Public speaking beta blockers

All About Propranolol for Performance Anxiety

Feeling anxious before a speech, event or social engagement? Originally designed to treat heart conditions, propranolol is also a highly effective medication prescribed off-label for treating the physical symptoms of social and performance anxiety.

Below, we’ve explained what propranolol is, how it works and how you can use it to manage most performance anxiety symptoms. We’ve also explained how propranolol differs from the other drugs used to treat anxiety, such as alprazolam (brand name Xanax) and diazepam (Valium).

What is Propranolol?

Propranolol, (a.k.a. propranolol hydrochloride) is a beta blocker -- a type of medication that works by blocking the beta receptors found in your body, according to an article published in the book, StatPearls.

Developed in the 1960s, propranolol is one of the oldest and most widely used beta blockers in existence according to an article published in the Journal of Psychopharmacology. There are millions of prescriptions for propranolol in the US alone, making it an incredibly popular medication. It is sometimes sold under the brand name Inderal.

Propranolol is available in a variety of forms, from a release capsule to an injection. The majority of people who use propranolol on a regular basis are prescribed the oral version of the medication.

Like other beta blockers, propranolol was originally designed as a treatment for cardiovascular conditions, such as irregular heart rate (arrhythmias), increased heart rate (tachycardia) or high blood pressure. Most people who are prescribed propranolol use it for this purpose, according to the same StatPearls article.

It’s also commonly prescribed for off-label use to treat performance anxiety and social anxiety.

How Long Does it Take For Propranolol to Work?

It will take about 30 to 60 minutes for you to notice the effects of propranolol. Those using propranolol for anxiety should plan to take their dose an hour or so before they wish to feel the desired effect.

How Long Does Propranolol Stay in Your System?

Propranolol can stay in your system for about 1-2 days. However, the effects of the drug, if taken regularly, can last for up to a week.

How Does Propranolol Treat Performance Anxiety?

First off, it’s important to understand that propranolol technically isn’t an anti-anxiety medication like Xanax (alprazolam, a benzodiazepine) or Zoloft (sertraline, an SSRI).

These drugs work by targeting specific parts of your brain and central nervous system, causing you to feel relaxed and calm. Although the specifics are complicated, they essentially work by stopping you from feeling the physical and psychological effects of anxiety.

Medications like Xanax and Zoloft usually treat long-term, persistent anxiety disorders such as panic disorder and generalized anxiety disorder (GAD). While Zoloft is needed on a daily basis to see results, Xanax, like propranolol, is taken on an as-needed basis for performance anxiety symptoms.

On the other hand, propranolol works by specifically targeting receptors in your body to block the action of stress hormones that cause the physical effects of anxiety.

It’s prescribed off-label as a treatment for specific types of anxiety that occur in certain situations, such as social anxiety or performance anxiety, according to the same article published in the Journal of Pharmapsychology.

Social anxiety usually occurs when you’re around other people. Many people feel anxiety about being judged by others or by doing or saying something embarrassing in a social environment.

Performance anxiety is a type of anxiety that can occur when you’re required to perform in front of others. You may have also heard it called “stage fright.”

It can strike when you need to perform in public, such as public speaking, as well as in private, such as having an interview one on one with someone.

When you feel anxiety, such as before meeting a new person or performing in front of others, it can trigger certain physical symptoms. According to an article published in the journal, Fronteirs in Psychology, these physical symptoms of anxiety include:

A dry mouth, taut throat and difficulty speaking
A racing heart
Rapid breathing
Nausea or discomfort lightheadedness
Jitters; Shakiness in your hands, jaw and lips
Sweating, especially from your hands

These symptoms of performance anxiety don’t just develop out of nowhere. Instead, they’re a physical reaction caused by the presence of specific stress hormones in your body, particularly the hormones adrenaline (epinephrine) and noradrenaline (norepinephrine).

When you feel nervous and stressed, such as before delivering a speech, your body ramps up its production of these stress hormones. These hormones work by attaching to beta receptors throughout your body.

Once these hormones attach to your beta receptors, they trigger the anxiety symptoms listed above, from shaky hands to sweating, nausea and a rapid heartbeat.

According to an article published in the book, StatPearls, propranolol works by blocking these receptors. With these receptors blocked, stress hormones like adrenaline don’t have their normal effects on your heart and other tissue. This means you’re less likely to experience physical symptoms like shaking, sweating or a rapid pulse.

Since propranolol only blocks beta receptors, it doesn’t actually stop the psychological effects of anxiety. You might still feel nervous before delivering a speech or meeting someone, but it’s less likely to result in any kind of physical reaction.

Interestingly, although propranolol doesn’t directly affect your brain, it can help to make you feel less nervous. Without the shaking, rapid heartbeat and sweating that usually happens when you feel anxious, it can become easier to relax, perform and stay focused.

A review published in the Journal of Psychopharmacology shows that propranolol works best as a short-term treatment for specific types of anxiety, such as performance anxiety, social anxiety and specific phobias. Propranolol isn’t beneficial for treating other types of anxiety, such as generalized anxiety disorder.

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How to Use Propranolol for Performance Anxiety

Propranolol is a prescription medication, meaning you’ll need to talk to your healthcare provider before you can buy and use it.

Using propranolol to treat performance or social anxiety is a simple process. Many people prescribed propranolol off-label take 10mg to 80mg of propranolol approximately one hour before the event that’s likely to cause stress, depending on the severity of their anxiety.

However, only use the dosage recommended by your healthcare provider.

According to the FDA, propranolol has a half-life of three to six hours, meaning it can last a few hours with one dose. Using a lower dose of propranolol than is recommended by your healthcare provider can reduce the drug’s effects and provide shorter-acting relief from anxiety symptoms.

Like with other medications for anxiety, it can take time to work out the right dose of propranolol for you.

Most healthcare providers recommend starting with a low to moderate dose and adjusting your dose based on your results and side effects.

Propranolol vs. Benzodiazepines for Performance Anxiety

Benzodiazepines such as alprazolam (Xanax) and diazepam (Valium) are also commonly used to treat anxiety.

Although they might seem similar, beta blockers such as propranolol differ from benzodiazepines in several ways:

Propranolol is not physically addictive. Although it’s possible to abuse propranolol and other beta blockers, these drugs aren’t physically addictive. Benzodiazepines such as Valium and Xanax, on the other hand, have a high risk of causing physical addiction.
Propranolol is designed for short-term, event-based anxiety. Benzodiazepines are normally prescribed for long-term, generalized anxiety, whereas propranolol works best as a treatment for short-term, event-based anxiety.
Propranolol primarily affects the body’s response to stress, not the brain. Benzodiazepines like Xanax® reduce anxiety by targeting parts of the brain and central nervous system. Propranolol primarily works by targeting the heart and other tissue with beta receptors.

In general, propranolol works best as a treatment for event-based anxiety, whereas drugs like benzodiazepines and SSRIs are normally used to treat recurrent, persistent anxiety disorders that aren’t triggered by specific events or settings.

Propranolol Side Effects

Used responsibly at a normal dose, propranolol is a safe, effective treatment for performance and social anxiety. However, like other beta blockers, it can result in some side effects.

Side effects are typically mild and uncommon but can still affect you, especially after you first begin using the medication. According to an article published in the journal StatPearls, common side effects of propranolol include:

Slower-than-normal heart rate. Because propranolol blocks the effects of adrenaline on your heart, it can give you a slow heart rate. It’s completely normal to experience a lower heart rate after you take propranolol. However, if your resting daytime heart rate drops below 50 beats per minute while using propranolol, you should contact your healthcare provider as soon as possible.
Sleep problems. The American Journal of Medicine and the FDA published reports of insomnia, awakenings at night and other sleep problems while taking propranolol for hypertension. Several beta blockers are also linked to vivid and unusual dreams.
Fatigue. Propranolol can make you feel more tired than normal due to its effects on the way your body responds to stress hormones. This is most common after you first start to use the medication and usually stops occurring after several days or weeks.
Diarrhea. According to the FDA, ome people who use propranolol might experience diarrhea shortly after taking the medication. Propranolol can also cause nausea, especially in the first few weeks of treatment.
Hair loss. Information published by the FDA says that propranolol is one of several beta blockers that can cause hair loss. The hair loss from propranolol is not permanent and is typically a result of the medication causing some hair follicles to enter their shedding phase prematurely.
Dry eye syndrome. Propranolol and other beta blockers can cause you to develop dry eyes, potentially resulting in eye irritation, according to the FDA.

According to an article published by the Official Journal of Indian Academy of Neurology, propranolol is generally safe and side effects are usually mild and can be managed. If you experience any of the above side effects from propranolol, it’s best to contact your healthcare provider.

Many of these effects can be reduced or avoided by adjusting your propranolol dose or switching beta blockers.

Propranolol also has the potential for several serious potential side effects, according to the FDA. These are rare and only affect a tiny percentage of users.

However, if you experience any of the side effects listed below, or experience an allergic reaction to propranolol, you should seek help from your healthcare provider as soon as possible:

Noticeably cold hands and/or feet
Chest pains (angina)
Congestion or sinus issues
Low blood sugar
Persistent insomnia or nightmares
Hallucinations
Difficulty breathing
Resting heart rate below 50 beats per minute (bradycardia)
Rapid weight gain and/or fluid retention in the legs and ankles
Severe nausea, diarrhea or vomiting

Failure to seek immediate medical attention for serious side effects could result in heart failure, kidney disease or failure, or death.

Signs of an allergic reaction to propranolol include rash, wheezing, chest or throat tightness, trouble breathing or talking, and facial, lip, mouth or throat swelling.

Propranolol Interactions

Propranolol interactions occur with a variety of other medications. Some of these interactions are listed below.

According to the FDA, major propranolol interactions can occur with antiarrhythmic drugs (which are used to treat heart rhythm problems) and hypertension drugs, such as calcium channel blockers, alpha blockers and angiotensin-converting enzyme (ACE) inhibitors.

Propranolol can also interact with other beta blockers, meaning you should never take it with drugs such as acebutolol, atenolol, bisoprolol, carteolol, esmolol, metoprolol, nadolol, nebivolol or sotalol. Used with propranolol, these drugs can cause a dangerous drop in your heart rate.

Propranolol should not be used with lisinopril or enalapril (both ACE inhibitors), with diltiazem (a calcium channel blocker), or with prazosin, terazosin or doxazosin (all alpha blockers). Propranolol interactions may also occur with certain asthma medications, such as theophylline or any nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen.

Due to its effects on heart rate and blood pressure, propranolol is not recommended for use with any stimulants, such as epinephrine, isoproterenol or dobutamine.

Propranolol can also interact with some blood thinners, such as warfarin, causing an increase in warfarin concentration, and with antidepressants such as sertraline.

Your healthcare provider might also recommend avoiding common stimulants such as caffeine, as these can affect the effectiveness of propranolol.

Propranolol can also affect your body’s ability to process high-potassium foods.

Since propranolol is a prescription drug, you’ll need to talk to your healthcare provider before you’re able to use it.

Make sure you inform your healthcare provider of all medications you use on a regular basis to avoid any potential drug interactions.

Is it Safe to Take Propranolol With Alcohol?

Propranolol should not be used with alcohol. One study published by the NIH found that consuming alcohol while you’re under the effects of propranolol can increase the chance of low blood pressure, causing you to feel lightheaded and sleepy. Additionally, the FDA recommends not mixing alcohol and propranolol.

Propranolol Warnings

Seek immediate medical attention if you experience serious withdrawal effects such as chest pain that worsens or spreads to the neck, jaw or arm, difficulty breathing or tightness in your chest or irregular heartbeat.

Before taking propranolol, be sure to discuss any other existing medical conditions with your healthcare provider, such as history of heart attack. Patients with diabetes may be at risk for low blood sugar due to propranolol, according to the FDA.

Additionally, if you have a chronic lung disease, such as emphysema or COPD, it is important to talk with your healthcare provider before taking propranolol in order to be properly monitored during your use.

Can You Overdose on Propranolol?

Yes. If you take too much propranolol, your heart rate can slow so much that it will be difficult to breathe.

Always take propranolol exactly as prescribed and if an overdose is suspected, seek emergency medical care.

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Learn More About Beta Blockers

Propranolol is one of several beta blocker medications used to treat heart conditions, some types of anxiety, migraines and other conditions.

Our guide to beta blockers goes into more detail on how beta blockers work.

10 Sources

Hims & Hers has strict sourcing guidelines to ensure our content is accurate and current. We rely on peer-reviewed studies, academic research institutions, and medical associations. We strive to use primary sources and refrain from using tertiary references.

Abe, et al. (1999). Effects of propranolol on cardiovascular and neurohumoral actions of alcohol in hypertensive patients. Blood pressure. Retrieved December 17, 2021, from https://www.ncbi.nlm.nih.gov/pubmed/10412881
Abubakar, et al (2017). Propranolol-Induced Circulatory Collapse in a Patient With Thyroid Crisis and Underlying Thyrocardiac Disease: A Word of Caution. Journal of investigative medicine high impact case reports, 5(4), 2324709617747903. https://doi.org/10.1177/2324709617747903
de Jongh, et al. (2015). Propranolol for the treatment of anxiety disorders: Systematic review and meta-analysis. Journal of Psychopharmacology, 30(2), 128–139. https://doi.org/10.1177/0269881115612236
Food and Drug Administration. (n.d.). Inderal (propranolol hydrochloride) tablets description ... Retrieved December 17, 2021, from https://www.accessdata.fda.gov/drugsatfda_docs/label/2011/016418s080,016762s017,017683s008lbl.pdf
Gupta, et al. Propranolol. Updated 2021 Nov 20. In: StatPearls Internet. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK557801/
Frangulyan, et al (2011). Beta-blockers as a cause of violent rapid eye movement sleep behavior disorder: A poorly recognized but common cause of violent parasomnias. The American Journal of Medicine, 124(1). https://doi.org/10.1016/j.amjmed.2010.04.023
Inderal (propranolol hydrochloride) tablets description ... (n.d.). Retrieved February 24, 2022, from https://www.accessdata.fda.gov/drugsatfda_docs/label/2011/016418s080,016762s017,017683s008lbl.pdf Shahrokhi, M. (2021, May 7). Propranolol. StatPearls Internet. Retrieved December 17, 2021, from https://www.ncbi.nlm.nih.gov/books/NBK557801/
Rowland, D. L., & van Lankveld, J. J. D. M. (2019, July 16). Anxiety and performance in sex, sport, and stage: Identifying common ground. Frontiers in psychology. Retrieved February 24, 2022, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6646850/
Srinivasan, A. V. (2019). Propranolol: A 50-year historical perspective. Annals of Indian Academy of Neurology. Retrieved December 17, 2021, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6327687/
U.S. National Library of Medicine. (n.d.). Propranolol (cardiovascular): Medlineplus Drug Information. MedlinePlus. Retrieved February 24, 2022, from https://medlineplus.gov/druginfo/meds/a682607.html

This article is for informational purposes only and does not constitute medical advice. The information contained herein is not a substitute for and should never be relied upon for professional medical advice. Always talk to your doctor about the risks and benefits of any treatment. Learn more about our editorial standards here.

Beta Blockers For Public Speaking

Getting up to speak in front of an audience is a nerve-wracking experience for most (if not all). For some, public speaking is a full-blown phobia. It’s such a wide-spread fear, that the fear of public speaking (scientific name Glossophobia) is often ranked in the top 5 list of peoples largest fears in life.

One particular survey found that the fear of public speaking affects 40% of Americans, making glossophobia/fear of public speaking the second most common fear in the US, behind snakes ^[1]. Another study found that nearly 75% of people suffer from some form of glossophobia at some point in their life ^[2].

These studies just go to show that the physical and mental effort of speaking in front of a crowd is overwhelming for many. Fear of public speaking can cause problems in an affected person’s life, such as slowing professional progression, and causing anxiety over common social situations.

The good news is that there are several solutions and strategies to help overcome glossophobia/fear of public speaking, and one of the more popular solutions being used by professional performers today are beta blockers.

In this article we are going to look into using beta blockers for public speaking, going into whether beta-blockers actually help with performance anxiety and stage fright, if they’re safe, what the side-effects and alternatives are and much more.

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Beta Blockers & Public Speaking: a Long History

You may have heard about many performers (musicians, professional public speakers, actors, etc.) who used to experience pre-performance jitters and anxiety symptoms, benefiting from using beta-blockers.

Beta-blockers are a type of pharmaceutical drug that doctors typically prescribe for cardiovascular conditions like high blood pressure, angina (chest pains) and irregular heart rhythm (arrhythmia). The full name is beta-adrenergic blocking agents and their main function is to block the release of adrenaline and other stress hormones ^[3].

Because of the way beta-blockers work within the body, many performers and public speakers use them to block the symptoms of performance anxiety. Actually one of the first popular mentions of beta blockers being used for anxiety purposes was a Lancet article from 1965 ^[4]. That article and tons of further research into stage fright & anxiety tells us that performers are experiencing the physical symptoms of performance anxiety in the first place because of the adrenaline pumping through their bloodstream and their heart working with greater force.

By blocking the release of stress hormones; beta-blockers are preventing the heart from going into overdrive, keeping blood pressure low, and keeping performance anxiety symptoms at bay ^[5].

Do Beta Blockers Really work?

People use beta-blockers “off-script” for public speaking because it is too much adrenaline that is responsible for their performance anxiety symptoms in the first place.

When you’re feeling anxious about something, like giving a public speech, it is to be expected that you’ll feel some level of stress. Naturally, you will feel somewhat of an adrenaline rush as a part of that stress response. For most people, that stress response is not a big deal, and they might even use it to their advantage to up the intensity of their performance ^[6].

But if you experience performance anxiety, that stress response has gone too far. You are experiencing a much greater effect of the adrenaline hormone, which causes your heart rate to skyrocket, along with other symptoms of stage fright and anxiety.

Since beta-blockers block the effects of adrenaline, they also prevent you from experiencing the physical symptoms of that same anxiety. Remaining physically calm has an overall calming effect, which then allows you to get through your speech and keep your stress response at bay.

So yes, beta blockers do work for blocking the effects of adrenaline.

Beta Blocker OTC Brand Names

There are various beta-blockers available today, but here are some of the most common ones available (and their ingredients).

Inderal (Propranolol)
Lopressor (Metoprolol)
Sectral (Acebutolol)
Coreg (Carvedilol)
Tenormin (Atenolol)
Zebeta (Bisoprolol)

All of these beta-blockers are prescription drugs. Inderal/Propranolol is the most common of them. There are also other medications that people commonly use off-script for anxiety, like Clonodine and Depakote, but these are not technically beta-blockers so we won’t cover them here.

It is critical to remember that everyone responds to medications and treatments differently. If you’re considering using beta-blockers for anxiety, or any another condition, be sure to consult a medical professional before you begin.

Are Beta Blockers Safe?

As long as you are only using beta-blockers occasionally, they seem to be quite safe with minimal risk of side effects.

Problems can arise if you need beta-blockers to be able to perform at all, as that’s when you might start using them frequently.

If you’re using beta-blockers too much, then it could get to a point where you become dependent on beta-blockers, and withdrawal could cause other problems such as high blood pressure.

So beta-blockers are safe to use when you need a quick stage fright solution, but it might be a good idea to start incorporating some natural alternatives to beta-blockers, as we will discuss later.

Beta-blocker side-effects

Beta-blockers are generally considered to be safe for public speakers (or any performer). Especially if you only take them occasionally. But beta blockers can come with potential side effects, although not too common among public speakers who only use beta-blockers every now and then.

Here is a list of the potential side effects of beta-blockers ^[7]:

Fatigue
Mood disorders
Digestive issues like gas, bloating, and constipation
Nausea, and in some cases, vomiting
Heartburn
Dry mouth

In some rare, but severe cases, one might also experience the following side effects from beta-blockers:

Wheezing and/or shortness of breath
Swelling of extremities like hands, feet, or ankles
Fainting
Pounding heartbeat

If you experience any of the side effects mentioned above, immediately notify your doctor.

What’s the best way to handle public speaking anxiety?

Glossophobia/Fear of public speaking does not have to be a chronic, lifelong affliction. There are various strategies and tools that a person can use to overcome their fear of public speaking, including medications (like beta blockers of course), mental strategies and dietary supplements.

The strategy that works for one person may not work for the next. If you suffer from public speaking anxiety, it’s important that you try to understand the root causes of your phobia, and experiment with different tools to see what works for you.

Let’s take a look at a few ways people combat fears of public speaking.

Beta Blockers

As we’ve covered, beta-blockers don’t treat the actual causes of public speaking anxiety but they can lessen the symptoms of the fight or flight response, such as increased heart rate and blood pressure.

Beta-blockers do appear to have some level of efficacy at treating the symptoms of elevated stress hormones.

Many public speakers use beta-blockers as a short-term fix, and accept that beta-blockers may come with additional risks, such as addiction or dependence risks.

Practice

Mild cases of public speaking anxiety may be treatable simply with practice.

Many people struggle with public speaking simply because it’s new to them. The fear of the unknown and lack of confidence may manifest itself in extreme fear or anxiety.

However, once you get used to speaking in front of people, and develop confidence within these kinds of situations, the fear may go away.

This probably wont solve the fear of public speaking for everyone. For more serious cases of glossophobia, other tools and strategies will be needed. In particular, if someone doesn’t experience anxiety in any other social situations, yet speaking in front of a crowd immediately sparks a stress response, one of the more concentrated strategies may work best.

Cognitive-Behavioral Therapy (CBT)

Cognitive-behavioral therapy (CBT) helps you take challenges that you find overwhelming, such as speaking or performing in front of a crowd, and shifts your mindset around them.

CBT seeks to replace your harmful thought patterns by breaking them down into smaller parts, and then replacing them with positive ones ^[8].

With CBT you work with a therapist and he or she will help you identify specific aspects of performing that you find stressful.

Then you would do mental exercises and assignments that create new positive associations with those performance aspects to make it less stressful, and eventually, something you look forward to.

Breathing Exercises

Certain breathing techniques can be effective in stopping the onset of physical anxiety symptoms caused by the body’s stress response.

While public speaking practice and CBT may help the problem long-term, breathing exercises can offer a short-term fix that you can put into practice before you need to address an audience.

One particular breathing exercise is known as “diaphragmatic breathing” or “belly breathing”, in which you take deep breaths, engaging the stomach and the diaphragm. In contrast to regular, unconscious breathing, an effort is made to bring the breath down into the stomach, which should rise and fall with each breath.

Diaphragmatic breathing has long been used in meditation, and meditative practices like yoga and tai-chi. Studies have shown deep breathing to have positive effects on cognition and stress, adequately reducing levels of cortisol, a hormone that gets released when we’re stressed or anxious ^[9]. It also helps reduce blood pressure and improve heart rate variability, which works to lessen the severity of symptoms one may experience with public speaking anxiety.

Natural Beta Blocker Alternatives

While many performers use beta-blockers like Propranolol and Metoprolol to help with their anxiety & stage fright, perhaps you’re not too excited about becoming dependent on a prescription beta-blocker every time you want to talk in front of an audience or know that you’ll be in a high-anxiety situation. Instead of having to get a prescription whenever you run out, you may want to consider a natural alternative to beta-blockers.

A natural alternative to beta-blockers would achieve the same end-result as a beta-blocker (providing relief from symptoms of performance anxiety) but it would do so by supporting your brain in a way that promotes overall relaxation, calmness, and improved cognitive function. The best natural alternative to beta blockers available today is PerformZen Calm Performance Formula.

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PerformZen is a natural supplement designed to help public speakers overcome glossophobia symptoms, and maintain their composure and mental focus when they have to deliver a speech under pressure!

PerformZen works by boosting GABA, which is a neurotransmitter that promotes calmness ^[10]. It also contains magnesium and vitamin B6, which combine together to improve cognitive performance ^[11].

Additionally, PerformZen contains L-theanine, theacrine, and Ginkgo Biloba, which are natural ingredients that promote calmness and provide a boost in clean energy.

If Beta Blockers aren’t the answer, what is?

Performance anxiety is no joke. If it’s more than a minor case of the jitters, it can have a significant impact on your life and ruin big moments for you (like giving successful public speeches).

But the good news is that you don’t have to let public speaking anxiety, or anxiety in general, control your life.

If you’ve been considering beta-blockers to help with your public speaking fears, you should know that although they can provide temporary relief, they are not a long term solution. Not to mention, there may be side effects, and you will need a prescription.

Natural supplements like PerformZen promote calmness and better mental function with ingredients that support your brain so it becomes more resilient to handle stressful situations like giving speeches/talks. http://www.researchautism.net/interventions/97/vitamin-b6,-magnesium-and-autism

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Beta blockers: humble saviors of humanity

This group of drugs, not being heard by the general public, has been confidently on the list of bestsellers for many decades in a row. Experts consider their development one of the main breakthroughs in drug therapy of the 20th century, and the Nobel Committee adheres to the same opinion, which awarded the creator of adrenaline beta receptor antagonists, or beta-blockers, the most prestigious scientific award.

On my own

In 1958, Scottish pharmacologist James Black joined ICI. The young specialist, whose father had recently died of a heart attack, intended to develop drugs for the treatment of coronary heart disease. The causes of the disease were generally known, but pharmacotherapy left much to be desired: nitrates were the only widely used agent, but their effectiveness was recognized as very limited.

The most promising direction in the treatment of coronary artery disease at that time were considered substances that can increase the delivery of oxygen to the heart muscle (that is, improve the blood supply to the myocardium). However, Black chose a different path: not to satisfy the "increased demands" of the heart, but to try to minimize them. The scientist intended to achieve this by suppressing the effects of adrenaline and norepinephrine.

The creator of 2 drugs that brought multi-billion dollar profits to manufacturers, led an extremely modest lifestyle and was a reclusive person who earned himself the reputation of a stubborn eccentric and "weird type" among representatives of pharmaceutical companies. Upon learning that he had become a Nobel Prize winner, he, in his own words, “fell into horror and despair”: he was oppressed by the need to participate in solemn events and speak to a huge audience.

The physiological function of adrenaline (or rather, the adrenal extract, the active substance of which has not yet been isolated in its pure form) was already known by the beginning of the 20th century. But only at 19In 1948, the American Raymodn Ahlquist managed to establish the role of the analogue of adrenaline - norepinephrine in the transmission of nerve impulses and describe the principles of operation of the receptors that these substances act on.

Somewhat later it turned out that there are 2 main types of adrenergic receptors - alpha, which are found mainly in the smooth muscles of various organs, the brain and liver, and beta, located mainly in the heart, blood vessels, kidneys, glands of external and internal secretion. All this data was useful to a young pharmacologist from ICI Pharmaceuticals.

According to Black's plan, blocking beta receptors should have led to a reduction in heart rate and cardiac output and, as a result, to a decrease in the heart's need for oxygen. As a result, one could expect a decrease in the number of angina attacks in patients with coronary artery disease and a drop in blood pressure.

With the development of beta-blockers, James Black succeeded in creating yet another revolution, this time in the treatment of stomach ulcers.

Moreover, in order to develop a new class of drugs, the scientist had to change his employer, as his plans seemed unpromising to the ICI leadership. Cimetidine, the first histamine h3-receptor blocker that reduces gastric acid production, was introduced to the market by Smith Kline in 1973 and immediately became a new bestseller, surpassing sales including propranolol. Black's achievements were recognized with the 1988 Nobel Prize in Physiology or Medicine, as well as a number of other prestigious awards. The Scottish researcher is rightfully considered one of the most prominent pharmacologists of the 20th century.

Not only the heart

After several setbacks, Black and his colleagues finally found a compound that interacted effectively with adrenergic receptors and met safety requirements. The first drug from the group of beta-blockers, propranolol, entered the market in 1964, surpassed all expectations and made a real revolution in cardiology. The new drug not only reduced the frequency and intensity of angina attacks, but also 4 times reduced the likelihood of heart attacks in patients with coronary artery disease. In addition, propranolol showed excellent results in the treatment of myocardial infarction, tachyarrhythmias (including hyperthyroidism, neuroses and other conditions), glaucoma, tremors of various origins, many types of headaches (including migraine) and a number of mental illnesses. Because of this, it quickly took the first place in the world in terms of sales among prescription drugs.

This advance paved the way for the synthesis of other beta-blockers with different pharmacological profiles. The discovery of beta receptor subtypes has made these drugs even more selective; in addition, it turned out that their action is influenced by a number of parameters, such as intrinsic sympathomimetic activity and lipo- or hydrophilicity. This, as well as the duration of action, determines the difference in indications for the use of beta-blockers.

Although beta-blockers can cause excessive blood pressure reduction, muscle weakness, drowsiness, depression, and libido suppression, many musicians, actors, politicians, and other celebrities use them without medical advice in public speaking to reduce anxiety, embarrassment, and panic. or tremor. Due to the similar effects of beta-blockers, they are considered doping in sports that require precise coordination of movements and composure: shooting, golf, billiards, etc.

In a basement somewhere nearby. After creating beta-blockers, James Black managed to create another revolution - this time in the treatment of stomach ulcers. Moreover, in order to develop a new class of drugs, the scientist had to change his employer, as his plans seemed unpromising to the ICI leadership. Cimetidine, the first histamine h3 receptor blocker to reduce stomach acid production, was introduced to the market by Smith Kline in 1973 and immediately became a new bestseller, outselling propranolol as well. Black's achievements were awarded the Nobel Prize in Physiology or Medicine1988 years old, as well as a number of other prestigious awards. The Scottish researcher is rightfully considered one of the most prominent pharmacologists of the 20th century.

James Black (1924–2010)

The creator of 2 drugs that brought multibillion-dollar profits to manufacturers, led an extremely modest lifestyle and was a reclusive person who earned himself the reputation of a stubborn eccentric and "weird type" among representatives of pharmaceutical companies. Upon learning that he had become a Nobel Prize winner, he, in his own words, “fell into horror and despair”: he was oppressed by the need to participate in solemn events and speak to a huge audience.

How it works

To understand the difference between selective and non-selective varieties of these drugs, it is necessary to consider the effects of individual subtypes of adrenaline beta receptors. Currently, there are 3 of them, although it is possible that this list will be expanded in the future.

Beta1 receptors are located predominantly in the heart and kidneys. In the heart, their stimulation leads to an increase in heart rate (due to the action on the sinus node and the conduction system of the heart) and myocardial contractility, which increases cardiac output and oxygen consumption by the heart muscle.

In a healthy person, these effects are a normal response to stress or exercise, but in coronary artery disease they exacerbate angina pectoris and, in severe cases, may contribute to the development of a heart attack. In heart failure, “boosting” an already overloaded myocardium paradoxically reduces the efficiency of cardiac activity. In addition, in predisposed individuals, excessive stimulation of beta1 receptors leads to the development of various types of tachyarrhythmias.

In the kidney, these receptors activate the renin-angiotensin-aldosterone system, which increases blood pressure by increasing vascular resistance and blood volume. The suppression of these effects is predominantly used in the treatment of coronary artery disease, hypertension and myocardial infarction. Due to the predominant effect of selective beta1-blockers (bisoprolol, betaxolol and metoprolol in the form of succinate, atenolol and nebivolol) on the heart, they are often called cardioselective.

Although beta-blockers can cause excessive blood pressure reduction, muscle weakness, drowsiness, depression, and libido suppression, many musicians, actors, politicians, and other celebrities use them without medical advice in public speaking to suppress anxiety, confusion, panic, or tremor. Due to the similar effects of beta-blockers, they are considered doping in sports that require precise coordination of movements and composure: shooting, golf, billiards, etc.

Beta1-blockers are absolutely contraindicated in unstable heart failure, blockade, severe hypotension, severe bradycardia, and sick sinus syndrome.

Beta2 receptors are located mainly in the smooth muscle cells of the internal organs, eyes and blood vessels, as well as in skeletal muscle, liver, pancreas and salivary glands. In the heart, the effect of these receptors is similar to beta1, but much less pronounced.

Stimulation of beta2 receptors leads to bronchial dilatation, slowing peristalsis and increased tone of the gastrointestinal sphincters (resulting in a slowdown in digestion), relaxation of the uterus, bladder and urinary tract sphincters, increased glycogen utilization by the liver and skeletal muscles, as well as a decrease in circulatory tone. vessels.

Because of this, only non-selective beta-blockers - propranolol, nadolol, oxprenolol, timolol and many others - are effective for tremor and vasospastic headaches (although only propranolol is used for these indications), as well as glaucoma (timolol is used). Contraindications for beta1-blockers include bronchial asthma, diabetes mellitus, Raynaud's syndrome and, in some cases, uterine hypertonicity.

Beta3 receptors are located in adipose tissue and "manage" its catabolism, but this effect is not used purposefully in the clinic.

Currently, beta-blockers remain practically the only drugs that have a pronounced effect on the prognosis of cardiac patients. These drugs improve the quality and duration of life, as well as reduce the risk of heart attacks and strokes in millions of patients worldwide.

The use of beta-blockers in arrhythmias deserves special mention. To control persistent tachycardia, including symptomatic (for example, with thyrotoxicosis or panic conditions), any drugs in this group are theoretically suitable, but preference is given to selective ones. In the treatment of acute tachycardia, which significantly affects hemodynamics, ultrashort-acting drugs (esmolol) are used, which are easy to titrate when administered by infusion. Atrial fibrillation (atrial fibrillation) is treated with a variety of medications, but amiodarone and sotalol are most commonly used in the absence of contraindications.

In addition to beta-blocking action, they have a number of effects on the myocardium, which are far beyond the scope of this article.

Oleg Lischuk

Journal "Russian Pharmacies" №24, 2012

Stage fright: a terrible secret of classical music. How to deal with anxiety | All articles | Planet of Talents

Few performers admit it, but stage fright is a serious problem for many classical musicians.

Stage fright is like insanity: it appears without warning, like a bolt from the blue. This is exactly what happened to the Scottish pianist Stephen Osborne , one of the most competent and emotional modern pianists. About ten years ago, during the performance of Mozart's 23rd Piano Concerto, it suddenly seemed to him that he was about to forget the next note.

“The excitement seized me more and more,” recalls the musician, “And although I didn’t forget anything, it felt like I was drowning, and the water was already right under my nose.” Osborn was so disturbed by this incident that he sought the help of a cognitive therapist. “He taught me a few tricks, such as imagining that I was somewhere in a calm, safe place, say, in a flower meadow before a performance. It helped, but I always understood that it was not for long.

Then, a few years later, during the performance of the first piano concerto by Rachmaninoff, a real disaster happened. “It was like an earthquake, because this time I actually had memory lapses, and I knew that the whole performance was going to hell. It was terrible, and repeated over and over again. I felt like it was the end of my career. Every time before going on stage, I thought, “How can I go out and perform when I know perfectly well what will inevitably happen now?”

Osborne isn't the only one with this fear. For many musicians, stage fright manifests itself with frightening symptoms such as finger tremors and palpitations. Classical musicians suffer more than others from manifestations of stage fright, since for them accuracy and virtuosity are above all. You make a mistake in a jazz break, and it is unlikely to be noticed; make a mistake in a string quartet and everyone will notice it.

It's no surprise that most musicians hide their fear of public speaking, but there are a few who aren't afraid to talk about it openly. In his autobiography, the American Opera Star, soprano René Fleming mentions that her worst attack of stage fright occurred in 1998 at La Scala, Milan, when the audience began to whistle during her performance in the title role in Donizetti's Lucrezia Borgia. She began to tremble, and she was shaking for several more days. For many months after this incident, every appearance on the stage for her was sheer torture.

The Polish-American pianist Leopold Godowsky was so excited on stage that he could only play at full strength in private surroundings. Other pianist, Vladimir Horowitz , perhaps, suffered most from the fear of public speaking. Once, having lost a battle with nerves, he interrupted performances for several years.

There are many ways to deal with this problem, which takes so much energy from musicians. One of them - the most common and simplest - is taking anti-anxiety drugs. In 2012, a survey among German orchestras found that almost a third of the musicians were taking sedatives or beta-blockers.

However, the difficulty lies in the fact that, while blunting nervous tension, drugs also blunt the intensity of feelings and creative inspiration, which are the main attributes of a successful performance. In addition, they treat the symptom, not the cause, says Aaron Williamon, who heads the Center for Public Speaking Research at the Royal College of Music. “In essence, stage fright consists of two main components - an involuntary physiological reaction of the body to a stressful situation, expressed in dry mouth, rapid heartbeat, etc.; and psychological aspects, including dangerous thoughts, for example, that the performance will certainly fail. Physiological symptoms can be easily relieved by exercise, which lowers levels of stress hormones such as cortisol. With psychological aspects, cognitive psychotherapy is very effective. It lies in the fact that it is necessary to help the musician treat the performance more rationally. For example, instead of considering the audience as your enemy, and thinking that a performance can be either perfect or disgusting, you need to come to terms with the fact that mistakes are inevitable, and the audience is always on the side of the performer.

Stephen Osborne treats performance anxiety the same way he treats a piece of music - as a challenging and interesting challenge to solve. He has never taken any drugs and is skeptical about the beneficial effects of cognitive psychotherapy.

“These are the methods of sports psychology: get rid of the excitement and achieve the best results,” he says, “But I think this does not apply to music. You cannot close your eyes to the fact that music is an embodied experience: with the help of your body, you make emotional experiences alive and real for listeners. If you shut yourself off from a part of your consciousness, it means that emotions in all their diversity will no longer be available to you. Osborne, on the other hand, takes what seems to be the complete opposite: he refers to stage fright as a "friend" to be honored. " No need to fight the excitement - you need to be able to benefit from it .

It is very likely that Osborne adheres to the old Romantic judgment that "the artist must suffer." “No, not at all,” the musician objects, “in fact, I play best when I worry the least.”

So we've come to the paradoxical idea that stage fright is good, but only when you're not worried... However, Osborne soon gives us a clue that will lead us out of this maze. He talks about reading a newspaper article a few years ago about "self-awareness," which is focusing on what's happening in the moment rather than constantly regretting the past or making plans for the future.

“I liked this idea,” the pianist continues, “and I completed a two-month course. What I like about the theory of self-awareness is that you stop trying to change things. If you find that your mind is wandering somewhere, accept it and just watch your thoughts. We are always dissatisfied with the way events unfold on their own, we are always trying to make them different. I especially notice this when I play the piano. It's amazing how much destructive aggression you can take from yourself when things don't go the way you want them to. It's highly unproductive."

This theory helps Stephen Osborne deal with complex pieces of music.

“It was like that when I was preparing to record Britten's Sabotage, which is a concerto for the left hand with an orchestra,” recalls Osborne, “There was only a month left until the day of recording, and I still couldn’t get two passages. I was just overwhelmed, terribly angry with myself. Then one day I suddenly thought, “Where is all this negative energy taking me? Yes, these places are imperfect, but so what. I’m not doing brain surgery, no one will die.” And I let go. It’s funny that after a few days both problems were solved.

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