Have you ever considered using Propranolol — one of the most commonly prescribed beta-blocker medications in the US — for your performance anxiety issues?
If so, you are not alone! Performance anxiety, also known as stage fright, is a common phenomenon that affects millions of people around the world. It stems from the fear of being judged negatively because of your performance, even if it is irrational and there’s no real evidence to justify the fear.
Performance anxiety is very common with professional musicians, public speakers, and even stand-up comedians – as you would expect. Many of these professional performers turn to Propranolol and similar beta-blocker drugs to deal with their performance anxiety symptoms.
In this article, we are going to cover what Propranolol is; how it works & why it’s popular among performers; famous celebrities who have publicly stated that they use propranolol for their anxiety symptoms; what the downsides & side-effects of Propranolol are and how the beta blocker compares to both prescription and natural alternatives available to help with performance anxiety symptoms.
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 Propranolol For Anxiety:
- Propranolol is the most commonly prescribed beta-blocker medications in America. Beta-blockers work by blocking the effects of adrenergic hormones in the body, such as adrenaline, and are typically used for resolving cardiovascular and heart conditions
- Propranolol is available over-the-counter under the brand names Inderal, Inderal LA, Hemangeol and Inderal XL
- An exaggerated stress response like that experienced with performance anxiety, leads to a spike in adrenaline. By blocking the effects of adrenaline with beta-blockers like Propranolol, you are preventing adrenaline from binding to beta receptors in the heart. This means that beta-blockers are essentially blocking the physical symptoms of performance anxiety
What is Propranolol?
Propranolol is one of the most commonly prescribed beta-blocker medications in the US. Beta-blockers, full medical name beta-adrenergic blocking agents, work by blocking the effects of adrenergic hormones in the body, 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 :
- 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 .
Here’s a solid video all about Propranolol:
Propranolol Over-The-Counter (OTC) brand names
Propranolol is sold over the counter 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 popular with musicians, speakers & public performers?
A 1987 survey by the International Conference of Symphony Orchestra Musicians, representing some of the largest orchestras in the U.S., found that 27 percent of their musicians were using beta-blockers for performance anxiety . Many experts assume that this number is much higher today.
As we previously explained, 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, 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.
We should make a note 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 .
4 celebrities who use Propranolol for their stage fright
In recent years, several celebrities have gone public about their usage of beta blockers like propranolol to help with their stage fright and performance anxiety symptoms, including Shawn Mendes, Katy Perry, Whitney Cummings and Bobby Lee.
How Shawn Mendes Uses Propranolol
Shawn Mendes, during a global tour stated that he was finding the continuous performances difficult in a Capital FM interview. Only 20 years old at the time, Shawn Mendes admitted to getting so nervous for his live shows that he “needed medication to calm him for over a year” .
The Canadian singer opened up about his struggles with anxiety and pre-show nerves , when telling fans:
“As a performer you get very nervous, sometimes you freak out and things can become a lot for you. And there’s medicine and things you can do to help and I meditate and I do a lot of things.
There’s a medicine called beta blockers and basically it’s a very calm medicine, but what it does is it slows your heart rate down so you can be less stressed out and calm down and breathe, but nevertheless it’s medicine and I want you guys to know that for the last year I’ve been taking the medicine that’s been slowing down my heart rate so that I can be calm on stage.”
Here’s the video of Shawn Mendes talking about his beta blocker/Propranolol and anxiety struggles during a performance:
— Pop Crave (@PopCrave) April 6, 2019
Katy Perry Uses Propranolol to Help With Her Anxiety
Katy Perry, the American singer, songwriter and television judge for American Idol, has performed in front of millions of fans and is (in)famous for her wild, electrifying performances .
In a 2014 Cosmopolitan magazine interview, Katy Perry talked about her use of beta-blockers to help with her anxiety in the past. In the interview she talked about how she “had a crippling fear that she would let everyone down, and so she used [beta blockers/propranolol] to overcome performance anxiety” .
Katy Perry made clear that her stage fright does not come from not being prepared, but from a fear that “fans will rush the stage or that I’ll vomit on stage during a performance”
The singer feels intense pressure to ensure that she fends off competition from rivals in the music industry :
“I have to take beta blockers [before each show], I get so nervous. [I think] that I have to get through this; I can’t let these people down, but mostly I can’t let myself down. I’ve been given a great opportunity and there are 500 bitches behind me who will snatch my weave off my head if I don’t kick-ball-change through this two-hour show.”
Whitney Cummings on her use of Propranolol to help her chronic migraine Issues
Whitney Cummings is a world-class comedian, actress, and screenwriter recognized for her prolific output and perfect comic timing. Many recognize her unique tall and lean frame and emphatic voice that quickly creates strong connections with her fans .
In an interview with Everyday Health, Whitney talked about her chronic migraine issues and how it led to her discovering beta-blockers to manage her anxiety that would come with her worry about said migraines :
[The migraine attacks] started when I was a kid. I remember going to Disneyland, and being the person who ruined the trip because Whitney has to go to the car and put a pillow over her head. A trip to Six Flags amusement park had to be cut short because Whitney has a migraine. I feel like I was always the bummer in my childhood.
…A big one of my migraine triggers is an increase in adrenaline and cortisol — which comes from stress, which we all have. It’s a neurological imbalance.
…Sometimes the stress leading up to something can trigger the migraine, and even the stress of anticipating a migraine can bring one on.
…I take beta-blockers now, which help hugely. I didn’t find out about them until about three years ago. I know if I have a big meeting, or a big audition, or a big performance, or anything where I know I’m going to be nervous, I just take one preemptively, so that I’m not blasting my brain with adrenaline.
My goal is to keep my neurochemicals, my hormones, and my blood sugar levels as consistent as possible.
Bobby Lee learned about Propranolol from Whitney Cummings
Bobby Lee is an actor and comedian from San Diego, California. The first Asian-American cast member on MADtv, he has appeared in movies like “Harold & Kumar Go to White Castle”, “Pineapple Express”, and “The Dictator”. To put it simply, Bobby Lee has staked his claim in the comedy scene and in Hollywood .
On the Good For You Podcast with Whitney Cummings, Bobby Lee talked to Whitney the host about how she was the first to tell him about beta-blockers and how they helped him stay calm during auditions :
“You also changed this about me. You’re so influential in my life [pointing at Whitney]…
Years ago, I used to sometimes go in to audition, and I would freeze… I would have a panic attack. And I came up to you one day, and I go “It’s so embarrassing… I get these little panic attacks”
And you’re the one who introduced me to beta blockers. In fact, I did this pilot in Chicago, and I wouldn’t have been able to do it without beta blockers.”
What are the recommended dosages for Propranolol?
We have an excellent article up on the site already detailing what the propranolol dose for anxiety are depending on different variables. To summarize, however:
Much of the dosage information you’ll find for Propranolol [is] 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.
Recommended time 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 .
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.
Are there known downsides to Propranolol?
Propranolol, and beta-blockers as a whole, are generally considered to be safe, especially if you only take them occasionally before a big performance, speech, exam, or job interview.
But if you start performing more frequently, and you find that Propranolol is really helping you get a handle on the jitteriness, you might start using it more regularly.
And if you’re going to use Propranolol regularly, then you should be aware of the potential downsides of Propranolol, and beta-blockers in general .
Potential Propranolol side effects
Severe side effects are not very common in people that use Propranolol for anxiety. But you should still know the potential side effects, so you can notify your doctor if you experience any of them. Your doctor can then evaluate if you should continue taking them.
Here are some of the potential side effects of Propranolol :
- Dryness in the eyes
- Below normal heart rate
- Tiredness or feeling weak
Severe side effects are rare, but if you experience any of the following, be sure to notify your doctor immediately.
- Allergic reactions like skin rash or hives
- Swollen face, lips, or tongue
- Trouble breathing
One of the main benefits of beta-blockers like Propranolol could also be a potential downside for some people.
For most people that experience severe stage fright, Propranolol will help them avoid the symptoms in a way that calms them down enough to be able to get through a performance. But for others, the calming effects of Propranolol may go too far. If Propranolol relaxes you to the point where you start feeling drowsy, that’s obviously not going to be good for your performance.
What you ideally want is to remain calm, but also mentally sharp and focused so you can perform at your best.
The good news is that there are ways to do just that, and we’ll discuss alternatives later in the article.
Propranolol interactions with other medications
If you’re taking any medications on a regular basis, you should let your doctor know when discussing whether Propranolol might be right for you. Propranolol may interact with other medications in a harmful/sub-optimal way. It may also impact how well another drug works.
Here are some of the common medications that may interact with Propranolol, and you might be advised to avoid Propranolol if you’re currently taking any of them .
- Arrhythmia (irregular heartbeat) medications
- Other blood pressure medications
- Asthma medications
- Nonsteroidal anti-inflammatory drugs (NSAIDs)
- Blood thinners
- Stomach ulcer medications
Does Propranolol require a prescription?
Yes, Propranolol is a prescription medication.
Assuming your doctor approves of you taking Propranolol for performance anxiety, and writes a prescription, you will have to refill that prescription every time you run out. This will not be an issue if you only plan on using Propranolol occasionally. But if you start using the drug more often, then it could become a significant inconvenience.
Is there a dependence/addiction risk with Propranolol?
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 .
Prescription alternatives to Propranolol for performance anxiety
Propranolol/Inderal is the most popular prescription beta-blocker in the US, sold under the brand names Hemangeol, Inderal, and InnoPran; but here are some of the other most commonly prescribed beta-blockers that are used for anxiety:
- Zebeta (Bisoprolol)
- Sectral (Acebutolol)
- Coreg (Carvedilol)
- Lopressor (Metoprolol)
- Tenormin (Atenolol)
- Bystolic (Nebivolol)
There is also typical anxiety medications like benzodiazepines (Xanax, Valium, etc) but I hesitate to recommend these medications due to significant dependence & addiction risks. There are several non-addictive Xanax & benzo alternatives available today.
Natural alternatives to Propranolol for anxiety
When it comes to the question: “Is Propranolol the best way to deal with anxiety?” – the answer is complex as 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 .
But perhaps you’re not too excited about becoming dependent on a beta-blocker like Propranolol every time you want to perform, or having to get a prescription whenever you run out? If so, you might be wondering if there are any natural alternatives to Propranolol.
A natural alternative would achieve the same end-result as propranolol, which is to provide relief from symptoms of performance anxiety. But it would do so by supporting your mind and body in a way that, over time, makes you more resilient to anxiety. Ideally, you would become better equipped to handle any stress response and you would learn to think about your performance in a way that makes it less stressful, to begin with.
Here are some of the most effective natural remedies to performance anxiety that I’ve personally come across:
GABA, or Gamma-Aminobutyric Acid, is a naturally-occurring amino acid that acts as a neurotransmitter. GABA is widely recognized as having a calming effect, and GABA deficiency is believed to play a part in anxiety disorders .
Studies performed on GABA supplementation have found it may have a positive effect on stress and anxiety , which would help block the symptoms associated with performance anxiety.
L-theanine is an amino acid well known for its relaxing properties . Studies have shown that L-theanine may decrease the severity of stress-related symptoms, while increasing cognitive performance .
Thus, taking L-theanine may help performers counteract the nerves that come with performance anxiety, as well as providing better focus during their performance. Taylor Swift is known to use L-theanine to help her handle the stress of stage performances, to serve as one popular example .
L-theanine can be taken as a supplement, and is also present in green, black and oolong teas, as well as some mushrooms.
Magnesium is a vital mineral, necessary for a wide range of the body’s natural functions. Magnesium deficiency is linked to cardiovascular diseases and hypertension .
Another of magnesium’s essential roles is to protect and regulate the nervous system .
Furthermore, several studies have found magnesium to have a positive effect on stress and anxiety , which leads us to believe it may be helpful in preventing or lessening the effects of performance anxiety.
Another natural amino acid, L-arginine can lower blood pressure, and may provide relief for the symptoms of hypertension and some forms of heart disease . It increases the release of nitric oxide in the blood, causing blood vessels to open and allowing blood to flow more freely.
More research is necessary to show whether or not L-arginine also proves effective for nerves and anxiety the same way that beta-blockers like Propranolol do.
L-arginine can be supplemented, as well as found in red meat, dairy, poultry and fish. Seek a doctor’s advice before taking any L-arginine supplement, however.
Garlic can be a natural alternative to beta-blockers like propranolol, providing many of the same positive effects on cardiovascular health and blood pressure.
Studies have shown significant beneficial effects of garlic on hypertension . Garlic works in much the same way as L-arginine, stimulating the production of nitric oxide and relaxing blood vessels .
Whether the antihypertensive benefits of garlic provide beneficial for performance anxiety is unproven, however its ability to replicate the effects of prescription beta-blockers is very promising!
Some dietary supplements contain a mix of ingredients that support focus, calm and cognition, which may counteract the negative side-effects of performance anxiety and stage fright.
One example that I personally like and recommend to clients is PerformZen, which contains GABA, L-theanine and Magnesium, as well as cognitive-enhancing ingredients Ginkgo Biloba, Vitamin B6 and Theacrine.
These ingredients have been shown to help induce a calming effect on the body, as well as keeping the brain as sharp as it needs to be during your performance. I recently reviewed PerformZen in this article & interviewed the founder (as well as secured a limited-time discount for PerformanceAnxiety.com readers). See the review here.
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 $7 off your first order!
Simply use the discount code PERFORMANCEANXIETY7 during checkout to claim your discount. This is valid until 30 Apr 2024 and is limited to the first 110 customers, so you should act fast:
Final thoughts on Propranolol for anxiety
You don’t have to let performance anxiety control you and get in the way of doing the things you love, like performing in front of an audience. For some, getting jittery has negative effects on their professional and/or personal life.
Beta-blockers like Propranolol can provide a much-needed relief from the physical symptoms so you can get through what you need to do. But a beta-blocker, or any other drug, will never be the complete solution you’re really looking for; which is to not be fearful about performing in front of an audience or facing anxiety in the first place.
To overcome performance anxiety in the long term, consider natural alternatives like those mentioned above: magnesium, GABA, L-theanine, L-arginine, garlic or a natural supplement like PerformZen.
In the meantime, If you’re considering Propranolol for a quick-fix to your anxiety symptoms, be sure to consult with your doctor to make sure it is right for you.
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