Propranolol and Metoprolol are two of the most popular beta blockers available that are used to cope with anxiety symptoms, especially for people who experience social anxiety or performance anxiety.
If you’re someone that gets a severe case of the jitters before a speech, presentation, or social event, you might be considering using beta-blockers. Perhaps you’ve heard from a colleague, or read on online forums, about how these medications saved their performing careers.
But which one should you pick – Propranolol or Metoprolol?
Below, we’ll talk about all you need to know about Propranolol and Metoprolol. We’ll cover some of the basic information like their dosage, potential side effects, etc.
Then we’ll discuss how these medications work to prevent symptoms of performance anxiety, and which one might be a better choice for you.
Finally, we’ll also provide some natural alternatives if you’re reluctant to continually use beta-blockers to get you through performances or social gatherings.
Metoprolol vs Propranolol 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 Metoprolol vs Propranolol for Anxiety:
- Metoprolol is a beta-blocker medication sold over the counter under the brand name Lopressor. Beta-blockers like Metoprolol are a class of prescription medications that are designed for and used to help with angina (chest pain), arrhythmia (irregular heartbeat), hypertension (high blood pressure) and in some cases migraines.
- Propranolol is also a beta-blocker medication sold over-the-counter under the brand name Inderal. Similar to Metoprolol, Propranolol is a prescription beta-blocker medication designed to help users with angina, arrhythmia, hypertension and other heart related conditions.
- Both Propranolol and Metoprolol are used off-script by performers and those in high pressure fields to help with anxiety and stage fright symptoms. Both beta-blockers work to slow the heartbeat and lower blood pressure, by blocking the release of the hormone epinephrine (adrenaline) in the body. By blocking the release of adrenaline, the symptoms of performance anxiety are slowed or stopped completely.
What is Propranolol?
Propranolol is one of the most commonly prescribed beta-blocker medications.
Beta-blockers are also known as beta-adrenergic blocking agents, because they work by blocking the effects of adrenergic hormones, such as 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 [1]:
- High blood pressure
- Irregular heartbeat
- Angina (chest pain)
Beta-blockers help those with cardiovascular issues by influencing the force with which your heart pumps blood.
Sometimes, beta-blockers are also prescribed for conditions like migraines, and harmless tremors of the arms, hands, etc.
Explanation of how Propranolol beta-blocker works for anxiety
Inderal & other Propranolol brand names
Propranolol is sold under the following brand names:
- Inderal
- Inderal LA
- Hemangeol
- 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.
Atenolol is an over-the-counter alternative to Propranolol. But you must consult with your doctor before you start any type of medications, even if they are available OTC.
What is Metoprolol?
Metoprolol is another very popular beta-blocker that works similarly to Propranolol. It blocks the effects of adrenaline, and it is also usually prescribed to treat cardiovascular issues like high blood pressure, irregular heartbeat, etc.
The brand name version of Metoprolol is Lopressor. Back in 1978, the FDA approved the use of Metoprolol under the name Lopressor [2].
Just like Propranolol, Metoprolol also requires a prescription from your doctor. It is prescribed around 27 million times each year in the United States.
Bisoprolol is an over-the-counter alternative to Metoprolol.
Video explanation of the beta-blocker Metoprolol and how it works for anxiety
Why do people take Propranolol and Metoprolol for anxiety symptoms?
Now that we’ve covered the basics about Propranolol and Metoprolol, let’s talk about why people take these beta-blockers to cope with anxiety.
As we mentioned before, beta-blockers work by blocking the effects of adrenaline [3]. To understand why that plays a role with anxiety symptoms, we need to understand what happens in your body when you experience performance anxiety symptoms.
Why you experience performance anxiety symptoms
There are two layers to your anxiety symptoms – the root underlying causes of your social or performance anxiety, and the physical manifestation of those anxiety symptoms.
Root causes of performance anxiety
The root causes can be a combination of a few different factors, including the following [4].
- Your parent’s/teacher’s expectations of you when you were a child
- Past negative experience with performances or social situations
- If you’re physiologically more likely to experience anxiety
- If you were bullied at a young age
These are only a few examples. The best way to get to the root causes of your anxiety is to work with a qualified therapist.
But regardless, beta-blockers can’t do anything to address the causes of anxiety. They can only affect the symptoms.
Beta-blockers and physical symptoms of anxiety
Where beta-blockers can make a big difference is when it comes to the physical symptoms of performance anxiety.
The physical symptoms of performance anxiety are typically a combination of a few or all of these symptoms [5].
- Shaky voice
- Dry mouth
- Trembling hands
- Too much sweating
- Racing heartbeat
- Nausea
- A sense of nervousness in the gut
- Panic attack in severe cases
If you’ve experienced stage fright before, then you know that it can get bad to the point where the symptoms can mess up your performance.
And it spares no one regardless of fame or success.
There are well-known cases of world-famous performers/artists like Adele, Hugh Grant, Barbara Streisand, just to name a few, that have suffered from debilitating anxiety to the point where they contemplated quitting acting or performing altogether.
Beta-blockers like Propranolol and Metoprolol put the brakes on the physical symptoms of performance anxiety.
This is why they are so popular among public speakers, musicians, artists, and performers. By controlling the physical symptoms, beta-blockers help you maintain composure so you can get through your performance.
A quick peek into online forums about artists and beta-blockers, and you’ll find countless stories about how beta-blockers have saved people’s speaking or performing careers.
But how exactly do beta-blockers help stop the physical symptoms of anxiety? That’s what we’ll cover next.
How do Propranolol and Metoprolol work for performance anxiety?
As we mentioned before, 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 [6].
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 [7]. 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.
What are the recommended dosages for Propranolol and Metoprolol?
If your doctor recommends Propranolol or Metoprolol, he or she will recommend the right dosage for you based on your health, medical history, etc.
But here are the typical doses for these beta-blockers.
- Propranolol – For anxiety, the typical dosage is 40mg once a day, or up to 40mg 3 times a day, depending on your prescription.
- Metoprolol – Typically between 50mg and 100mg a day.
Are there known side effects of Propranolol and Metoprolol?
Beta-blockers, in general, are pretty safe. But here are some of the potential, albeit rare, side effects of Propranolol and Metoprolol [1][2].
Possible side effects of Propranolol
- Dry eyes
- Abnormally low heart rate
- Fatigue or weakness
- Nausea
Severe side effects are quite rare, but if you experience any of the following symptoms after taking Propranolol, be sure to contact your doctor immediately:
- Allergic reactions like skin hives or rashes
- Swelling in the face – lips, tongue, etc.
- Shortness of breath
Possible side effects of Metoprolol
- Irritability or mood swings
- Gut issues like gas, bloating, constipation
- Nausea
- Heartburn
- Dry mouth
Just like Propranolol, these severe Metoprolol side effects are quite rare:
- Shortness of breath
- Unexplained swelling of hands, feet, or ankles
- Fainting
Propranolol vs Metoprolol: Which one should I take?
Overall, both of these medications work similarly, and for most people, either one would work fine to prevent anxiety symptoms.
But your doctor would know better which one would be ideal for you based on your health, medical history, or any other medications you’re currently taking.
But assuming your doctor approves the use of beta-blockers, here are some minor differences between Propranolol and Metoprolol to help you decide between the two.
Is Propranolol right for you?
Propranolol is typically more popular among performers because it works best for short-term relief. It helps normalize heart rate, and reduce trembling, sweating, etc.
It brings you back to a calm state, at least physically, which then has an effect on you mentally, and you feel calmer overall.
Another reason performers like Propranolol is that the side effects are minimal.
But for some, Propranolol may go too far. It makes them so relaxed that they feel too drowsy to perform at their best. While it’s not ideal to be a jittery mess, you also don’t want to feel sleepy and lethargic during a speaking event.
Is Metoprolol right for you?
Metoprolol is less popular for anxiety and is typically used more for high blood pressure. And the side effects can be more frequent than Propranolol, although overall, still quite insignificant and rare.
If Propranolol makes you drowsy, or if your doctor suggests that Propranolol might interact with other medications, then Metoprolol could be an option for you.
Are there any natural beta-blocker alternatives for performance anxiety?
Although beta-blockers are relatively safe and effective, you may be reluctant to become dependent on them long-term.
If used for a long period consistently, there’s a risk that you could become dependent on them. Not just for performing, but to maintain regular cardiovascular function. Although that’s quite uncommon among people who use them for stage fright.
Regardless, here are some natural beta-blocker alternatives to help you maintain your calm and composure before a performance.
L-theanine
L-theanine is an amino acid found in green tea, black tea, and oolong tea. You can also find it in supplements.
L-theanine has been shown to increase GABA in your brain, which is a neurotransmitter linked with a greater sense of calmness and balanced mood [8].
Valerian Root
A herb found in the root of the valerian plant, valerian root is another supplement that is often recommended to ease symptoms of tension and anxiety [9].
It was used in traditional medicine in ancient Greece and Rome to deal with symptoms of nervousness, stress, trembling, etc.
But it can also make some people drowsy. So, keep that in mind if you’re considering it before a performance.
Magnesium and vitamin B6
Combining magnesium and vitamin B6 can improve mental performance before a performance.
Research has indicated that combining these two ingredients improves focus and behavior in kids who are diagnosed with ADHD [10].
You could even combine vitamin B6, magnesium, and L-theanine, for example, to get the best of both worlds.
L-theanine supports a relaxed state, and the B6/magnesium combination provides that extra mental focus so you can deliver an amazing performance.
Cognitive performance supplements
Probably the most effective natural beta-blocker alternatives are supplements that boost mental performance.
They’re typically a combination of various ingredients in the right proportions that work together to suppress anxiousness, while at the same time providing a boost in natural energy and mental focus.
One such supplement that has worked for us is PerformZen. It combines various ingredients, including L-theanine, magnesium, and vitamin B6, as we mentioned above, to help calm the nerves before a speech.
At the same time, it helped increase mental sharpness and focus so we could connect with our audience with greater enthusiasm.
Instant All-Natural Performance Anxiety Relief
PerformZen is a natural supplement uniquely crafted to overcome stage fright and performance anxiety so you can perform at your best on demand!
Final thoughts on Propranolol vs Metoprolol
If you’re someone that suffers from severe social anxiety, and it’s affecting your career as a performer or public speaker, then beta-blockers like Propranolol and Metoprolol could be an option for you.
They can help prevent the physical symptoms of anxiety and allow you to maintain composure, so you can get through your exam, speech, audition, performance, or even a date.
But remember that you must consult with your doctor before you start using beta-blockers, whether it’s prescription drugs or an OTC version.
And if you’re reluctant on becoming reliant on beta-blockers for your anxiety symptoms, try some of the alternatives mentioned above to promote a naturally calm and relaxed state before your next gig.
Propranolol vs Metoprolol Frequently Asked Questions
I received some emails/comments from readers who had more specific questions about Propranolol & Metoprolol. I’m publishing my responses here to refer people to in future. If you have your own questions, leave a comment down below or get in contact here.
Is Propranolol ototoxic?
To clarify, ototoxicity is what happens when toxins from medications damage your ears. There are hundreds of medications in the market that may cause damage to the ears. Some of these drugs are used to treat severe infections of illnesses. For some people, one of the unfortunate side effects is ototoxicity [11]. Because ototoxicity impacts the inner ear, the symptoms are primarily related to hearing and balance and include:
- Ringing in the ears (also known as tinnitus)
- Dizziness
- Hearing loss in one or both ears
- Loss of balance
- Blurred vision
- Bouncing vision
Ototoxic Medications that can cause hearing loss include antibiotics like Gentamicin, Streptomycin & Erythromycin; Loop diuretics like Furosemide; Chemotherapeutic agents like Cisplatin & Carboplatin; and even simple Aspirin [11].
Tinnitus, a symptom of ototoxicity where there’s ringing in the ear, is rare with Propranolol, and appears to be slightly more common with bisoprolol and nebivolol (Bystolic) beta-blockers [12].
There is plenty of anecdotal accounts of peoples hearing being affected by using Propranolol, so it would definitely help to discuss an alternative in the same medication class (perhaps Metoprolol, but keep your options open) with a healthcare provider if you notice tinnitus or any change in your hearing.
One last thing to keep in mind is that having high blood pressure is also associated with tinnitus. Blood pressure regulation is one of the main uses of Propranolol, so in some cases tinnitus symptoms could be from high blood pressure — rather than the Propranolol medication.
- ^ https://www.nhs.uk/medicines/propranolol/
- ^ https://www.nhs.uk/medicines/metoprolol/
- ^ https://www.nhs.uk/conditions/beta-blockers
- ^ https://www.mayoclinic.org/diseases-conditions/social-anxiety-disorder/symptoms-causes/syc-20353561
- ^ https://www.sciencedirect.com/topics/psychology/performance-anxiety
- ^ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5369873/
- ^ https://www.health.harvard.edu/staying-healthy/understanding-the-stress-response
- ^ https://pitjournal.unc.edu/article/improving-college-exam-performance-l-theanine-and-caffeine
- ^ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7585905/
- ^ https://pubmed.ncbi.nlm.nih.gov/16846100/
- ^ https://uvitals.com/medications-that-cause-hearing-loss/
- ^ https://www.goodrx.com/drugs/side-effects/these-11-prescriptions-may-cause-ringing-in-the-ears
Hi Folks, Propranolol had been shown to be ototoxic and metoprolol has not, so a major downside of the former is the possibility of losing ones hearing.
Hi Justin, interesting point and it led me down an interesting rabbithole around ototoxicity and Propranolol/Metoprolol that I wrote more about in the FAQ Section. Thanks for the lead!