Propranolol (Inderal) for Anxiety: How It Works, How Much to Take, and Side Effects

People with anxiety have many problems, but there are many ways to treat it, and medicine is one of them. Some anti-anxiety medicines change mood and emotions by working directly on the central nervous system. Others, like beta-blockers, work against a different substance. For example, they lessen the effects of dopamine.

Inderal, which is a brand name for propranolol, is a beta-blocker that is used to treat nervousness. It is mostly used to treat high blood pressure, chronic angina, and trembling, but because of how it works, it is also sometimes used to treat anxiety and panic attacks. This piece talks about how propranolol works, how much to take, and any possible side effects.

What Does Propranolol (Inderal) Mean?

Propranolol hydrochloride works on both beta-1 and beta-2 receptors because it is a non-selective beta-blocker. These receptors can be found in the heart, different organs, and muscles. They work with adrenaline, which is a major stress hormone. Because of this, propranolol lowers blood pressure and heart rate and makes you feel calmer.

It’s important to know that propranolol has not been cleared by the Food and Drug Administration (FDA) ⁽¹⁾ to treat anxious conditions. Inderal’s recommendations say that it can be used to treat anxiety and panic attacks, but this use of propranolol is called “off-label.”

Sometimes the physical signs of worry can make the mental and emotional ones worse. So, by lowering the above responses, Inderal may help change how people feel about worry in general, making the feedback loop quieter.

When might propranolol be useful?

There are different kinds of anxiety ⁽³⁾, and many of them have physical signs that can be upsetting. Some of these are:

• Anxiety or panic attacks can occur. A rush of adrenaline is often what makes the sudden and strong physical signs of a panic attack worse. People who take propranolol for anxiety or panic attacks may notice that the attacks aren’t as bad or last as long because it lessens the effects of adrenaline.
• Social anxiety. ⁽⁴⁾ Being around other people or even just thinking about them can be overwhelming for people with social anxiety, leading to a variety of physical signs. When used to treat social anxiety, the drug propranolol can help control these reactions, making social situations easier and stress-free.
• This condition is known as performance or situational anxiety. Propranolol can help people who have severe physical signs of nervousness when they have to speak or act in public. But medicine isn’t the only way to help. People with performance anxiety can also benefit from talk therapy and different self-help techniques for long-term relief.

Propranolol can help with the physical effects of worry, but it is critical to use it along with other types of therapy, such as cognitive-behavioral therapy or coaching. Taking such a broad view of the problem helps with both the mental and emotional parts of worry.

It’s still crucial to gradually expose yourself to the situations you’re afraid of, preferably with a therapist’s help, for conditions like social anxiety or phobias. Propranolol can be one tool, but you don’t always need to take medicine because therapy can help you overcome the underlying fears.

How much propranolol to take for anxiety

The right amount of Inderal to take for anxiousness depends on a person’s symptoms, body weight, and ability to handle medicines. Always talk to a doctor or nurse before starting or changing any medicine.

A dose of 10–40 mg taken about an hour before an event is typical for people with social or performance anxiety. Your doctor may prescribe a sustained-release dose form once a day if you have generalized anxiety disorder. You must adjust the dosage as necessary and regularly monitor it closely.

You won’t be making decisions about dosage. To figure out the right dosage for you, your doctor will quiz you. Initially, they might start you on a lower dose and raise it as needed. Always take the precise amount of medication as directed by your doctor. Taking more or less without first consulting your provider can be risky.

When used to treat anxiety, how quickly does propranolol work?

Like a lot of other anti-anxiety medicines, Inderal (propranolol) starts working pretty quickly. The amount of time it takes to reach its highest quantity varies by type. For immediate-release medicines, it takes 1 to 4 hours, and for long-acting medicines, it takes about 6 hours.

In what amount of time does propranolol work?

Propranolol’s duration of action depends on its manufacturing process and the individual’s health status. Usually, the effects last between 3 and 4 hours. However, extended-release forms can have beneficial effects for longer. If you have concerns about the effects of your medicine, talk to your doctor to see if you need to change your treatment.

When Should I Take Propranolol?

Depending on the intended use, there are different optimal times to take propranolol.

• Situational anxiety. People who need to take propranolol for social anxiety, like before a show or public speaking, should usually take it 30 to 60 minutes before the event.
• Daily management. If you are taking propranolol to treat your sadness or anxiety ⁽⁵⁾ on a regular basis, it is best to take it at the same time every day. If you are using an immediate-release drug, you can spread out the doses throughout the day. Long-term release.

People typically take this medicine once a day, usually in the morning, to help with nervousness. Talk to your doctor or nurse about how to take propranolol in your specific case.

How long do most people take propranolol for anxiety?

The length of time a person may need propranolol depends on a lot of different things, including their anxiety type:

• Short-term use. Some people may only require propranolol for specific events such as shows, tests, or interviews. Propranolol is only used when it is needed in these situations.
• Chronic anxiety management. Some people may need to take propranolol for anxiety as part of a longer-term plan to deal with their condition. In these situations, care can last anywhere from a few months to a few years. Regular checkups with a doctor are important to find out if the medicine is still needed, if the amount needs to be changed, and to watch for side effects.

No matter how long you plan to take propranolol for, keep in mind that stopping it all of a sudden can cause return effects or withdrawal signs. Talk to a doctor or nurse before stopping or changing any medications.

Propranolol (Inderal) Side Effects

Propranolol, like most drugs, has the potential to cause mild to severe side effects. Although not everyone encounters adverse effects, it’s crucial to be aware of what to watch out for. If you encounter any of these side effects, let your doctor know, particularly if they are interfering with your ability or desire to continue taking your medication as directed.

Common and Mild Side Effects

These adverse effects are frequently transient and might get better as your body gets used to the drug:

• Being exhausted or experiencing dizziness
• Heart rate slowness (bradycardia)
• Cold feet or hands
• cramping in the stomach, diarrhea, or nausea
• Either constipation or diarrhea
• Sleep disturbances or vivid dreams (particularly with higher doses)
• Emotional flatness or mild sadness
• Vision blur or other visual abnormalities
• Lethargy and exhaustion
• Low blood pressure (which could make you feel lightheaded)
• Dry eyes
• Alopecia (loss of hair)

Serious Adverse Reactions

Side effects can be more severe for some people. Although side effects are less frequent, they can be dangerous and may require medical attention.

• Heart-related problems include arterial insufficiency (particularly Raynaud-type symptoms), congestive heart failure, hypotension (low blood pressure), or worsening AV block (a form of heart rhythm problem).
• Disorientation, short-term memory loss, mental fog, catatonia, hallucinations, or diminished cognitive function are examples of neurological symptoms.
• Bronchospasm is a respiratory problem, particularly for those who have asthma or other respiratory disorders.
• Severe gastrointestinal side effects include ischemic colitis, mesenteric artery thrombosis, or vomiting.
• Mood Shifts: Emotional instability or depression (sudden mood swings).
• Skin problems include Stevens-Johnson Syndrome and toxic epidermal necrolysis, two uncommon but potentially fatal skin reactions.
• Male impotence or Peyronie’s disease are examples of sexual side effects.

Unusual Blood and Immune Responses

Propranolol can have major effects on your blood or immune system, though they are uncommon:

• There is a decrease in white blood cells, also known as agranulocytosis.
  disorders that impact blood coagulation, such as thrombocytopenic purpura or non-thrombocytopenic purpura.
• The symptoms are similar to those of systemic lupus erythematosus (SLE).

Reactions to Allergies

Additionally, some people may experience uncommon but severe allergic reactions to propranolol. Medical intervention is necessary for these.

• Severe anaphylaxis is a potentially fatal allergic reaction.
• breathing difficulties, airway or throat tightness.
• Fever, sore throat, and rash could be signs of a more widespread allergic reaction.
• An irritated or sore throat can cause discomfort.
• flushing, swelling, or itching.

Please discontinue the medication and seek emergency care immediately if you experience difficulty breathing, swelling of the face or throat, or an unexpected rash.

Warnings and How This Medicine May Interact With Other Drugs

Researchers have found that when people are given propranolol for generalized anxiety disorder or panic disorder, it can be mixed with antidepressants to make the treatment work better. However, combining it with certain other medications may lead to adverse interactions. That’s why it’s important to let the doctor know about any other medicines you’re taking.

Here are some exchanges to keep in mind:

• Blood pressure medications. If you take propranolol with other drugs that lower blood pressure, like ACE inhibitors or diuretics, your blood pressure may drop too much. This could lead to signs like feeling dizzy or faint.
• Diabetes medications. Propranolol may change blood sugar levels and hide the signs of hypoglycemia, which is low blood sugar. People with diabetes should keep a close eye on their blood sugar and talk to their doctor about any changes to their medicines.
• Asthma medications. It is possible for beta-blockers, like propranolol, to make asthma or blocked lung diseases worse. They might not work well with bronchodilators, which help your lungs open up.
• Antidepressants. When taken with propranolol, some antidepressants can raise the amount of propranolol in the body, which can make side effects more likely. Fluoxetine and paroxetine are two examples.
• Warfarin. Propranolol can raise the amount of the blood thinner warfarin in the body. This might make bleeding more likely. When these drugs are given together, the INR (a measure of how well blood clots) should be checked regularly.
• Over-the-counter medications. Propranolol can combine with over-the-counter medicines like painkillers, antibiotics, and medicines for colds and flu. Talk to a pharmacist or doctor first before putting them together.
• Alcohol. It can make the blood pressure-lowering effects of propranolol stronger, which can make you feel dizzy or even cause you to pass out.
• Herbal supplements. Some herbs, like St. John’s Wort or goldenseal, may not work well with propranolol. Before starting to use any natural treatments, it’s always best to talk to a doctor or nurse.

Tell your doctor about all of the prescription drugs, over-the-counter medicines, and vitamins you are taking. Updating them on a regular basis lets amounts of medicines be changed to get the best treatment effects and lower the risk of problems.

When Propranolol Should Not Be Used

Not everyone can safely or appropriately use propranolol. Propranolol should not be taken if you:

• They are in a state of cardiogenic shock.
• possess a heart block apart from first-degree or sinus bradycardia.
• Have severe breathing problems, such as bronchial asthma.
• Have a known allergy or sensitivity to propranolol.

Additionally, it may not be advisable to use propranolol while pregnant or nursing. Based on research on animals, it is categorized as a pregnancy category C medication, which indicates that there may be fetal risk. Human cases have linked it to low birth weight, small placentas, and potential birth complications. Your healthcare provider will assist in balancing the risks and benefits if you are pregnant or nursing because the medication can also be passed into breast milk.

Additionally, propranolol may need to be used with greater caution in:

• older adults, particularly those whose liver, kidney, or heart function has changed with age.
• children, as its efficacy and safety in young patients have not been thoroughly proven.

In the end

Even though propranolol is mostly used to treat heart problems, it has also been used to treat nervousness. It may help with physical signs of worry, but it can also have side effects or interact with other drugs. These things can make you safer and more successful if you know about them and stay in touch with your healthcare provider.

Before starting or changing the amount of the anxiety medicine propranolol, you should always talk to your doctor.