Depending on your experience with the prescription drug, Propranolol (sold over-the-counter as Inderal) is potentially one of the best things to happen for those suffering from anxiety of different forms (social anxiety, performance anxiety, etc.) or… one of the worst!
In my time working with clients suffering from performance anxiety and generalized anxiety issues, as well as in writing about propranolol here on PerformanceAnxiety.com (see ‘Propranolol vs Metoprolol for Anxiety‘ & ‘Ultimate Guide To Propranolol‘ & ‘Propranolol Dosage For Anxiety‘) I have come to learn that while Propranolol is widely-used — being the most commonly prescribed beta-blocker medication in the US and also the drug most commonly used by those I have surveyed as an off-script aid for anxiety-related issues — it is not without its detractors and critics.
A recent client of mine had been experiencing some fairly severe side-effects from Propranolol since she started using the beta-blocker several years ago, and had gone on a deep-dive to see if she was alone with her experiences. She pulled up as many Propranolol reviews as she could find that leaned towards, or plainly mentioned, using propranolol for anxiety purposes, and she forwarded them all to me in a neatly-formatted google doc. I asked her permission to share my feedback on all of these propranolol reviews for anxiety purposes here in article format, so that others might also be able to understand Propranolol, it’s side-effects & potential downsides, and ultimately judge for themselves if they want to use Propranolol to help with their own anxiety symptoms. My client obliged, so below I will go through some of the propranolol reviews that I found, offer my thoughts and feedback and link through to the reviews source so you can read further, if you like.
But first, it’s worth explaining what Propranolol is, how it works and why it’s so popular amongst performers and those who regularly face high-anxiety situations (think those who perform in front of crowds for a living like public speakers & actors facing auditions)…
What is Propranolol?
Propranolol is the most commonly prescribed beta-blocker medications in America. Beta-blockers, which have the full medical name beta-adrenergic blocking agents, work by blocking the effects of adrenergic hormones in the body; the main one being adrenaline .
Doctors typically prescribe beta-blockers to treat various heart conditions, if lifestyle adjustments fail to do the job.
Here are some of the typical conditions for which your doctor might recommend a beta-blocker like Propranolol :
- High blood pressure
- Irregular heartbeat
- Angina (chest pain)
Beta-blockers can help those with cardiovascular issues by influencing the force with which your heart pumps blood.
Sometimes, beta-blockers like propranolol are also prescribed for conditions like migraines, and harmless tremors of the arms, hands, etc . Propranolol is sold over the counter in the US under the following brand names:
- Inderal LA
- Inderal XL
Propranolol requires a prescription from your doctor, whether you need it for a heart condition, or you’re considering beta-blockers for performance anxiety .
Why is Propranolol so popular amongst professional performers?
In a, now famous, 1987 survey by the International Conference of Symphony Orchestra Musicians, representing some of the largest orchestras in the U.S., it was found that 27 percent of their participating musicians were using beta-blockers for performance anxiety . Many experts assume that this number is much higher today.
Beta-blockers like Propranolol block the effects of adrenaline and prevent it from binding to the beta receptors in the heart. This has an overall calming effect on the heart and the force with which it has to pump blood. Consequently, the heart can return to its regular workload, and your blood pressure can remain steady .
An exaggerated stress response like what a performer experiences when suffering from performance anxiety, is associated with a dramatic spike in adrenaline.
So, by blocking the effects of adrenaline, you are preventing it from binding to the beta receptors in the heart. So, beta-blockers essentially block the physical symptoms of performance anxiety.
When you take a beta-blocker like Propranolol, it can slow your heart rate, reduce the trembling and sweating, and regulate your breathing and blood pressure. It can help you feel relaxed, essentially negating the stress response to help you get through any performance or high-anxiety situation.
You can easily see why a performer would find massive value in being able to block performance anxiety or stage fright, almost on-demand, using propranolol!
It is worth noting that each individual is different, especially when it comes to causes of anxiety. We also vary widely in symptoms, the severity of those symptoms, and how we react to specific medications. So, how you respond to a beta-blocker can be different from someone else .
What are the commonly known side-effects of Propranolol?
While Propranolol is a commonly prescribed drug, and shows efficacy (effectiveness) for a number of conditions (including anxiety), it does have some reported side effects.
These side effects may vary in intensity from person-to-person. Depending on the severity of the condition Propranolol is prescribed for, the side effects may be worth it. In other cases, these side effects may be enough to make people want to consider alternative treatments to beta-blockers like Propranolol.
Here are several reported Propranolol side effects :
- Dizziness or feeling lightheaded
- Fatigue or weakness
- Dry eyes
- Cold fingers and toes
- Stomach pain
- Diarrhea or constipation
- Low heart rate
- Low blood pressure
- Trouble sleeping or vivid dreams
- Decreased sex drive
- Mood changes or depression
- Memory loss
- Anaphylaxis (allergic reaction)
It has been estimated that at least 1 in 100 people experience some form of side-effect when taking Propranolol .
Propranolol can cause light-headedness and fatigue, due to the way that Propranolol reduces heart rate and blood pressure. This also slows circulation, which can lead to coldness in the fingers, hands, toes and feet in more serious cases.
Additionally, side effects such as personality or mood changes, and memory issues can happen because Propranolol slows the release of certain hormones, such as epinephrine (adrenaline).
These hormones, released as part of the bodies fight or flight response, also act as neurotransmitters . Thus, when you alter the release of these hormones, you may encounter neurological issues.
Altogether, these side-effects are generally pretty rare, but do occur in some cases.
Is there a risk of addiction/dependence with Propranolol?
Propranolol is not considered to be a physically addictive substance. Yet there is still a risk of developing a psychological dependence to this drug .
The risk is likely to be greater for someone taking Propranolol for anxiety, particularly professionals who rely on the calming effects of Propranolol on a regular basis.
While it’s not a widely discussed issue, there are cases reported of Propranolol abuse, most commonly due to the positive effect it can have on symptoms of anxiety .
A more common issue is Withdrawal symptoms when stopping Propranolol abruptly, or after taking Propranolol for a long time. Studies have shown symptoms such as chest pain, headache, palpitations and sweating from Propranolol withdrawal . You may also experience a dangerous spike in blood pressure and/or heart rate when going off it all of a sudden .
If you do stop taking Propranolol, you should consult with a medical professional first, in order to discuss a plan to safely get off your medication. A taper-down period of four to seven days is often recommended to avoid any withdrawal issues .
Propranolol For Anxiety Reviews
Considering that Propranolol is the most prescribed beta-blocker in the US, it should come as no surprise that there’s now plenty of Propranolol reviews available online. As I mentioned at the top of this page, I honed in on the reviews that are focused on Propranolol being used for anxiety purposes (sometimes the review just out-right states this, other times I extracted this context myself) and below, I’m going to share these reviews and provide some feedback from the perspective of a professional who helps clients overcome their anxieties and perform/operate at their best.
Propranolol Review #1: Panic attacks, anxiety, tachycardia and public speaking
I was prescribed propranolol because I was experiencing seemingly random panic attacks, as well as for generalized anxiety coupled with being mildly tachycardic (110bpm resting). All three of these have been completely quashed by the drug. The anxiolytic effect is from it suppressing your adrenergic system, which all but eliminates the “fight or flight” fear response. This also makes it very useful for public speaking engagements. Unlike benzodiazepines, it won’t address the mental aspect of the anxiety but rather the physical, allowing me to rationalize my way out of it.
So let’s talk side-effects. In the short term, I experienced an unusual loquaciousness — a strange urge to vocalize ALL of my thoughts, even when no-one else was present. This passed with time. I also experienced restless legs for a good while.
Long term, I feel like it has affected my memory. Time feels like it’s going way too fast and I have some trouble recalling memories. I’m told this is reversible and indeed, when I took a little break from the daily pills my memory did return much more clearly. I’ve also been experiencing shortness of breath from even slight amounts of physical activity, as it artificially lowers your heart rate/blood pressure meaning that your heart can’t quite keep up with your body’s demand for oxygen under strain.
My anxiety was quite crippling so I feel that to be rid of it is more than worth the side effects. I couldn’t speak to people, couldn’t get a job, and I was an alcoholic from trying to self-medicate. It’s solved these problems for me at minimal “cost” so I’m quite satisfied with the results. Yours may vary of course.
This is one of the propranolol reviews that stuck out to me the most. The main reasons being the initial intended use of helping with random panic attacks, as well as generalized anxiety and mild Tachycardia (a condition where your heart rate is regularly more than 100 beats per minute ) and the mention of propranolol being useful for public speaking engagements.
As the reviewer mentions, Propranolol worked to helped solve their generalized anxiety, random panic attacks and mild Tachycardia — but came with some pretty severe side-effects that make it arguable if the medication was worth using, or if the person should consider some Propranolol alternatives.
The user mentioned “unusual loquaciousness”, or a desire to vocalize all of their thoughts while using Propranolol. To be honest, this is the first time I have heard of such a side-effect, but I suspect this was just the reviewers unique way of describing unusual mental quietness, which is an effect I’ve experienced when using propranolol myself, or listening to my clients experiences doing so. For most people, our minds are constantly racing with numerous thoughts at differing levels of consciousness (imagine holding a broad to-do list for your day, information about an ongoing conversation you’re having over messages with your friend, thoughts and plans about the current days work you’re currently engaged in plus 15 other data points, all at once. Our minds are fast-driving engines from birth until death, looked at through a certain lens). If we quieten all this mental noise down, we’re left with an unusual level of clarity that, for some, might leave them excited and “chatty” about this hyper-clear thought!
The effects on memory can happen, but there are other lifestyle choices that can be a much stronger catalyst for things like this (poor sleep being a major one) so there is a chance that the reviewer over-attributed this to Propranolol. Shortness of breath linked with lowered blood pressure caused by Propranolol also sounds likely, but the same issue of over-attribution could be occurring too.
It’s unfortunate to hear about the reviewers stints with alcoholism and job issues experienced due to their anxiety issues, so I am glad to hear that Propranolol was relatively effective in solving some of their problems. I would heavily consider looking at beta-blocker alternatives for this particular reviewer, to help with these severe side-effects.
Propranolol Review #2: The Propranolol Evangelist
“For those of you like me who suffer severe performance/social anxiety, including rapid heartbeat, shaking, struggling to speak etc… this drug is a perfect fix. It stops your body from being overrun with adrenaline which enables you to come across calm and composed. It’s so effective. Good luck to all those who suffer with this condition as it can really impact ones life.”
This reviewer was obviously happy to have found a solution to their performance anxiety issues! In our article about Propranolol vs Metoprolol for anxiety, we revealed that propranolol does work just as the reviewer states for performance anxiety:
…beta-blockers like Propranolol and Metoprolol work by blocking the effects of adrenaline. They reduce the force with which your heart pumps blood and help stabilize blood pressure, heartbeat, etc .
Beta-blockers keep the jitters at bay in a similar manner, by blocking the effects of adrenaline.
The reason you experience extreme nervousness before a performance is because your body goes into survival mode.
Even though you’re not in actual physical danger, the fear of rejection, humiliation, failure, etc. is strong enough to the extent that your brain perceives the situation to be a real threat.
Your body reacts with what is known as a stress response . It shuts down any functions that aren’t necessary for survival (which is why you get that gut-wrenching feeling), and gets ready to fight, or run fast, to survive.
That is why your heart starts racing, your palms get sweaty, and your blood pressure skyrockets.
When your body goes into survival mode, it releases stress hormones, including adrenaline. And it is the adrenaline that is responsible for ramping up your cardiovascular system to the point where it results in the jittery symptoms of stage fright.
And by blocking the effects of adrenaline, beta-blockers help your heart maintain its natural rhythm and prevent anxiety symptoms.
Propranolol Review #3: Effects on blood pressure
“I have been on this med for over 10yrs and now my doctor is telling me I have low blood pressure so he has taken me off Propranolol completely. I am experiencing extreme withdrawal symptoms and would never wish this problem on anyone.”
It is known that low blood pressure is a long-term effect of Propranolol (that is, after all, what the drug is commonly prescribed to do: lower blood pressure). We’ve also mentioned on our Propranolol page that users need to be careful about coming off of Propranolol too quickly, as it does present significant risk:
Propranolol does not come with a high risk of addiction or dependency. However, there is a risk of Propranolol 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 Review #4: Don’t struggle alone
“I’m in my 30’s and have only really had mild, manageable anxiety before. I started a new job 3 months ago and it’s just gone into overdrive to the extent that I ended up having full blown panic attacks, couldn’t sleep, would be thinking about work constantly, even first thing at a weekend when I wasn’t working. I’m having counselling (which helps to a degree) but have also been given propranolol. It works really, really well for me. Within an hour of taking a 40mg tablet I will go from thinking my job is completely beyond me and I’ll never be able to be successful, to thinking it’s entirely possible and positive about the future. Back, neck and shoulder pain that is had for years also went, which made me think I’ve been living with anxiety far longer than I actually realised. The effects only last about 6 or 7 hours, so I’m currently taking 1 X 40mg tablet 3 times a day. For people also taking it, if you’re only taking 1 tablet (and unless you’re only taking it to be able to sleep) I wouldn’t recommend taking it in the evenings because the effects will likely have worn off by the morning. I had mild headaches initially, and the odd period of nausea but all very manageable side effects. I don’t think propranolol is necessarily the “long term” answer and I’m speaking to my doctor about going onto a course of anti-depressants but for the time being these tablets are a life saver. I’ve also struggled with public speaking / being centre of attention most of my life. I’d go red, get a sweaty forehead, dry mouth etc. This tablet also stops all that – it won’t turn you into a polished speaker, but it make it much easier for you to get your point across as you won’t be displaying physical symptoms of anxiety. I’m really pleased I found this tablet, and even if/when I come off it in the future I think it’s something I’ll use periodically for the rest of my life, when I have things that are causing me anxiety.
For anyone struggling with anxiety, please don’t struggle alone, or in silence. We are fortunate enough to be alive at a time when there are all sorts of medical solutions available and they really do work. There’s still a stigma associated with people that have anxiety / depression and some people think they’ve somehow failed because they’re taking medicine. Please give it a go, the worst that can happen is it does nothing. Good luck.”
I wanted to share this review specifically to highlight a note made by the writer: “For anyone struggling with anxiety, please don’t struggle alone, or in silence. We are fortunate enough to be alive at a time when there are all sorts of medical solutions available and they really do work.”
This is exactly the mentality we operate on at PerformanceAnxiety.com ~ there are solutions to anxiety and you don’t need to struggle alone. We aim to be your companion in overcoming your anxiety issues.
So what do the Propranolol Reviews tell us?
There are plenty more Propranolol reviews that you can read online if you’re curious, to get started in your search I recommend WebMD, IWantGreatCare & Drugs.com
The biggest takeaway from reading all of these reviews is that Propranolol can be effective, but comes with some pretty serious side-effects for some users. If you are considering using propranolol (or any other beta-blocker like Metoprolol, Coreg/Carvedilol or Atenolol) to help with your anxiety issues, please speak with a medical professional and consider looking at some natural alternatives to beta blockers first.
- ^ https://performanceanxiety.com/propranolol/
- ^ https://www.nhs.uk/medicines/propranolol/
- ^ https://performanceanxiety.com/propranolol-metoprolol-anxiety/
- ^ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5618811/
- ^ https://www.mayoclinic.org/diseases-conditions/high-blood-pressure/in-depth/beta-blockers/art-20044522
- ^ https://performzen.com/propranolol-for-anxiety/
- ^ https://www.singlecare.com/blog/propranolol-side-effects/
- ^ https://www.drugs.com/medical-answers/norepinephrine-epinephrine-difference-3132946/
- ^ https://performzen.com/propranolol-side-effects/
- ^ https://journals.sagepub.com/doi/full/10.1177/0253717620936985
- ^ https://pubmed.ncbi.nlm.nih.gov/436208/
- ^ https://www.drugs.com/propranolol.html
- ^ https://www.ahajournals.org/doi/pdf/10.1161/01.CIR.58.2.202
- ^ https://www.heart.org/en/health-topics/arrhythmia/about-arrhythmia/tachycardia–fast-heart-rate
- ^ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5369873/
- ^ https://www.health.harvard.edu/staying-healthy/understanding-the-stress-response
- ^ https://pubmed.ncbi.nlm.nih.gov/436208/
- ^ https://www.ahajournals.org/doi/pdf/10.1161/01.CIR.58.2.202