takeways about Nebivolol for Anxiety:

  • Nebivolol is a prescription beta-blocker drug typically prescribed for treating heart and cardiovascular conditions. Nebivolol works by suppressing or completely blocking the effects of adrenaline, the stress hormone associated with our fight-or-flight response. Nebivolol is commonly used off-script to help people manage their anxiety and stage fright issues
  • Compared to other beta blockers like Propranolol, the tolerability of nebivolol has been shown in studies to be superior to that of other variations like Atenolol and Metoprolol
  • Nebivolol is also the only beta-blocker known to induce the production of nitric oxide, particularly relevant in hypertension, where nitric oxide dysfunction occurs

What Are Beta Blockers?

Nebivolol is part of a class of drugs called beta blockers. Beta blockers are a prescription medication typically used to treat heart conditions.

Beta blockers, full title beta-adrenergic blocking agents, effectively slow down the heart and reduce blood pressure. They work by suppressing/blocking the effects of epinephrine, or adrenaline, the stress hormone associated with our “fight or flight” response [1].

Beta blockers are most commonly prescribed to treat heart and cardiac related issues, including angina, arrhythmia, heart failure, migraines and hypertension (high blood pressure). By blocking the release of adrenaline, beta blockers are helping to regulate heart rate and blood pressure, thus providing relief for the aforementioned conditions [2][3].

How do Beta Blockers Work for Anxiety?

Beta blockers are extremely popular as a ‘anxiety pill‘ and are used off-script (meaning for a reason other than what is prescribed or approved) by many people to help treat their anxiety symptoms. Some doctors may sometimes prescribe beta blockers to use for anxiety, but it is often a ‘last-resort’ option once other treatments have been tried and found ineffective.

When a person experiences anxiety, particularly social anxiety and performance anxiety (aka stage fright), it often comes with an elevated stress response. This stress response triggers a release of adrenaline, which is released into the bloodstream, causing an increase in heart rate and blood pressure, as well as symptoms like rapid breathing, sweating, nausea and trembling [1].

Beta blockers suppress adrenaline, and thus help suppress the physiological symptoms of social and performance anxiety. So while beta blockers don’t directly treat anxiety, they may help reduce the severity of how someone experiences bouts of anxiety or panic attacks.

What is the beta-blocker Nebivolol?

What is Nebivolol?

Nebivolol is one of several commonly prescribed pharmaceutical beta blockers. More accurately, Nebivolol is a novel beta1-blocker. Beta-1 blockers exert their effect by binding to the beta-1 receptor sites selectively and inhibiting the action of epinephrine and norepinephrine (adrenaline and related hormones) on these sites [4].

Like other Beta Blockers (such as Atenolol, Metoprolol and Propranolol) Nebivolol is most commonly prescribed for heart-related & cardiac conditions such as hypertension, angina, and signs of congestive heart failure.

Compared to other beta blockers, the tolerability of nebivolol has been shown in studies to be superior to that of Atenolol and Metoprolol [5]. Nebivolol is also the only beta-blocker known to induce the production of nitric oxide, particularly relevant in hypertension, where nitric oxide dysfunction occurs [6].

Nebivolol is commonly available with a prescription under the brand name Bystolic.

Recommended Nebivolol Dose For Anxiety

Nebivolol is taken orally in tablet form, recommended with or without food. Recommended nebivolol dosage for high blood pressure in adults is 5 milligrams (mg) once per day. For adolescents, usage and dosage must be determined by your doctor [7].

As stated, Nebivolol is primarily prescribed as a beta blocker for heart-related and cardiac conditions, rather than for anxiety. While Nebivolol can sometimes be used off-label for anxiety symptoms, it’s important to note that the effectiveness and appropriate dosage may vary depending on the individual and their specific situation.

That said, the recommended Nebivolol for anxiety dosage ranges from 2.5 milligrams (mg) to 10 milligrams (mg) per day, as a single dose.

Before deciding to take nebivolol/Bystolic for anxiety, it is crucial to consult with a qualified healthcare professional, such as a doctor or psychiatrist, who can assess your condition and provide personalized recommendations. They will consider your specific needs and monitor your response to the medication to ensure its effectiveness and safety.

Please note that the information provided here should be considered for general knowledge purposes and should not be considered as medical advice. Always speak to a licensed healthcare professional before using any medication to assist with health conditions. With nebivolol it’s important to check with your doctor that the intended dosage is safe, and will not cause issues with any other medication or health issues you may have, amongst other precautions.

Are There Any Downsides or Side-effects To Using Nebivolol For Anxiety?

Nebivolol, and beta blockers as a class of drugs, are generally considered to be safe, especially if only taken occasionally before big performances such as speeches, exams, or job interviews.

But when individuals start performing on a more frequent basis, and they find that Nebivolol is really helping them manage their jitteriness and anxiety issues (essentially creating a short-term positive feedback loop), they may start using the drug more regularly.

If you’re considering using Nebivolol on a more regular basis, then you should be aware of the potential downsides of Nebivolol, and beta blockers in general [8].

With Nebivolol, individual reactions to the medication may differ, and not everyone will encounter side-effects. Generally speaking, potential side-effects of nebivolol can include:

  1. Fatigue or tiredness: Nebivolol has the potential to induce feelings of fatigue, drowsiness, or weakness, potentially impacting energy levels and alertness.
  2. Dizziness or lightheadedness: Some individuals may experience dizziness or lightheadedness while taking nebivolol, necessitating caution when changing positions quickly or engaging in activities requiring balance.
  3. Cold extremities: Nebivolol’s mechanism as a beta blocker can reduce blood flow to the extremities, resulting in cold hands and feet (this can happen with the usage of other beta blockers like Propranolol & Atenolol, as well).
  4. Reduced heart rate: Nebivolol, as a beta-blocker, can lower heart rate, potentially leading to bradycardia (a slow heart rate), which may be more noticeable in individuals with pre-existing heart conditions.
  5. Sexual dysfunction: In some cases, individuals may encounter sexual side effects such as decreased libido or difficulties achieving or maintaining an erection when consistently using Nebivolol, although nebivolol is generally considered the least ED inducing beta-blocker as it has a slight nitric oxide effect.
  6. Gastrointestinal issues: Nebivolol can occasionally trigger digestive symptoms like nausea, abdominal discomfort, or diarrhea.

Do note that this list of side effects is not exhaustive, and there may be other rare or severe reactions associated with Nebivolol. For a comprehensive understanding of potential risks and side effects specific to your medical history and circumstances, it is advisable to consult a healthcare professional before using the medication, and check-in with them regularly if using nebivolol consistently over longer periods of time.

Nebivolol Does Require A Prescription

Nebivolol is a prescription medication. It is classified as a beta-blocker and is typically prescribed by a healthcare professional, such as a doctor or a cardiologist, to treat conditions like hypertension (high blood pressure) and heart failure.

Due to its mechanism of action and potential side effects, it is necessary to consult a healthcare professional who can assess your specific medical condition, take into account any other medications you may be taking, and determine the appropriate dosage and treatment plan for you. They will evaluate your health history and consider any contraindications or precautions before prescribing Nebivolol or any other beta blocker or medication.

How effective is Nebivolol for anxiety?

The effectiveness of nebivolol for anxiety symptoms really depends on the individual using the medication — its effectiveness can differ drastically from person to person.

There is limited clinical evidence specifically supporting nebivolol’s use in treating anxiety disorders, but as a beta blocker drug primarily prescribed for hypertension and heart failure, it has been shown to be an effective drug in studies with minimal side-effects.

The same studies do show that Nebivolol does have a significant effect on heart rate and inhibition of the sympathetic nervous system as part of the mechanism that assists with hypertension and heart/cardiac issues for study participants, through prohibiting or lowering the release of stress hormones like adrenaline (which is exactly what makes beta blockers effective for reducing or sometimes eliminating stage fright & performance anxiety symptoms in the first place) [9].

In short: Nebivolol is just as effective as other beta blockers at assisting with anxiety symptoms, perhaps better in some cases due to the drugs slight nitric oxide effect [9].

Natural Alternatives to Nebivolol for Anxiety

Let’s take a look at some of the natural alternatives to beta blockers like Nebivolol.

The obvious advantages to natural alternatives are that you don’t need a prescription, and alternatives are only worth considering if they are beneficial to your health.

Another benefit to natural beta blocker alternatives is that they should strengthen your mind and body to be less susceptible to stress, and better equipped to handle a stress response overall. So instead of artificially blocking the release of adrenaline with beta-blockers, you will be releasing less adrenaline in the first place, and therefore experiencing less performance anxiety [10].

Nebivolol Alternative #1: Brain Boosting Supplements

The most obvious natural alternative to beta-blockers, in my book, is using an performance-anxiety-targeting supplement like PerformZen. I recommend PerformZen to many of my clients, and even had an interview with the founders where I share my own review of the supplement. You can check that out here.

PerformZen uses natural ingredients like GABA, L-theanine, and others, to reduce stress and help you remain calm under pressure [11]. There are also other ingredients like magnesium and vitamin B6 that work together to increase mental focus [12].

So, you get the best of both worlds. On one hand, you feel calm and relaxed, and on the other hand, you’re better focused so you can concentrate and deliver a great speech or performance.

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Nebivolol Alternative #2: Green, Black, & Oolong Tea

Green, black, and oolong tea are excellent sources of L-theanine. And L-theanine is one of the ingredients that increases the availability of GABA in your brain. GABA helps you feel more relaxed by reducing excess activity in your brain [13].

So, before a performance or high-anxiety situation, a nice cup of tea can calm the nerves by reducing excessive mental chatter and helping you focus on your performance more constructively.

Nebivolol Alternative #3: Diaphragmatic Breathing

‘Diaphragmatic breathing’ or Deep Belly Breathing is the process of taking long breaths in and out of your stomach (‘belly’), instead of your chest. It’s the type of breathing that is the foundation for most meditation or relaxation techniques.

When you’re experiencing a stress response, your body switches gears. It turns on something known as the sympathetic nervous system (which admittedly is a strange name for how it feels).

Diaphragmatic breaths deactivate the sympathetic nervous system and switch the body back to the parasympathetic nervous system. It brings your blood pressure down and restores equilibrium in your body [14].

Next time you start feeling jittery before a performance or nervous in a social setting; find some privacy, close your eyes, and start taking deep breaths into your stomach. Repeat until you feel your heart rate returning back to normal. Take a look at our Tactical Breathing guide for more guidance on this technique.

Final Thoughts on Nebivolol as a Treatment for Anxiety Issues

With the tools and medications available today, it’s no longer necessary to let anxiety control your life/career and prevent you from doing the things you love — especially if that’s performing for an audience or operating in high-pressure scenarios.

Beta blocker medications like nebivolol can provide a much-needed relief from the physical anxiety symptoms so you can get through what you need to do. But Nebivolol, or similar medications like Depakote or Clonidine, will never be the complete solution you’re really looking for, which is to not be fearful about performing in front of an audience in the first place.

To overcome performance anxiety in the long term, consider natural alternatives like teas high in L-Theanine, diaphragmatic breathing, and/or a natural alternative supplement like PerformZen.

In the meantime, If you are considering Nebivolol as a short-term fix for your anxiety symptoms, be sure to consult with your doctor to make sure that the drug is right for you.

Take a look at our other beta blocker articles:

Bisoprolol for Anxiety
Over the counter beta blocker substitutes
Propranolol vs Bisoprolol Beta-Blockers for Anxiety
Propranolol for Public Speaking Anxiety
Propranolol vs Metoprolol for Performance Anxiety - which is best?
Propranolol For Anxiety Ultimate Guide

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PerformanceAnxiety.com Owner & Lead Writer

Anita is the owner and lead writer for PerformanceAnxiety.com. A seasoned musician and public speaker herself, she is no stranger to the very real fear and anxiety that can strike right before a high-pressure situation. That's why Anita is passionate about writing content that helps people learn about and overcome their anxieties & social fears so that they can perform at their best when it counts and live anxiety-free lives.