Propranolol, often known by the brand names Hemangeol or Inderal, is one common medication used to treat certain types of anxiety. Anxiety can feel frustrating, even overwhelming, if you don’t have access to personalized care. For many people, taking medication is a significant step in allowing them to improve their mental health.

This page outlines some important information about treatment with propranolol.

What is propranolol? How does it work?

Propranolol is a medication that can be used to treat certain types of anxiety such as performance anxiety and stage fright. It is approved to treat irregular heart rhythms, certain types of tremor, and heart disease. Propranolol can also help prevent angina(chest pain), migraine headaches, and to improve survival after a heart attack.

Propranolol belongs to a class of medications called beta blockers. Beta receptors are located primarily in the heart and bind to adrenaline. When a person becomes excited or stressed adrenaline enters the bloodstream from the adrenal glands and binds to beta receptors in cardiac muscle causing the heart to beat faster and stronger. This rapidly pumps more blood to the body, raising blood pressure and enabling one for fight or flight. Beta blockers block the effect of adrenaline on the heart. This allows heart rate and the strength of cardiac contractions to remain at normal levels during stress. These blocking effects also prevent a rise in blood pressure by keeping the amount of blood pumped to the body at a normal level. As a result, the physical symptoms often associated with anxiety such as tachycardia, palpitations and bounding pulse may be diminished.

Propranolol does not reduce normal heart rate and normal blood pressure in a relaxed person. Propranolol prevents the elevation in heart rate and blood pressure usually caused by adrenaline when a person encounters stress.

How is propranolol typically used?

Typically, lower doses are prescribed to treat anxiety related issues than are prescribed for cardiac issues. Dosages for anxiety typically may range from 10mg to 40mg but dosages may differ from person to person depending on their specific needs and the desired outcome. Doctors may start their patients off on a lower dosage and gradually increase it over time. This can help prevent negative reactions associated with starting a medication too quickly.

Propranolol is often taken prior to an event which causes anxiety such as public speaking or performing. Propranolol may help reduce the anxiety which comes from anticipating a public performance or other stress inducing event. 

It may take some time to see the full effects of propranolol. To ensure that you receive the full benefits, take your medicine consistently, as directed by your doctor.

What are some possible side effects?

Some common side effects of propranolol may include:

• Tiredness
• Diarrhea 
• Lightheadedness or dizziness
• Constipation

Some serious (but uncommon) side effects include:

• Blisters or peeling skin
• Difficulty breathing or swallowing
• Itching
• Swelling of the face, throat, or lips
• Irregular heartbeat

Call 911 or seek emergency care if you notice any severe side effects. You can find a more comprehensive list of propranolol side effects here. 

Why do these side effects occur? 

Any medication can potentially lead to side effects. A person’s likelihood of having side effects depends on many factors, including genetics, age, lifestyle, and the type of medication itself. Side effects may occur because drugs often have broad or poorly targeted effects, or the drug target itself may have many downstream effects on the body. 

Propranolol acts primarily on beta receptors in the heart. Beta receptors are also located in the lungs, kidneys, GI tract, liver, blood vessels and skeletal muscle. If propranolol affects these systems then that could cause side effects.

Many non-serious side effects of mental health medications like propranolol go away after a few weeks as your body gets used to the medication. However, if a side effect persists, is intolerable, or severely hinders your ability to go about your daily life, talk to your doctor, because this might be a sign that the medication is not a good fit. 

How do your genes relate to propranolol? 

Genetics can affect your body’s response to medication. Propranolol is broken down through three major processes in the body: Aromatic hydroxylation, N-dealkylation and side-chain oxidation, and direct glucuronidation. People with a certain variation in any of the genes involved in these processes might break down the medication more slowly than others. This means the drug sticks around in your body for longer than average and may lead to unwanted side effects. If this happens, a doctor might opt to prescribe a different medication or prescribe a lower dosage. 

One way to predict whether you’ll have a positive outcome while taking propranolol is by taking a genetic test to determine what genetic variations you have and how they affect medication metabolism. Your DNA test results can help your doctor avoid less suitable medications and make more informed decisions so that you can get better, faster.

Special Precautions

• Propranolol has been linked to an increased risk of heart conditions. Inform your doctor if you or anyone has a family of heart conditions. You should also inform your doctor immediately if you start to feel any pain in your chest when taking propranolol. 
• Skin reactions can also occur when taking propranolol. If you notice any rash or itch, inform your doctor immediately for further instructions on what to do. 
• Propranolol may cause changes in blood sugar levels. Inform your doctor if you are diabetic before taking the medication. 
• Propranolol can cause you to feel dizzy or lightheaded. Avoid driving or handling heavy machinery after taking the medication. 
• Inform your doctor before using alcohol if you are propranolol as the medication can worsen the effects of alcohol and some other medications.

If you show signs of an allergic reaction to propranolol (hives, difficulty breathing, rash, swelling), call 911 or go to the nearest emergency department.

Some medications, vitamins, and herbs may interfere with how propranolol works. Make sure to tell your doctor about all other medications you are taking before starting Propranolol to avoid negative interactions. For full details, see the FDA’s full list of precautions. 

Looking to find the right medication for your mental health? Join Prairie today to connect to expert providers and affordable medication options.