Performance anxiety, or stage fright, is a rarely talked about, yet very common affliction. According to some estimations, 40 percent of Americans have experienced some form of performance anxiety or stage fright .
In some cases, this is a one-off, and the person never thinks about it again. For others, performing or speaking in front of a crowd is a regular thing – for example for musicians or other professional performers.
There are a number of treatments for the symptoms of performance anxiety, which a lot of people rely on to get them through a speech, interview, gig, or otherwise. These treatments range from lifestyle changes, to dietary choices and supplements, to pharmaceuticals.
Propranolol is one of these, which may be prescribed by a doctor if you suffer from regular bouts of anxiety. Yet anxiety is not the originally intended use for Propranolol, so there are some things you should know before taking it to try and treat your condition.
Read on and we’ll briefly cover how Propranolol works, and let you know the common dosage and all other relevant information you need to know before taking Propranolol for performance anxiety.
How Propranolol works for anxiety
- Angina (chest pain)
- Arrhythmia (irregular heartbeat)
- Hypertension (high blood pressure)
Propranolol slows the heartbeat and lowers blood pressure, by blocking the release of the hormone epinephrine (commonly known as adrenaline), which has the opposite effect. When adrenaline is released, the heart beats faster, more blood gets pumped around the body, and for some people, undue stress is caused to the heart and cardiovascular system.
It just so happens, adrenaline is also the cause of many of the physical symptoms of anxiety and stage fright. The reason we experience high blood pressure, sweating and rapid breathing before a performance or social setting is our body’s “fight or flight” response, a natural process of the nervous system designed to help us survive dangerous or threatening situations.
When our brain interprets that we may be in danger, it kicks the fight or flight response into action, which releases a flood of adrenaline into the bloodstream .
With anxiety disorders, our system incorrectly interprets some situations, such as a performance, as a life-threatening situation, and thus starts to release adrenaline into the bloodstream. This results in symptoms synonymous with anxiety, such as trembling, sweating, and high blood pressure.
Propranolol counters by slowing the rate at which adrenaline is released, and thus providing relief for many of the unwanted and unnecessary physical symptoms.
So, while Propranolol does not address the root causes of anxiety, it can be effective in treating and reducing the symptoms, which can get in the way of a performance or produce a degree of discomfort in social settings.
Is Propranolol safe?
Generally speaking, Propranolol is safe, including for long-term use . While taking beta-blockers for anxiety is often done “off-script”, meaning for something other than the original use, doctors do prescribe Propranolol to treat anxiety.
While there are no major risks, there are some side-effects that come with Propranolol. It’s common to feel slight dizziness or light-headedness, due to how the drug lowers your blood pressure.
It can also have interactions with other medicines, and may not be suitable for people who already have low blood pressure, or people taking other medicine for high blood pressure.
There is also a risk of withdrawal if taken for a long time and abruptly stopped. The symptoms of withdrawal are consistent with a spike in blood pressure, and can be serious . For this reason, it’s recommended to taper off over a period of four to seven days after long-term use .
Propranolol dosage for anxiety
Much of the dosage information you’ll find for Propranolol are for treating heart conditions and high blood pressure. Thus, it’s vital that you understand the recommended Propranolol dosage for anxiety, if this is the reason you’re taking it.
Propranolol in tablet form ranges in strength from 10mg tablets to 160mg. It also may be prescribed in liquid form, however this is most often used for infants, so we’ll stick to Propranolol in tablet form here.
Adult doses for things like hypertension, angina and arrhythmia generally range from 40mg to 320mg per day, depending on the condition . That may be split into several doses per day.
These doses are likely to be overkill for anxiety however, and increase the risk of negative side effects, dependence and withdrawal symptoms, without any significant benefit.
The recommended Propranolol dose for anxiety is between 10mg to 40mg. 10mg may be enough to see relief from your symptoms. If not, it is generally safe to increase the dosage up to 40mg. However, keeping to the smallest dose that proves effective will help minimize any side effects.
Be aware, this is just a guideline, and not medical advice. Pay attention to the dosage prescribed by your doctor, as you may have other medical conditions or prescriptions that have to be taken into account.
When to take Propranolol for anxiety
If you take Propranolol for performance anxiety and stage fright, you can take it only when necessary for the relief of performance anxiety symptoms. There’s no need to maintain a regular dose. In fact, doing so increases the risk of harm, specifically withdrawal.
Take your dose approximately one hour before the event, performance or whatever reason you need relief. Propranolol can be taken with or without food, so there is no need to worry about timing it with your meals.
Standard release vs sustained release
Note that Propranolol tablets come in two forms: standard release (also referred to as immediate release) and sustained release.
Standard release tablets are absorbed by the body and start working almost right away, whereas sustained release tablets dissolve slowly, and continue to be absorbed throughout the day.
Sometimes sustained release tablets are prescribed for conditions that require consistent treatment, as they don’t need to be taken as often. However, for performance anxiety, you need immediate relief, so only standard release tablets should be considered.
How fast does Propranolol start working?
Propranolol generally provides relief from symptoms within 30 to 60 minutes. This may vary from person to person, depending on factors like body composition, dose, severity of symptoms, and more.
For some people it may start working in as little as 20 minutes, or in rare cases, several hours.
For performers, it’s best to take your dose around an hour before you need it, to give enough time for it to kick in.
How long does Propranolol last?
The exact length will vary from person to person, but for most, the effects of Propranolol last for around four hours.
The half-life of Propranolol is between 3-6 hours . Half-life means the time it takes for half of the drug to be processed and no longer active in your body.
Small amounts of Propranolol may remain active for as long as one or two days, so in rare cases, side effects may remain for this length of time.
Is Propranolol the best solution for performance anxiety?
Propranolol certainly shows efficacy in treating the physical symptoms of anxiety, particularly those of performance anxiety and stage fright. Doctors even prescribe it for this use, and it’s quite commonly used by classical musicians to treat anxiety during a performance .
Is it the best way to deal with performance anxiety, though?
Lifestyle changes, if possible, should always be preferred. Try breathing exercises, yoga, meditation, or cognitive-behavioral therapy to address the root issues of your condition. Fear Setting is an interesting exercise for overcoming stage fright, recently made famous by the author Tim Ferris.
Alternatively, if you need immediate, short-term relief, natural alternatives may provide similar benefits to beta-blockers like Propranolol, with less risk of side-effects, dependence or withdrawal.
Cognitive-enhancing supplements like GABA and L-theanine may help boost mental clarity and help you de-stress before a performance . Additionally, supplementing with certain vitamins and minerals, such as Magnesium and Vitamin B6, may be effective in reducing even severe cases of stress .
Another natural solution, PerformZen, has proved extremely effective in my experience at treating performance anxiety. This supplement features a combination of the four ingredients mentioned above, as well as Theacrine, which aids mental clarity and energy, and Ginkgo Biloba, which is an effective stress reducer .
This combination provides the positive calming effects of Propranolol, but also boosts alertness and mental clarity, which are more subtle symptoms of performance anxiety that beta-blocker drugs do not address.
This may mean a natural solution such as the one above is not only safer, but more effective than beta-blockers for performance anxiety.
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Final thoughts on the right Propranolol dosage for anxiety
The effective dose for Propranolol will vary from person to person, as each person’s body is likely to react to it a little differently. However, you can generally expect a dose from 10 mg to 40 mg to provide sufficient relief.
It’s important to understand that the Propranolol dose for anxiety is much less than that which is recommended for many other conditions, such as angina or hypertension.
Be sure to follow your doctor’s advice when taking Propranolol, and if you’re concerned about the side effects or risk of withdrawal, consider trying a natural alternative.
- ^ https://www.consumerreports.org/cro/2012/04/can-you-treat-stage-fright/index.htm
- ^ https://www.mayoclinic.org/diseases-conditions/high-blood-pressure/in-depth/beta-blockers/art-20044522
- ^ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3056281/
- ^ https://www.nhs.uk/medicines/propranolol/
- ^ https://pubmed.ncbi.nlm.nih.gov/436208/
- ^ https://www.ahajournals.org/doi/pdf/10.1161/01.CIR.58.2.202
- ^ https://www.drugs.com/dosage/propranolol.html
- ^ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6327687/
- ^ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5618811/
- ^ https://pubmed.ncbi.nlm.nih.gov/17182482/
- ^ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6298677/
- ^ https://performzen.com/