Propranolol is a beta blocker. The prescribing information for propranolol hydrochloride tablets describes propranolol hydrochloride as a synthetic beta-adrenergic receptor blocking agent. NIMH says health care providers may prescribe beta-blockers off-label to treat short-term anxiety symptoms, even though the medication is not approved for that specific purpose.
What the label says it is
The label states that propranolol is a nonselective beta-adrenergic receptor blocking agent possessing no other autonomic nervous system activity. It says the tablets are available as 10 mg, 20 mg, 40 mg, 60 mg, or 80 mg tablets for oral administration. These sentences describe the product. They are not statements about any use.
What the label says beta blockade does
According to the label, when access to beta-receptor sites is blocked by propranolol, the chronotropic, inotropic, and vasodilator responses to beta-adrenergic stimulation are decreased proportionately. The label adds that in angina pectoris propranolol generally reduces the oxygen requirement of the heart at any given level of effort by blocking the catecholamine-induced increases in the heart rate, systolic blood pressure, and the velocity and extent of myocardial contraction. The first sentence is a general description of what blocking beta receptors does. The second is about patients with angina pectoris.
The label also carries a lung warning. It says that, in general, patients with bronchospastic lung disease should not receive beta blockers, and that propranolol should be administered with caution in this setting since it may provoke a bronchial asthmatic attack by blocking bronchodilation. Whether a warning applies to a person is a decision for a licensed provider.
What is not established about how it works
The label says the specific mechanism of propranolol's antitremor effects has not been established, but beta-2 (noncardiac) receptors may be involved and a central effect is also possible.
For anxiety, the sources are tentative. A 1984 review abstract on catecholamines in anxiety describes a positive feedback process in which released catecholamines augment behavioral responses. It calls this "possibly analogous" to the use of clonidine or beta-adrenergic blocking agents to diminish somatic symptoms attending anxiety-provoking situations in humans. This is a review abstract, not a trial.
A 1982 abstract of a stage-fright study in string players tested atenolol, a different beta blocker, not propranolol. The 22 players received 100 mg of atenolol or placebo. The authors conclude that the drug was at least partially effective as shown by an improvement in technical-motor performance, and that the beneficial effects of beta blockade in stage fright only involve a peripheral site of action. The same abstract reports a slight but not significant improvement under beta blockade (-7.48%).
What health sources say about anxiety and off-label use
Two patient-facing pages describe use for anxiety and what off-label means. They are information pages, not trials.
| Question | What the source says |
|---|---|
| What does NIMH say? | The NIMH page on mental health medications says health care providers may prescribe beta-blockers off-label to treat short-term anxiety symptoms, even though the medication is not approved for that specific purpose. |
| What does an FDA page say about off-label use? | An FDA patient page says unapproved (off-label) use can mean a drug is used for a disease or medical condition that it is not approved to treat. It adds that if you and your healthcare provider decide to use an approved drug for an unapproved use, FDA has not determined that the drug is safe and effective for the unapproved use. |
What this does not tell you
The label statements describe the tablets, beta blockade in general, angina, a lung warning and tremor. They do not describe situational use before a presentation, audition or interview.
The anxiety sources are a review abstract with hedged wording, one small atenolol study, and patient information pages. The review abstract says "possibly analogous", and the site-of-action conclusion comes from a single small study of a different drug. None of these sources is a propranolol trial. None says whether anyone should take propranolol or at what dose. That decision belongs to a licensed provider.