Inderal dosage for anxiety
Propranolol: medicine for heart problems, anxiety and migraine
1. About propranolol
Propranolol belongs to a group of medicines called beta blockers. It's used to treat heart problems, help with anxiety and prevent migraines.
If you have a heart problem, you can take propranolol to:
- treat high blood pressure
- treat conditions that cause an irregular heartbeat (arrhythmia), like atrial fibrillation
- help prevent future heart disease, heart attacks and strokes
- help prevent chest pain caused by angina
Propranolol can help reduce your symptoms if you have too much thyroid hormone in your body (thyrotoxicosis). You'll usually take it together with medicines to treat an overactive thyroid.
This medicine is only available on prescription. It comes as tablets, slow release capsules, or as a liquid that you swallow.
2. Key facts
- Propranolol slows down your heart rate and makes it easier for your heart to pump blood around your body.
- It's usually prescribed for high blood pressure and other heart problems, but it can also help with the physical signs of anxiety, like sweating and shaking.
- Your very first dose of propranolol may make you feel dizzy, so take it at bedtime. After that, if you do not feel dizzy, you can take it in the morning.
- The main side effects of propranolol are feeling dizzy or tired, cold hands or feet, difficulties sleeping and nightmares. These side effects are usually mild and short-lived.
3. Who can and cannot take propranolol
Most adults and children aged 12 and over can take propranolol.
But it is not officially approved for treating high blood pressure in children under 12 years old.
Propranolol is not suitable for everyone. To make sure it's safe for you, tell your doctor before starting to take propranolol if you:
- have ever had an allergic reaction to propranolol or any other medicine
- have low blood pressure or a slow heart rate
- have heart failure which is getting worse
- have diabetes
- have liver or kidney problems
- have severe blood circulation problems in your limbs (such as Raynaud's phenomenon), which may make your fingers and toes tingle or turn paler than usual or blue
- have metabolic acidosis, when there is too much acid in your blood
- have lung disease or asthma
- are pregnant, trying to get pregnant or breastfeeding
4.
How and when to take propranolol Propranolol comes as 2 different types of medicine:
- standard release – this releases propranolol into your body quickly, so you may need to take it several times a day depending on your dose
- slow release – this releases the medicine slowly so you do not have to take it as often, once a day is usually enough
If you are taking it once a day, your doctor may advise you to take your first dose before bedtime, because it can make you feel dizzy. After the first dose, if you do not feel dizzy, take propranolol in the morning.
Important: Important
Keep taking propranolol even if you feel well. You will still be getting the benefits of the medicine.
Dosage and strength
Propranolol tablets come in strengths of 10mg, 40mg, 80mg or 160mg.
The slow release capsules are 80mg or 160mg. The liquid comes in strengths of 5mg, 10mg, 40mg or 50mg in 5ml.
How much you take depends on why you need propranolol.
The usual doses for adults are:
- high blood pressure – the starting dose is usually 80mg, taken twice a day. If this dose is not working well enough to reduce your blood pressure, your doctor may increase it to a maximum of 160mg twice a day
- migraine or angina (chest pain) – 40mg, taken 2 or 3 times a day. This can be increased to 120mg to 240mg a day. Your doctor or pharmacist will explain how to split the dose over the day
- irregular heartbeat (arrhythmia) – 10mg to 40mg, taken 3 or 4 times a day
- anxiety – 40mg taken once a day which can be increased to 40mg taken 3 times a day
- too much thyroid hormone (thyrotoxicosis) – 10mg to 40mg, taken 3 or 4 times a day
Doses are usually lower for people aged over 65 or people with a kidney or liver problem.
If your child needs propranolol, your doctor will usually use your child's weight to work out the right dose.
How to take it
Propranolol does not usually upset your stomach so you can take it with or without food. It's best to do the same each day.
Swallow the tablets whole with a drink of water. If you find the tablets difficult to swallow, some brands have a score line to help you break the tablet in half. Check the information leaflet for your brand to see if you can do this.
If you're taking capsules, swallow them whole with a drink of water. Do not break, chew or crush them.
If you're taking propranolol as a liquid, it will come with a plastic syringe or spoon to help you measure out the right dose. If you do not have one, ask your pharmacist for one. Do not use a kitchen teaspoon as it will not measure the right amount of medicine.
If you forget to take it
If you forget to take a dose of propranolol, take it as soon as you remember, unless it's nearly time for your next dose. In this case, just leave out the missed dose and take your next dose at the usual time.
Never take 2 doses at the same time. Never take an extra dose to make up for a forgotten one.
If you often forget doses, it may help to set an alarm to remind you. You could also ask your pharmacist for advice on other ways to help you remember to take your medicine.
If you take too much
An overdose of propranolol can slow down your heart rate and make it difficult to breathe. It can also cause dizziness and trembling.
The amount of propranolol that can lead to an overdose varies from person to person.
Urgent advice: Contact 111 for advice now if:
- you take more than your prescribed dose of propranolol
Call 111 or go to 111 online
If you need to go to A&E, do not drive yourself.
Get someone else to drive you or call for an ambulance.
Take the propranolol packet or leaflet inside it plus any remaining medicine with you.
5. Side effects
Like all medicines, propranolol can cause side effects in some people, but many people have no side effects or only minor ones.
Side effects often improve as your body gets used to the medicine.
Common side effects
These common side effects happen in more than 1 in 100 people. They're usually mild and short-lived.
Talk to your doctor or pharmacist if the side effects bother you or last more than a few days:
- headaches
- feeling tired, dizzy or weak
- cold fingers or toes
- feeling or being sick (nausea or vomiting), or diarrhoea
- stomach pain
Serious side effects
It happens rarely, but some people have serious side effects when taking propranolol.
Tell a doctor or contact 111 straight away if:
- the whites of your eyes turn yellow, your skin turns yellow although this may be less obvious on brown on black skin, or you have pale poo or dark pee – these can be signs of liver problems
- you get nosebleeds that last for more than 10 minutes, unexplained bruising, or you bruise more easily than usual – these can be signs of low numbers of platelets in your blood (thrombocytopenia)
Go to 111.nhs.uk or call 111.
Immediate action required: Call 999 or go to A&E now if:
- you have shortness of breath with a cough which gets worse when you exercise (like walking up stairs), swollen ankles or legs, chest pain, or an irregular heartbeat – these are signs of heart problems
- you have shortness of breath, wheezing and tightening of your chest – these can be signs of lung problems
Serious allergic reaction
In rare cases, propranolol may cause a serious allergic reaction (anaphylaxis)...jpg)
Immediate action required: Call 999 or go to A&E now if:
- you get a skin rash that may include itchy, red, swollen, blistered or peeling skin
- you're wheezing
- you get tightness in the chest or throat
- you have trouble breathing or talking
- your mouth, face, lips, tongue or throat start swelling
You could be having a serious allergic reaction and may need immediate treatment in hospital.
These are not all the side effects of propranolol. For a full list, see the leaflet inside your medicine packet.
Information:
You can report any suspected side effect using the Yellow Card safety scheme.
Visit Yellow Card for further information.
6. How to cope with side effects of propranolol
What to do about:
- headaches – make sure you rest and drink plenty of fluids.
Try not to drink too much alcohol. Ask your pharmacist to recommend a painkiller. Talk to your doctor if the headaches last longer than a week or are severe. - feeling tired, dizzy or weak – as your body gets used to propranolol, these side effects should wear off. If propranolol makes you feel dizzy, sit or lie down until you feel better. It's best not to drink alcohol as it will make you feel worse. Do not drive or ride a bike until you feel better.
- cold fingers or toes – put your hands or feet under warm running water, massage them and wiggle your fingers and toes. Do not smoke or have drinks with caffeine in, as this can make your blood vessels narrower and further restrict blood flow to your hands and feet. Try wearing mittens (they're warmer than gloves) and warm socks. Do not wear tight watches or bracelets.
- feeling or being sick or diarrhoea – stick to simple meals and do not eat rich or spicy food.
It might help to take your propranolol after a meal or snack. Drink lots of fluids, such as water or squash, to avoid dehydration. Take small, frequent sips if you're being sick. Signs of dehydration include peeing less than usual or having dark, strong-smelling pee. Do not take any other medicines to treat diarrhoea and vomiting without speaking to a pharmacist or doctor. If you take contraceptive pills and you're being sick or have severe diarrhoea, your contraception may not protect you from pregnancy. Check the pill packet for advice. - stomach pain – try to rest and relax. It can help to eat and drink slowly and have smaller and more frequent meals. Putting a heat pad or covered hot water bottle on your tummy may also help. If you are in a lot of pain, speak to your pharmacist or doctor.
7. Pregnancy and breastfeeding
Propranolol and pregnancy
Propranolol is not thought to be harmful during pregnancy, but it may affect your baby's growth in later pregnancy.
Discuss taking propranolol with your doctor or midwife as you may need extra scans to check your baby's growth.
If you're trying to get pregnant or you're already pregnant, talk to your doctor about the benefits and possible harms of taking propranolol. There may be other medicines that are better to use during pregnancy.
Propranolol and breastfeeding
If your doctor or health visitor says that your baby is healthy, it's OK to take propranolol while breastfeeding.
Propranolol passes into breast milk in tiny amounts. It has not been known to cause any side effects in breastfed babies.
It's important to treat your high blood pressure to keep you well. Breastfeeding will also benefit both you and your baby.
If you notice that your baby is not feeding as well as usual, or seems unusually sleepy, or if you have any other concerns about your baby, then talk to your doctor or health visitor.
Non-urgent advice: Tell your doctor if you're:
- trying to get pregnant
- pregnant
- breastfeeding
For more information about how propranolol can affect you and your baby during pregnancy, visit the Best Use of Medicines in Pregnancy (BUMPS) website.
8. Cautions with other medicines
There are some medicines that may affect the way propranolol works.
Tell your doctor if you're taking:
- other medicines for high blood pressure. The combination with propranolol can sometimes lower your blood pressure too much. This may make you feel dizzy or faint. If this keeps happening to you, your doctor may change your dose
- other medicines for an irregular heartbeat such as amiodarone or flecainide
- other medicines which can lower your blood pressure.
These include some antidepressants, nitrates (for chest pain), baclofen (a muscle relaxant), medicines for an enlarged prostate gland like tamsulosin, or Parkinson's disease medicines such as levodopa - asthma or chronic obstructive pulmonary disease (COPD) medicines
- diabetes medicines, particularly insulin – propranolol may make it more difficult to recognise the warning signs of low blood sugar. Speak to your doctor if you have low blood sugar levels without getting any of the usual warning signs. Check your blood sugar after exercise, and follow usual advice about checking it before driving, cycling or operating machinery
- medicines to treat nose or sinus congestion, or other cold remedies (including those you can buy in the pharmacy)
- medicines for allergies, such as ephedrine, noradrenaline or adrenaline
- non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, diclofenac or naproxen.
These medicines may increase your blood pressure, so it's best to keep them to a minimum
Mixing propranolol with herbal remedies or supplements
There's very little information about taking herbal remedies and supplements with propranolol. They are not tested in the same way as pharmacy and prescription medicines.
Medicine safety
Tell your doctor or pharmacist if you're taking any other medicines, including herbal medicines, vitamins or supplements.
9. Common questions about propranolol
How does propranolol work?Propranolol is a type of medicine called a beta blocker.
Like other beta blockers, propranolol works by changing the way your body responds to some nerve impulses, including in the heart. It slows down your heart rate and makes it easier for your heart to pump blood around your body.
It works differently if you're using it for anxiety. When you are anxious, your brain makes chemical messengers called adrenaline and noradrenaline. These make your heart rate faster and make you sweat or shake. Propranolol helps block the effects of these chemical messengers. This reduces the physical signs of anxiety.
It's not fully understood how propranolol prevents migraines. It may work by relaxing the blood vessels involved, or by reducing activity in the visual cortex. This is the part of the brain where migraines are believed to start.
How long does propranolol take to work?Propranolol usually starts to work in a few hours.
For heart conditions or high blood pressure, propranolol can take up to a week to reach its full effect. You may not feel any different but that does not mean it is not working. It's important to keep taking your medicine.
For migraines, it can take several weeks for propranolol to start making a real difference, so keep taking it.
This depends on why you're taking propranolol.
For heart conditions or high blood pressure, treatment is usually long term and may be for the rest of your life.
For anxiety, you'll usually take propranolol for a short amount of time, to help with your physical symptoms. Speak to your doctor about the risks and benefits of taking it for more than a few months. This will depend on your symptoms, whether it's a one-off or a recurring problem, how well propranolol works for you and whether you get side effects.
For migraines, treatment can last for several months or years, depending on how bad your symptoms are.
Can I take propranolol for a long time?Propranolol is generally safe to take for a long time.
If you're taking it for a heart condition, or to prevent migraines, it works best when you take it long term.
If you're taking it for anxiety, there do not seem to be any lasting harmful effects if you take it for several months or years. But it's best to take propranolol only for as long as you need it.
You'll need to have your blood pressure checked regularly if you're taking propranolol for a long time for migraines or anxiety.
What will happen if I stop taking it?Talk to your doctor if you want to stop taking propranolol. If you're bothered by side effects, your doctor may be able to prescribe a different medicine instead.
Stopping propranolol suddenly may make your health problem worse. In addition, if you stop suddenly after taking it for a long time, you may get extra side effects as a reaction to stopping it. These include an irregular heart rate, sweating and shaking.
If you stop taking propranolol, it will take about 1 to 2 days for it to be completely out of your body but the side effects can last for up to 1 week.
Propranolol works as well as other beta blockers for reducing blood pressure. The main difference between propranolol and other beta blockers is that it does not just affect your heart. It can affect other parts of your body too, such as your lungs.
There are lots of other medicines to lower your blood pressure and treat chest pain. They work in a different way to beta blockers and include:
- ACE inhibitors like ramipril and lisinopril
- angiotensin receptor blockers like candesartan
- calcium channel blockers like amlodipine
- medicines that make you pee more (diuretics) like furosemide
Beta blockers are not usually the first choice for high blood pressure. The medicine your doctor prescribes depends on your age and ethnicity.
If you're under 55 and not of African Caribbean or black African origin, you'll usually be offered an ACE inhibitor or an angiotensin receptor blocker.
If you're 55 or older, or you're any age and of African Caribbean or black African origin, you'll usually be offered a calcium channel blocker.
Sometimes you may have to try other blood pressure-lowering medicines if you get side effects. Many people need to take a combination of different medicines to lower their blood pressure.
How does it compare with other medicines for preventing migraine?Atenolol, metoprolol, timolol and nadolol are all beta blockers and they work well in preventing migraines. However, most doctors prescribe propranolol.
There are some other medicines that are known to prevent migraines but they are not officially approved in the UK. They include amitriptyline, sodium valproate and gabapentin and they may have different side effects.
Topiramate can also be used to prevent migraines. It works just as well as propranolol. However, topiramate has not been officially approved for migraine for children under the age of 16.
Ask your doctor or pharmacist which medicine is best for you.
How does it compare with other medicines for anxiety?Propranolol treats the physical symptoms of anxiety – for example, it stops your heart beating too fast. You'll usually only take propranolol for a short time.
The physical symptoms of anxiety are caused by chemical imbalances in the brain. Your doctor may prescribe an antidepressant like sertraline to treat these imbalances. You usually take antidepressants long term.
Many doctors prefer medicine-free treatments for anxiety. These include talking therapies like cognitive behavioural therapy. If you're having talking therapy, your doctor may prescribe propranolol at the same time.
This will help you with your physical symptoms.
Tell your doctor that you're taking propranolol if you're going to be put to sleep using general anaesthetic, or you're having any kind of major operation.
Your doctor may advise you to stop taking propranolol before surgery. This is because propranolol can lower your blood pressure too much when it's combined with some anaesthetics.
Can I drink alcohol with it?Drinking alcohol can increase the blood pressure-lowering effect of propranolol, which can make you feel dizzy or lightheaded.
During the first few days of taking propranolol or after an increase in your dose, it's best to stop drinking alcohol until you see how the medicine affects you.
If you find propranolol makes you feel dizzy it's best to stop drinking alcohol.
Apart from being careful with alcohol, you can eat and drink normally while taking propranolol.
Eating a healthy, balanced diet can help if you have high blood pressure or another heart condition.
Will it make me put on weight?Some people on propranolol say they put on weight, especially in the first few months of taking it. This is not known to be a common side effect of taking propranolol, and there is not enough information to say for sure why some people put on weight.
It could, for example, be because propranolol can make you feel tired which could make you less active. It could also affect the way your body uses energy.
If you're worried about putting on weight with propranolol, speak to your doctor.
Will it affect my contraception?Propranolol will not stop your contraception working.
However, some types of hormonal methods of contraception, like the combined pill and contraceptive patch, are not usually recommended if you're taking propranolol or other medicines for high blood pressure. This is because some hormonal contraceptives can raise your blood pressure and stop propranolol working properly.
Talk to your doctor if you're taking a hormonal contraceptive.
If propranolol makes you sick (vomit) or have severe diarrhoea for more than 24 hours, your contraceptive pills may not protect you from pregnancy. Look on the pill packet to find out what to do.
Read more about what to do if you're on the pill and you're being sick or have diarrhoea.
Will it affect my fertility?There is no evidence that propranolol affects fertility in men or women.
If you're trying to get pregnant, or you're having problems getting pregnant while on propranolol, speak to your doctor.
Some people on propranolol say their sex drive goes down and some men find they cannot get an erection. However, this is not a common side effect and there is not enough evidence to say for sure that propranolol is causing it.
If you're having problems with your sex life, talk to your doctor.
Do I need to avoid playing sports?You do not need to stop playing sports if you take propranolol. But do not push yourself too much.
Regular exercise is good for you because it lowers blood pressure by keeping your heart and blood vessels in good condition.
Be aware, though, that in some sports propranolol is not allowed if you're competing at a high level.
Can I drive or ride a bike?Propranolol can make some people feel dizzy, especially when they first start taking it or after taking a bigger dose.
If this happens to you, do not drive a car, ride a bike, or use tools or machinery.
It's an offence to drive a car if your ability to drive safely is affected. It's your responsibility to decide if it's safe to drive. If you're in any doubt, do not drive.
Talk to your doctor or pharmacist if you're unsure whether it's safe for you to drive while taking propranolol. GOV.UK has more information on the law on drugs and driving.
Can lifestyle changes help?If you have heart problems, you can boost the health of your heart by making some key lifestyle changes. These changes will also help if you have high blood pressure.
- Quit smoking – smoking increases your heart rate and blood pressure. Quitting smoking brings down your blood pressure and relieves heart failure symptoms. Try to avoid second-hand smoke too.
- Cut down on alcohol – drinking alcohol while you're taking propranolol can make you feel dizzy or light headed.
Also drinking too much alcohol raises blood pressure over time and makes heart failure worse. It's best to keep to the recommended limit of no more than 14 units of alcohol a week. A standard glass of wine (175ml) is 2 units. A pint of lager or beer is usually 2 to 3 units of alcohol. - Exercise – regular exercise lowers blood pressure by keeping your heart and blood vessels in good condition. It does not need to be too energetic, walking every day will help.
- Eat well – aim to eat a diet that includes plenty of fruit and vegetables, wholegrains, fat-free or low-fat dairy products and lean proteins. It's a good idea to follow these tips for a lower salt diet too. Eating too much salt is the biggest cause of high blood pressure. The more salt you eat, the higher your blood pressure will be. Aim for no more than 6g of salt a day.
- Deal with stress – when you're anxious or upset, your heart beats faster, you breathe more heavily and your blood pressure often goes up.
This can make heart failure worse too. Find ways to reduce stress in your life. To give your heart a rest, try napping or putting your feet up when possible. Spend time with friends and family to be social and help avoid stress.
If you get severe headaches, there are steps you can take to help prevent migraines. This includes working out what things trigger an attack so you can avoid them.
A Guide On What You Need To Know
What is Propranolol used for?
Propranolol is used to treat various health conditions, including cardiovascular diseases. It’s a beta-blocker, which is a type of medicine that can manage heart rhythms.
Due to this, Propranolol can be used to relieve the physical effects and signs of anxiety (particularly social or performance anxiety), slowing a racing heartbeat and reducing sweating and trembling.
This is one of the main uses of Propranolol.
There are a few different forms of Propranolol (you can take it in a tablet, a capsule, or a liquid), and it’s offered in varying dosages: your doctor or pharmacist can prescribe a dosage that suits the condition you’re treating.
Propranolol uses
Propranolol has a wide range of health uses covering both physical and mental issues. Here are some of the conditions Propranolol is used to treat and alleviate the symptoms of:
- Anxiety
- Panic disorder
- Migraine
- High blood pressure (hypertension)
- Heart rhythm disorder (fast or irregular heartbeats)
- Chest pain caused by angina
- Overactive thyroid gland
- Infantile hemangioma
This list isn’t exhaustive; Propranolol can also be used to treat other conditions and disorders that we have not mentioned above. It’s also used as a preventative measure in some cases. It can reduce the risk of suffering a heart attack or stroke, for instance.
The Propranolol dosage you should take will depend on why you need it in the first place. Your doctor or pharmacist will be able to help you with the correct dosage.
Anxiety
As we’ve mentioned above, one of the uses of Propranolol (in its 10mg tablet form) is to relieve the physical symptoms of social and situational anxiety.
Propranolol 10mg tablets will help to reduce physical anxiety symptoms including:
- Sweating
- Flushing
- Fast heartbeat
- Fast breathing (hyperventilating)
- Shaking or trembling
Propranolol will not treat the psychological symptoms of anxiety, such as feeling tense, nervous, worried or feeling a sense of dread. However, these psychological symptoms are often reduced by the reduced physical symptoms from propranolol.
Migraines
Propranolol can also be taken regularly to reduce the number of migraine attacks experienced by migraine sufferers. It is the most commonly used drug of choice for migraine prevention.
It is worth noting that Propranolol doesn’t reduce the severity or duration of migraines.
How does Propranolol work?
Propranolol works by slowing your heart rate and affecting your blood vessels, making it easier for your heart to pump blood around your body.
If you are feeling particularly anxious, worried or stressed about an upcoming event (such as an interview, exam or presentation at work), then you may experience anxiety symptoms such as a racing heart, sweating and flushing. By slowing down your heart rate, Propranolol can tackle the physical symptoms of anxiety and help you to feel calmer.
Propranolol also inhibits the effects of the stress hormone noradrenaline, which further combats these physical anxiety symptoms.
Propranolol doesn’t treat the mental symptoms of anxiety such as worry, a sense of dread or a foggy mind, but lots of people find that easing their physical symptoms with medication can also help to alleviate mental symptoms, making them less aware of how nervous they are.
Propranolol is a type of beta-blocker. Beta-blockers are medical treatments that were initially developed to treat heart problems but are now also used to help with anxiety and migraines.
Propranolol dosage
Propranolol comes in various different dosages, with each featuring a distinct concentration of the active ingredient. The dosage in a given tablet, capsule or liquid serving can range from 10mg to 160mg.
The right Propranolol dosage for anxiety will vary from person to person; if you find that 10mg is not alleviating your anxiety symptoms, you can increase your dosage to as many as four 10mg tablets before an event. You can also take this Propranolol dose for anxiety up to three times a day.
Stronger doses of Propranolol are available to decrease the frequency of regular migraines.
The typical Propranolol dosage for migraines is 40mg once or twice a day, but this can be increased to as much as 240mg daily if migraines worsen or continue.
It’s important that you do not exceed the recommended Propranolol dosage prescribed by your doctor or pharmacist for your condition. Doing so could result in unpleasant side effects, or worse, an overdose which would cause light-headedness, blurred vision and even fainting (these things stem from major reductions in heart rate and blood pressure). It could even result in severe heart problems.
If you miss a dose, take the missed tablet as soon as possible. If you can’t take that missed tablet before it’s nearly time for the following dose, though, you should forget about it and resume your regular routine. Never double your dose to make up for a missed tablet.
How quickly does Propranolol work for anxiety?
Propranolol can work very quickly to help relieve situational anxiety symptoms. It can help to reduce peripheral symptoms such as sweating, tension and tachycardia in as little as half an hour and on some occasions, 20 minutes.
If you have a stressful situation, event or performance that you’re worried and anxious about — such as a presentation at work, an interview or an exam — then you usually need to take Propranolol about 30 to 60 minutes before.
For some people, it may take a little longer to feel the effects of Propranolol — perhaps a few hours — so it’s a good idea to test it out first, rather than using it for the first time before a situation you’re worried about.
How long does Propranolol last?
Propranolol generally lasts between three to four hours. For most people, Propranolol can provide around four hours of symptom relief.
During this time, Propranolol helps with the physical symptoms of anxiety, such as flushing, increased heart rate, shaking, and sweating. As noted, while it doesn’t alleviate the mental symptoms of anxiety (such as worry, mental fog, or mental blankness), becoming less aware of the obvious physical symptoms can lead to those mental symptoms improving.
The half-life of a medicine is the time it takes for the amount of it in your body to be reduced by half, and Propranolol has a half-life of around three to six hours. In all likelihood, it will take around one to two days for a dose to be completely out of your body, with some potential Propranolol side effects lasting that long (or even lingering longer).
Best time to take Propranolol for anxiety
The best time to take Propranolol propranolol for anxiety is dependent on a few factors.
If you are using Propranolol to combat performance anxiety, take your normal dosage (which will be between 10mg-40mg), about half an hour before the situation or event that you are worried about begins.
If you are using Propranolol for more general social anxiety during the day, then you can take it at regular intervals throughout the day. Start by taking one 10mg tablet three times per day. If you feel it is necessary, you can increase the dose to four tablets, but it’s a good idea to speak to your doctor about this.
Propranolol can be taken either with or without food, so you don’t need to worry about planning to take it around your mealtimes.
Is Propranolol good for anxiety?
Propranolol is widely acknowledged to be an effective treatment for anxiety and is generally considered safe to take for a long time.
There don't seem to be any lasting harmful effects if you take it for several months or even years.
There are some cases in which it isn’t advisable to use Propranolol, though, such as if you’re pregnant, have certain medical conditions, or are already taking other types of medication.
You should also avoid mixing Propranolol and alcohol. This is because Propranolol and alcohol both serve to reduce blood pressure. As a result, you could end up with dangerously low blood pressure, leading you to experience dizziness, lightheadedness, headaches, and a range of other symptoms.
As is the case with all medicines, there are some possible side effects to be aware of. With that said, side effects are rare and normally mild; many users experience only minor side effects or no side effects at all.
These are some of the most common side effects associated with taking propranolol:
- Problems sleeping
- Nightmares
- Cold hands
- Tiredness
- Dizziness
- Cold feet
If you stop taking the medication suddenly, you could experience these withdrawal symptoms:
- An irregular heartbeat
- Chest pain
- Sweating
- Shaking
It should also be noted that Propranolol isn’t generally recommended for patients with peripheral vascular disease.
This is because it’s been reported that beta-blockers can worsen the symptoms of intermittent claudication.
You should consult your doctor if you experience any side effects when taking Propranolol.
Summary
Propranolol is a type of prescription-only medicine called a beta-blocker. It’s used to treat anxiety and a range of other health conditions including heart problems and migraines.
Propranolol comes in different strengths: the dosage you should take will depend on the health condition you are treating.
Low doses of Propranolol can be used to help treat performance or situational anxiety by reducing physical symptoms including flushing, shaking, sweating, and an elevated heart rate. Propranolol can work very quickly to relieve these symptoms (taking effect in between 30 and 60 minutes) and can last for around three to four hours.
Sources
- Propranolol 10mg Tablets Patient Information Leaflet: https://www.medicines.org.uk/emc/product/2903/pil
- https://www.
nhs.uk/medicines/propranolol/ - https://bnf.nice.org.uk/drug/propranolol-hydrochloride.html
- https://www.mind.org.uk/information-support/types-of-mental-health-problems/anxiety-and-panic-attacks/about-anxiety/
- https://www.nhsinform.scot/illnesses-and-conditions/mental-health/
- https://www.mentalhealth.org.uk/a-to-z/a/anxiety
- https://www.gokick.com/blog/beta-blockers-faq/how-long-does-propranolol-last/
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If you suffer from severe stage fright or social anxiety, you may be prescribed propranolol to relieve symptoms.
Originally developed to relieve chest pain associated with heart disease, propranolol is primarily used to treat or prevent conditions including atrial fibrillation, high blood pressure (hypertension) and migraines (Srinivasan, 2019).
Propranolol, also sold under the brand name Inderal, belongs to a class of drugs called beta-blockers that help lower heart rate and lower blood pressure by blocking hormones such as adrenaline (AHA, 2020).
Vitals
- Propranolol may be prescribed off-label to relieve symptoms of social anxiety such as stage fright or public speaking anxiety.
- Propranolol is most commonly used to treat high blood pressure and other heart conditions.
- This medicine may cause side effects including dizziness, nausea, dry eyes, rash, diarrhea and sexual dysfunction.
- People living with comorbid conditions, including lung disease, diabetes, or liver disease, should be careful or avoid taking propranolol as it can lead to serious side effects.
Because propranolol is so effective in reducing some of the symptoms associated with anxiety - such as sweating and heart palpitations - it is sometimes used for performance anxiety or stage fright (Srinivasan, 2019).
Here's what you need to know about propranolol, its side effects, and how the drug is used for anxiety.
What is propranolol?
Propranolol (brand name Inderal) is a prescription drug. used to treat and manage cardiovascular disease, as well as a variety of other conditions such as migraine, essential tremor, and pheochromocytoma, a type of tumor that develops in the adrenal glands above the kidneys (Srinivasan, 2019).
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Because the drug lowers blood pressure, which reduces the workload on the heart, it is also sometimes prescribed off-label (that is, for use not officially approved by the US Food and Drug Administration (FDA) to relieve symptoms of performance and social anxiety). phobias.
And if you've ever experienced performance anxiety, you're well aware of the symptoms: palpitations, clammy hands, feeling like you might vomit.
To suppress symptoms, for example, before a public performance or musical performance, a healthcare provider may recommend taking a beta-blocker beforehand (Srinivasan, 2019).
Propranolol is available as immediate and extended release oral tablets, as well as intravenous injection or liquid form for those who have difficulty swallowing tablets. It is available in dosages of 10, 20, 40, 60 and 80 mg. An extended release version can be found in higher doses of 120mg and 160mg.
Dosages will vary depending on what it is prescribed for. The extended release propranolol is taken once a day, while the immediate release version can be taken 2-4 times a day. Propranolol is available by prescription only and costs anywhere from $9 to $33 for a 30-day supply.
In addition to being an off-label use for social anxiety, propranolol is also an FDA-approved treatment (FDA, 2010):
- High blood pressure
- Chest pain (angina pectoris)
- Atrial fibrillation K a heart condition that causes an irregular heartbeat (AHA, 2016).
- Heart attack (myocardial infarction)
- Migraine
- Essential tremor : An involuntary movement or tremor of the body that is not caused by another disease that most commonly affects the hands and is more common with age.
- Hypertrophic obstructive cardiomyopathy (HOCM): Historically known as hypertrophic subaortic stenosis, HOCM is a genetic disorder that hits the wall separating the left and right sides of the heart (Nishimura, 2017). HOCM causes abnormal wall thickening and can lead to sudden death in young people. Beta-blockers are often used to stabilize the heart rate and relieve symptoms of HOCM such as chest pain, shortness of breath, and dizziness.
- Pheochromocytoma: A rare tumor that appears in the adrenal glands.
Beta blockers: how they are used to treat heart disease
4 minute read
Side effects of propranolol
Propranolol carries an FDA black box warning, which means it has serious or life-threatening risks if used incorrectly (FDA , 2010).
Stopping this drug suddenly can lead to chest pain or even a heart attack - do not stop taking propranolol without talking to your doctor.
Here are some of the most common side effects of propranolol (DailyMed, 2019):
- Dizziness or lightheadedness
- Abdominal pain
- Nausea, vomiting and diarrhea.
- Fatigue
- Dry Eyes
- Changes in mood
- Tingling in the hands
- shortness of breath, wheezing or cough
- Sexual dysfunction
less common, but more serious adverse reactions to pro -Prahnol were included low blood pressure, reducing the level of sugar in blood , severe allergic reactions, and bradycardia, where the heart rate drops too low, leading to dizziness, fainting, fatigue, and chest pain.
Propranolol may also mask the symptoms of other diseases. For example, it may mask signs of hypoglycemia (low blood sugar) in people with diabetes; when blood sugar levels are too low for a long time, seizures and even death can occur.
Beta-blockers can also mask the symptoms of hyperthyroidism (when your body produces excess thyroid hormone), which can lead to thyroid storm, a condition in which heart rate and blood pressure can spike to fatal levels. Propranolol can also worsen other underlying conditions, including heart failure and lung disease.
What are the side effects of propranolol?
6 minutes to read
Propranolol interactions
Propranolol interacts with hundreds of drugs, some of which are mild and others are severe. Here are some of the major drug interactions to be aware of (FDA, 2010):
- Drugs affecting the cytochrome P-450 system: Propranolol is broken down in the liver by the P-450 system. When taken with other drugs that affect this system, propranolol levels in the body may be too high or too low. Examples of these drugs include cimetidine, fluconazole, and fluoxetine.
- Antiarrhythmics: These drugs affect heart rate and may increase the risk of side effects when taken with propranolol.
Common antiarrhythmic drugs include amiodarone, digoxin, lidocaine, propafenone, and quinine. - Calcium channel blockers: Propranolol also increases the risk of side effects such as low blood pressure and slow heart rate when taken with certain calcium channel blockers. Examples include: diltiazem, nicardipine, nisoldipine, nifedipine and verapamil.
- Migraine medicines: Propranolol increases the concentration of the migraine medicines zolmitriptan or rizatriptan when taken together.
- Blood pressure medicines: The effects of medicines used to lower blood pressure, such as alpha-blockers or angiotensin-converting enzyme (ACE) inhibitors, are increased when taken with propranolol, causing blood pressure to drop too much. Examples include: doxazosin, enalapril, lisinopril, prazosin and terazosin.
- Theophylline: This drug is known as a bronchodilator used to treat lung conditions such as asthma.
If taken with propranolol, the effects of theophylline may be reduced. - Diazepam: Diazepam, sold under the brand name Valium, is used to relieve symptoms of anxiety. Propranolol increases the levels of diazepam in the body, which also increases the risk of side effects.
- Medicines for high cholesterol: Some cholesterol medicines can lower the level of propranolol in the body, and vice versa. Medicines to be aware of include:
- Monoamine oxidase inhibitors (MAOIs) : This group of drugs is used to treat depression and other conditions. Taking an MAOI with propranolol may increase the risk of side effects. Types of MAOIs are isocarboxazid, phenelzine, selegiline, and tranylcypromine.
- Warfarin: Warfarin is a medicine that prevents blood clots. When combined with propranolol, warfarin levels can increase in the body and increase the chance of bleeding.
- Nonsteroidal anti-inflammatory drugs (NSAIDs) : NSAIDs help with pain and inflammation.
However, they may reduce the effectiveness of propranolol; examples of NSAIDs include naproxen and ibuprofen. - Alcohol: Drinking alcohol while taking propranolol may increase the risk of side effects such as dizziness and fatigue.
This is not the whole list of medicines that can interact with propranolol. Tell your doctor about all the medicines you are taking before starting treatment with propranolol.
Who should not take propranolol
There are certain groups of people who should be careful when taking propranolol and others who should not take it at all. Propranolol can worsen conditions - including heart failure, liver disease, myasthenia gravis (a disease that causes muscle weakness), kidney disease, and circulatory-related diseases such as peripheral vascular disease or Raynaud's disease - and should be taken with caution (FDA, 2010 ).
Other risk groups include people living with diabetes, bradycardia (slow heart rate) and low blood pressure.
People with lung conditions such as asthma, emphysema, or chronic obstructive pulmonary disease (COPD) should avoid taking this drug. There is still not enough research on whether propranolol is safe for pregnant women. If you are breastfeeding, check with your doctor before using this medication as it has been found to pass into breast milk (FDA, 2010).
Whether you're taking propranolol for anxiety or high blood pressure, lifestyle changes can also improve your overall health. Quitting smoking, exercising regularly, eating well, and managing stress are all ways to help reduce anxiety symptoms and keep your heart healthy.
Recommendations
- American Heart Association (AHA) - angina pectoris (chest pain). (2015). Retrieved 20 October 2020 https://www.heart.org/en/health-topics/heart-attack/angina-chest-pain
- American Heart Association (AHA) - Cardiac drugs. (2020). Retrieved 20 October 2020 https://www.heart.org/en/health-topics/heart-attack/treatment-of-a-heart-attack/cardiac-medications#beta
- American Heart Association ( AHA) - What is atrial fibrillation.
(2016). Retrieved October 20, 2020 https://www.heart.org/en/health-topics/heart-attack/angina-chest-pain - Centers for Disease Control and Prevention (CDC) - Estimating Prevalence, Treatment and control of hypertension among adults in the United States. (2020). Retrieved October 21, 2020 from https://millionhearts.hhs.gov/data-reports/hypertension-prevalence.html
- DailyMed - propranolol hydrochloride capsule. (2019) Retrieved 20 October 2020 from https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=8efc9fc6-6db0-43c9-892b-7423a9ba679f
- Dezsi, C.A., & Szentes, V. (2017). The real role of β-blockers in daily cardiovascular therapy. American Journal of Cardiovascular Drugs, 17(5), 361-373. 10.1007/s40256-017-0221-8. Retrieved from https://pubmed.ncbi.nlm.nih.gov/28357786/
- National Institute of Neurological Disorders - Tremor Fact Sheet. (2020). Retrieved 22 October 2020 from https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Fact-Sheets/Tremor-Fact-Sheet
- National Organization for Rare Diseases (NORD) - Pheochromocytoma.
(no data). Retrieved October 22, 2020 from https://rarediseases.org/rare-diseases/pheochromocytoma/ - Nishimura, R.A., Seggwiss, H., and Schaff, H.W. (2017). Hypertrophic obstructive cardiomyopathy. Circulation Research, 121, 771-783. https://doi.org/10.1161/CIRCRESAHA.116.309348
- Srinivasan, A. V. (2019). Propranolol: a 50-year perspective. Annals of the Indian Academy of Neurology, 22(1), 21-26. https://dx.doi.org/10.4103%2Faian.AIAN_201_18
- US Food and Drug Administration (FDA): Inderal Tablets (propranolol hydrochloride) (2010). Retrieved 20 October 2020 from https://www.accessdata.fda.gov/drugsatfda_docs/label/2011/016418s080,016762s017,017683s008lbl.pdf
- Virani, C.S., Alonso, A., Benjamin, E. J., Bittencourt, M. S., Callaway, C. W.,… Cao, C. W. (2020). Heart Disease and Stroke Statistics - 2020 Update: Report from the American Heart Association. Circulation, 141, 139-596. https://doi.org/10.1161/CIR.0000000000000757
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What Diazepam is and what it is used for
Diazepam belongs to a group of medicines called benzodiazepines.
Used to treat anxiety, muscle spasm and seizures (seizures).
Diazepam is used to treat some conditions including:
In adults
- short-term relief (2-4 weeks only) of severe anxiety, which is an emotional state of sweating, trembling, anxiety, and palpitations that may also be accompanied by insomnia (sleep disorder) or mental disorders
- providing muscle relaxation in muscle spasm and cerebral palsy (a brain lesion characterized by impaired motor activity and rigidity or stiffness)
- epilepsy (when taken with other drugs)
- patients with symptoms of alcohol withdrawal
- providing relaxation for restless patients during dental procedures
In children
- to relieve tension and irritability caused by cerebral spasticity (a condition associated with a disease or injury that affects the brain or spinal cord, accompanied by weakness, uncoordinated movements, stiffness).
- to relieve muscle spasm caused by tetanus (when taken with other drugs).
Both adults and children can take diazepam as a premedication before surgery to help them relax and fall asleep.
What you need to know before you use Diazepam
Do not take Diazepam and tell your doctor if:0016 Talk to your doctor or pharmacist before taking diazepam tablets: Other precautions Other medicines Tell your doctor if you are taking or have recently taken any other medicines, including medicines obtained without a prescription. Especially: Taking these drugs with Diazepam may affect your mental state, make you sleepy, have respiratory depression and lower your blood pressure. Diazepam with food and drink Do not drink alcohol while taking diazepam. Alcohol enhances the sedative effect of diazepam and may cause marked drowsiness. Grapefruit juice may increase blood levels of diazepam. Drinks containing caffeine may reduce the effect of diazepam. Pregnancy and breast-feeding Do not take diazepam if you are pregnant, planning to become pregnant or breast-feeding. If you take diazepam late in pregnancy or during labor, your baby may experience low body temperature, discomfort, and difficulty breathing. If you took the drug regularly in late pregnancy, your baby may develop withdrawal symptoms. Check with your doctor or pharmacist before taking any medicines. Effects on ability to drive and use machines The drug may cause drowsiness, forgetfulness, poor coordination together with other effects may affect daily activities (see Possible side effects ). Therefore, you must refrain from driving or working with any machinery, from those activities in which you may put yourself at risk. This medicine may affect your ability to drive because it may make you drowsy or dizzy. Important information about the ingredients that are part of Diazepam Diazepam tablets contain lactose If you are informed that you have the intolerance of some sugar it's a cure. How to take Diazepam Always take this medicine exactly as directed by your doctor. You should not take diazepam for more than 4 weeks. If you have any doubts about taking the drug, you should consult your doctor or pharmacist. Tablets are swallowed whole with a glass of water. Dose Adults Children For cerebral spasticity to eliminate tension and irritability: 5 mg to 40 mg daily in divided doses. If your child has been prescribed Diazepam before surgery, the usual dose is 2mg-10mg. Elderly or sickly patients If you are an elderly or sickly patient, you are more sensitive to the effects of Diazepam, such as confusion, and your doctor should reduce the dose. The dose should not be more than half the adult dose. If you have liver or kidney problems, you should also lower your dose. If you have taken more diazepam than recommended If you (or someone else) has taken many tablets at the same time, or you suspect that a child may have swallowed the tablets, go to the nearest emergency room or immediately tell your doctor. In case of overdose, you may feel awkward and uncoordinated, feel drowsy or deep sleep, speech problems, irregular or slow heartbeat, uncontrolled eye movements, muscle weakness or agitation. Severe overdose can lead to coma (unconsciousness), impaired reflexes and difficulty breathing. If you forget to take diazepam Do not take a double dose to make up for the missed dose. If you forget to take your next dose, take it as soon as you remember and continue taking the next dose as usual. If you stop taking Diazepam Do not stop taking the drug without consulting your doctor, because before stopping the drug, the dose should be gradually reduced until the drug is completely discontinued. If you suddenly stop taking Diazepam, you may experience unpleasant side effects including depression, nervousness, irritability, sweating or diarrhea. If you have taken a large dose, you may occasionally experience confusion, seizures, or unusual behavior. Treatment should be discontinued gradually, otherwise the symptoms for which you have been treated may recur more intensely than before (relapsing insomnia and restlessness). The risk of all this increases with sudden discontinuation of the drug. You may also experience mood changes, anxiety, restlessness, or changes in sleep patterns. If you have any further questions on the use of this medicine, ask your doctor or pharmacist. Possible side effects Like all medicines, diazepam can cause side effects, although not everyone gets them. Call your doctor right away if you notice any of these side effects, or if you experience side effects not listed in this package insert: Some side effects may be serious and require immediate medical attention: Uncommon: may affect 1 to 10 in 1,000 people Rare: may affect 1 to 10 in 10,000 people Very rare: may affect up to 1 in 10,000 people Other side effects: Very common: may affect up to 1 in 10 people Frequent: may affect 1 to 10 in 100 people Uncommon: may affect 1 to 10 in 1,000 people Rare: may affect up to 1 to 10 people in 10,000 . The attending physician should be informed. Very rare: may affect up to 1 in 10,000 people Unknown: frequency of occurrence cannot be estimated from the available data Withdrawal syndrome: see “If you stop taking Diazepam”. Reporting side effects: If you notice any side effects, tell your doctor, pharmacist or pharmacist, including any side effects not listed on this leaflet - liner. You can also report side effects to Arpimed LLC by going to the website www.arpimed.com and filling out the appropriate form “Report a side effect or ineffectiveness of a drug” and to the Scientific Center for Expertise of Drugs and Medical Technologies named after. Academician E.Gabrielyan, by going to the website www.pharm.am in the section “Report a side effect of a drug” and fill out the form “Map of reporting a side effect of a drug”. Scientific center hotline: +37410237665; +37498773368. How to store Diazepam 
These side effects are more likely to occur in children or the elderly. 
If you are an elderly patient, suffering from cirrhosis or any of the conditions listed in section 2, then it may increase the sedative effect of Diazepam and you should inform your doctor or pharmacist about this. 
They can also acquire a severe course. These side effects are most likely to occur in children or the elderly.
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