If you’re someone that gets a severe anxiety before a speech, presentation, social event or any high-stakes situation, you might be considering using beta-blockers like Propranolol and/or Xanax to help solve your problem. Perhaps you’ve heard from a colleague, or read on online forums, about how these medications helped the performing careers of others or helped them through a high-anxiety scenario.
While, at first glimpse, Xanax & Propranolol may appear similar and may seem to work in similar ways, the reality is they both are completely different classes of drugs with different mechanisms of action, different side effects, and vastly different risks of dependency.
So which one should you pick to help with your performance anxiety – Propranolol or Xanax?
Below, we’ll go over everything you need to know about Propranolol and Xanax. We’ll cover some of the basic information like prescriptions, 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 cover some natural alternatives to Xanax & Propranolol, in case you’re reluctant to continually use prescription medications to get you through performances, social gatherings, and other high-anxiety scenarios.
What is Propranolol?
Propranolol is one of the most commonly prescribed beta-blocker medications in the US. Commonly sold under the brand names Inderal and Hemangeol, Propranolol is a type of non-selective beta-blocker that was originally created for people suffering from heart conditions and high blood pressure (as well as other health issues like arrhythmia, angina and heart failure.)
Beta-blockers (also known as beta-adrenergic blocking agents) work by blocking the effects of adrenergic hormones, such as adrenaline, in the body. Adrenaline typically produces an elevated heart rate, so by blocking adrenaline beta-blockers actively reduce stress on the heart and lower blood pressure .
How does Propranolol Prevent Performance Anxiety?
The symptoms of performance anxiety or stage fright overlap quite strongly with those of high blood pressure and heart conditions, which is why people began using beta-blockers like Propranolol to treat these conditions in the first place.
Performance anxiety occurs when you experience a significant stress response to an upcoming event. This stress triggers the body’s ‘fight or flight’ mechanism, causing an increase in the production of epinephrine (adrenaline) .
This increase in adrenaline causes the heart to beat faster. Blood pressure increases, and you start to breathe more rapidly .
Some side-effects can occur at this point; such as trembling, sweating, nausea and a dry mouth. These side-effects can be particularly detrimental for performers.
As Propranolol works by slowing the rate by which adrenaline is released into the blood, thus reducing heart rate and blood pressure, the medication can also be effective at reducing the symptoms of performance anxiety or stage fright, counteracting the body’s stress response.
How to Obtain Propranolol & Do I Need A Prescription?
Propranolol is a prescription-only drug, and Propranolol (as opposed to Xanax) is not a controlled-dose drug as it does not carry a (significant) risk of abuse; this means that doctors are generally more open to prescribing it for those who suffer from event driven performance anxiety.
Propranolol is available as an oral tablet, oral extended-release capsule, and oral solution under different brand names. If you are suffering from anxiety, providers will usually prescribe the medication in its tablet form . In the US, the most common brand names that Propranolol is sold under are Hemangeol, Inderal, and InnoPran.
Other beta-blockers like Metoprolol and Atenolol are common OTC (over-the-counter) alternatives to Propranolol, and they work in much the same way (blocking the effects of adrenergic hormones) so are also used to help with anxiety symptoms.
What Are The Side Effects Of Propranolol?
Beta-blockers like Propranolol, in general, are pretty safe. But here are some of the potential, albeit rare, side effects of Propranolol :
- Dry eyes
- Abnormally low heart rate
- Fatigue or weakness
Severe side effects with Propranolol 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
How Long Does Propranolol Stay In Your System?
Propranolol has a half-life of 6.4 hours which, particularly compared to Xanax, is quite short . You wont feel the affects from Propranolol for all that long, even if it does technically remain within your system for a couple of days. Also, there are a number of factors that will determine how long it takes Propranolol to leave your body; including your metabolism, height and weight, your overall level of health, age, and how much you have taken.
Propranolol Dosage For Anxiety
As Propranolol is a prescription drug in the United States, if you’re considering using Propranolol for performance anxiety, you’ll have to ask your doctor if it may be an option for you.
If your doctor decides to prescribe Propranolol for you, then he or she will also let you know your daily dosage.
You must stick to the recommendations of your doctor. They know your medical history and all your other current medications and health issues. Going beyond what your doctor prescribes can have health consequences.
For most adults, an effective Propranolol dose for anxiety is between 40-80 mg per day .
For most people who use Propranolol for stage fright, the best time to take it some time before they’re about to go on stage. You want to give it enough time for the effects to kick in, but not so early that it is no longer useful. Again, consult with your doctor for when and how much Propranolol you should take before you have to perform.
What is Xanax?
Xanax is an anti-anxiety medication in the benzodiazepine family. This is the same family that includes diazepam (Valium), clonazepam (Klonopin), lorazepam (Ativan), flurazepam (Dalmane), and others.
Xanax works by decreasing abnormal excitement within the brain. The Food and Drug Administration (FDA) approved Xanax in October 1981.
How Does Xanax Prevent Anxiety?
Benzodiazepines like Xanax act on the brain and central nervous system (CNS) to produce a calming effect.
Xanax in particular slows down the movement of brain chemicals that may have become unbalanced, resulting in a reduction in nervous tension and anxiety. Xanax does this by boosting the effects of a natural chemical called gamma-aminobutyric acid (GABA), which is made in the brain .
How to Obtain Xanax & Do I Need A Prescription?
Xanax is a powerful medication that can be an effective treatment for individuals who experience severe or chronic mental health issues. Xanax is prescription-only and it’s a controlled-dose drug as it is commonly abused.
If you are considering Xanax treatment for anxiety speak with your doctor about it as a short-term solution. Be sure to tell the doctor about any other medications you are currently using as, like with many medications, Xanax can interact negatively with other drugs used both for recreation and those that were prescribed.
Xanax is only meant to be used as a short-term solution and should not be taken for long periods of time.
To highlight the point: though it has been shown to be effective in some cases, Xanax is also considered to be very addictive. It should only be taken under the close supervision of a healthcare expert.
What Are The Side Effects Of Xanax?
Possible side effects of Benzodiazepines like Xanax should be differentiated by the treatment duration (i.e. whether it’s short or medium/long term).
In the short term, the most common side effects of benzos like Xanax include :
- Reduced cognitive alertness
- Slurred speech
- Lack of muscle coordination and strength, which can lead to falls and other injuries
- Impairment of driving skills
- Decreased sexual appetite and erection problems in men
The following short-term side effects of benzos like Xanax are less common :
- Depression and mood changes
- Blurred vision
- Nausea and poor appetite
- Breathing difficulties
- Increased risk of seizures in epileptics
If benzodiazepines like Xanax are used for longer, especially if abused for recreation, the following side effects have been observed in some cases:
- Lasting behavioral changes
- Poor control over emotions
- General loss of interest (in leisure activities, other people, job, etc.)
- Increased anxiety
- Loss of libido
- Suicidal ideation
It is also worth noting that Xanax is not considered a safe medication for several groups of people, including those who:
- Have an allergy to other benzodiazepines, including diazepam and lorazepam
- Have a history of liver disease or kidney disease
- Have personal or family history of substance abuse
- A history of glaucoma
- Are pregnant or currently nursing
It is incredibly important to consult with a healthcare provider to determine if any prescription medication is right for you.
When speaking with your healthcare professional, be sure to provide them with a full list of other medications and supplements you’re taking as negative drug interactions with Xanax are possible.
How Long Does Xanax Stay In Your System?
On average, Xanax has an elimination half-life of about 11 hours (though the range is from about 6-27 hours, and often higher in obese patients). This means that it takes a healthy person’s body 11 hours to get rid of half of a dose of the drug . Compared to Propranolol, this is very long!
There are a number of factors that can alter the rate that Xanax leaves the body, including:
- Metabolism speed
- Height and weight
- Body fat content
- Health of the liver and/or kidneys
- Amount of the drug taken
- How long the drug has been used
Xanax Dosage For Anxiety
Xanax comes in either tablet form, an extended-release tablet, an orally disintegrating tablet (a tablet that dissolves quickly in the mouth), and a concentrated solution (liquid) to be taken by mouth.
Xanax should be taken by mouth exactly as a doctor directs. The dosage will be based on the following factors:
- Why the person is taking it
- Their age
- How their body responds to the treatment
A doctor may gradually increase the dosage of Xanax until the drug works effectively for that person and their needs. If using Xanax, you are advised to closely follow the doctor’s instructions to reduce the risk of side effects.
If a person has used Xanax regularly for a long time or in high dosages, withdrawal symptoms can/will occur if they suddenly stop taking it. Usually, to prevent this, a doctor will reduce the dosage of Xanax gradually.
Xanax is available in doses of:
- 0.25 milligrams (mg): This will be white, oval, scored, and imprinted with “XANAX 0.25.”
- 0.5 mg: This will be peach, oval, scored, and imprinted with “XANAX 0.5.”
- 1 mg: This will be blue, oval, scored, and imprinted with “XANAX 1.0.”
- 2 mg: This will be white, oblong, multiscored, and imprinted with “XANAX” on one side and “2” on the reverse side.
A person should not crush, chew, or break a Xanax extended-release tablet. They should swallow the tablet whole. It is specially made to release the drug slowly into the body. Breaking the tablet can cause too much of the drug to be released at once.
And finally, it is not advised for people to share their medications with other people. It may not be suitable for them and may harm them .
Xanax Risks of Addiction and Physical Dependence
Xanax is a controlled substance and has become an often abused drug due to what’s known as the “Xanax high”. It is fairly easy to develop a tolerance to Xanax and the drug is abused by people both with and without a prescription.
Signs of Xanax abuse include:
- Continued use despite side effects
- Inability to stop using Xanax
- Loss of interest in other activities
- Obsession with obtaining more Xanax
- Risky behavior; like combining your prescription and alcohol or driving after taking your medicine
Similar to other addictions, Xanax abuse can lead to poor health, ruined relationships, forgotten responsibilities, and maybe worse.
If you, or someone you know, is suffering from addiction please contact the Substance Abuse and Mental Health Services Administration (SAMHSA) at 1-800-662-HELP (4357) or through the website.
Propranolol Or Xanax For Anxiety: Which Is Better?
Benzodiazepines such as Xanax are a family of the drugs that have a tranquilizing effect and thus have been used to treat anxiety disorder, agitation, muscle spasms, and many other conditions for nearly six decades. Propranolol (Inderal) belongs to the beta-blocker family of medications, which have the original purpose of treating patients with high blood pressure (hypertension) and various heart issues.
The differences between Xanax & Propranolol can be summarized into 3 main areas:
1. Xanax Targets The Brain; Propranolol Targets The Heart
The chief difference between Xanax and propranolol becomes clear when we look at the way the drugs work. Xanax and other benzodiazepines target the brain and central nervous system, whereas propranolol is focused on the cardiovascular system. The former primarily has a psychoactive impact, while the latter mostly influence you physically (although the act of taking a beta-blocker in itself does has a reassuring psychological effect) .
2. Propranolol Is More Suited For One-off Use; Xanax Fits Medium-term Treatment
Since propranolol’s effect on the body is, to put it bluntly, more straight-forward and doesn’t require re-wiring the brain. It only takes 30-60 minutes after taking a pill to yield the desired effect. This makes the drug useful for single-event performance anxiety, for example prior to an important presentation, public speech or test.
In contrast, Xanax is typically prescribed for medium-term treatment (as in several weeks to 4 months) to tackle more serious anxiety disorders. It takes several days and sometimes even weeks for Xanax to reach its maximum effect, Additionally, at the end of the treatment period, the drug can’t be abruptly stopped but instead needs to be gradually phased out to avoid withdrawal-related side effects .
3. Xanax Can Be Addictive And There’s A Serious Risk Of Abuse
Benzodiazepines like Xanax have a long track record and, in general, are considered safe as long as they are used in the short to medium term and in the doses prescribed by a doctor. However, if used for longer than a few months, there is a high risk of forming an addictive habit, where your body physically craves the medication, as we covered earlier in this article.
Benzodiazepine abuse is a widespread problem, which is why the more potent variations are banned in many countries. Benzodiazepine overdose can be fatal, and the risk of overdose is higher when combined with other drugs. In contrast, propranolol hasn’t been found to cause addiction, even after long-term use .
Are There Natural Alternatives To Propranolol Or Xanax For Anxiety?
If you’re not too excited about the addiction risks of Xanax or the potential side-effects of Xanax or Propranolol, you may be wondering if there are natural alternatives to Benzodiazepines and Beta-Blockers.
A natural alternative would achieve the same end-results, which is to provide relief from symptoms of performance anxiety.
But a good alternative to Xanax or Propranolol would do so by supporting your mind and body in a way that, over time, makes you more resilient! You’d become better equipped to handle any stress responses that come your way and learn to think about your performances in a way that makes them less stressful to begin with.
PerformZen has proved extremely effective at treating performance anxiety, in my experience, as it contains a combination of GABA & L-theanine, which help boost mental clarity; Theacrine, which aids mental clarity and energy; Ginkgo Biloba, which is an effective stress reducer; along with vitamins and minerals like Magnesium & Vitamin B6, which have proven effective in reducing even severe cases of stress.
This combination provides the same positive anti-anxiety effects of benzos or beta-blockers, but also boosts alertness and mental clarity, which are more subtle symptoms of performance anxiety that most drugs do not address. Overall, this may mean a natural solution such as PerformZen is not only safer, but more effective than beta-blockers or benzos for performance anxiety.
Note From The Author: I reached out to PerformZen, creators of the Calm Performance Formula supplement that I use and have recomended to many of my clients who struggle with anxiety, and they agreed to offer PerformanceAnxiety.com readers an exclusive discount of $5 off your first order!
Simply use the discount code PERFORMANCEANXIETY during checkout to claim your discount. This is valid until 30 Jun 2022 and is limited to the first 100 customers, so you should act fast:
Conclusion: Xanax Vs Propranolol Vs Natural Alternatives For Anxiety
A medical professional will decide which drug is the best treatment for your specific case of anxiety.
In general, if you are dealing with event-based anxiety that requires a one-off or infrequent treatment, Propranolol or another beta-blocker like Metoprolol is a preferable first choice.
If you are struggling with a more profound anxiety disorder, your doctor may want to prescribe Xanax for a short period, in addition to an anti-depressant or anti-anxiety medication for long-term treatment.
If you do not like the sound of either medication, then take a look at our in-depth article on natural beta-blocker alternatives for anxiety which goes over several natural solutions to help with different types of anxiety.
If you do decide to talk with your doctor about Propranolol or Xanax, make sure you discuss the side-effects & statistics around addiction fully and make an informed decision as to which solution is best for you knowing all of the risks!
Propranolol & Xanax Frequently Asked Questions
I received some emails from readers who had more specific questions about Propranolol & Xanax. 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.
- Q: Is Xanax a beta blocker?
- A: No, Xanax is not a beta blocker. Xanax is an anti-anxiety medication in the benzodiazepine family. Other drugs in the Benzodiazepine class include diazepam (Valium), clonazepam (Klonopin) and lorazepam (Ativan). Xanax works by decreasing abnormal excitement within the brain.
- Q: Is Propranolol a beta blocker?
- A: Yes, Propranolol is the most commonly prescribed beta blocker in the US. Propranolol a non-selective beta-blocker, meaning that along with beta-1 (β1) receptors, propranolol also blocks beta-2 (β2) receptors in the body. Beta-blockers work by blocking the effects of adrenergic hormones, such as adrenaline, in the body reducing stress on the heart and lowering blood pressure.
- Q: Which is better for anxiety – Propranolol or Xanax?
- A: There are 3 main differences between Xanax & Propranolol: 1) Xanax and benzodiazepines target the brain and central nervous system, whereas propranolol is focused on the cardiovascular system. 2) Propranolol is more suited for one-off use against performance anxiety; Xanax fits more medium-term anxiety treatment. 3) If used for longer than a few months, there is a high risk of forming an addictive habit, where your body physically craves Benzodiazepines like Xanax. In general, if you are dealing with event-based anxiety that requires a one-off or infrequent treatment, Propranolol is a preferable first choice. If you are struggling with a more profound anxiety disorder, your doctor may want to prescribe Xanax for a short period.
- ^ https://www.mayoclinic.org/diseases-conditions/high-blood-pressure/in-depth/beta-blockers/art-20044522
- ^ https://performanceanxiety.com/natural-beta-blocker-alternatives/
- ^ https://www.health.harvard.edu/staying-healthy/understanding-the-stress-response
- ^ https://khealth.com/learn/anxiety/propranolol/
- ^ https://www.nhs.uk/medicines/propranolol/
- ^ https://www.drugs.com/compare/propranolol-vs-xanax
- ^ https://reference.medscape.com/drug/inderal-inderal-la-propranolol-342364
- ^ https://www.medicalnewstoday.com/articles/263490#dosage
- ^ https://www.medzino.com/us/health-center/benzodiazepines-vs-propranolol-which-drugs-work-best-for-performance-anxiety-/
- ^ https://americanaddictioncenters.org/xanax-treatment/how-long-in-system