Getting The Most From Your Treatment
- Try to keep your regular appointments with your doctor. This is so your doctor can check on your progress.
- Treatment with propranolol can often be long-term. Continue to take the tablets/capsules unless your doctor tells you to stop. Stopping treatment suddenly can cause problems in some people, so your doctor may want you to reduce your dose gradually if this becomes necessary.
- If you are due to have an operation or dental treatment, it is important to tell the person carrying out the treatment that you are taking a beta-blocker. This is because some anaesthetics may increase the risk of unwanted effects.
- If you drink alcohol, ask your doctor for advice about taking propranolol and alcohol. Alcohol will add to the blood pressure-lowering effect of propranolol and so may not be recommended for you.
- If you have diabetes, propranolol can block the symptoms of low blood sugar. Your doctor will advise you about this.
- If you buy any medicines, check with a pharmacist that they are suitable for you to take. Some medicines may not be.
- Your doctor may give you dietary and lifestyle advice about eating a healthy diet, not smoking, and taking regular exercise. If so, it is important that you follow the advice you are given.
How Much Does Propranolol Lower Blood Pressure
Propranolol can cause a significant decrease in blood pressure, especially when used at a high dose.
In a study from 2004 that involved 434 participants with hypertension.
Patients were given placebo and doses of propranol in 80mg, 120mg, 160mg or 640mg daily increments. The study concluded that the decrease in blood pressure was significant in all propranolol dosages after eight weeks of treatment, and that propranolol was well-tolerated among participants.
How Does Propranolol Work For Anxiety
When your body goes into fight-or-flight mode as a response to stress, norepinephrine kicks in. It sends your heart rate through the roof, makes your breathing short and shallow, and, in some of us, produces upsetting amounts of sweat.
Unfortunately, as humans, our bodies have not yet adjusted to our modern environment.
Our physical response to stress is the same, whether were nervous about presenting to a room full of people or facing down a hungry lion.
The physical processes designed to keep us alive and uneaten in the animal world are obstacles in a human world that rewards crisp, relaxed performances.
A high heart rate can further elevate anxiety, resulting in a negative spiral. Shallow breathing or trembling can spoil a performance, regardless of how practiced a speaker or performer is.
When you take your Propranolol dose for anxiety, however, it blocks adrenaline from impacting the way your body feels.
That helps prevent many of the physical responses to stress like high heart rate, labored breathing, and excessive sweating. The elimination of those physical symptoms helps calm many people as they prepare to perform at their peak.
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Brand And Generic Names
Propranolol has been around for a long time and is available as a tablet, capsule, liquid, long-acting capsules, and injectable forms. It is currently available as a generic medication in the form of propranolol hydrochloride. There are also different brand names available. Inderal is the brand name of the short-acting version of propranolol. Inderal LA, Inderal XL, and InnoPran XL are brand names for the longer-acting versions of propranolol. Hemangeol is the liquid form of propranolol.
Propranolol For Anxiety Disorders: A Nonselective Beta Blocker
Propranolol is a beta blocker originally synthesized in the 1960s by James W. Black, a British scientist. It is a derivative of older beta-adrenergic antagonists dichloroisoprenaline and pronethalol, each of which lacked safety and efficacy to warrant medicinal usage. Chemically, propranolol is formed upon insertion of an oxymethylene group into the aryl ethanolamine structure of pronethalol this increases its overall potency as a nonselective beta-adrenergic inhibitor and mitigates risk of carcinogenicity.
As a pharmaceutical, propranolol is documented as the first ever beta blocker approved for the treatment of hypertension . In addition to its efficacy as an antihypertensive, propranolol is commonly dispensed by medical professionals as a treatment for conditions including: dysrhythmias, hyperthyroidism, kinetic tremors, and migraine headaches. Due to its myriad of potential uses, propranolol is classified as an essential medicine by the World Health Organization.
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A Treatment For Anxiety Thats Fallen Out Of Favor
Many people are afraid of public speaking. But when it gets severe and persistent enough, its codified in the DSM-5 as a type of social anxiety disorder specific to performance. About 15 million adults in the U.S. are believed to have social anxiety disorder, often undiagnosed and untreated.
Those who do seek treatment have a few options: Cognitive behavioral therapy, which involves talking to a therapist or completing online exercises. The class of antidepressants known as selective serotonin reuptake inhibitors, such as Paxil and Zoloft, which block the reabsorption of a neurotransmitter that regulates anxiety. Benzodiazapines like Xanax, which relieve anxiety by enhancing the effects of a neurotransmitter called GABA in the brain.
Then there are beta blockers like propranolol, which take a different tack. They suppress the autonomic arousal associated with fear meaning no more racing heart. No more shaking hands.
Many psychiatrists embraced beta blockers for social anxiety and performance anxiety in the 1970s. But theyve since fallen out of favor and are not considered a first-line treatment, in part because they arent as effective for people whose anxiety doesnt manifest in mainly physiological ways.
Bringing up propranolol is resurrecting a dead body, said Hofmann, the Boston University psychologist.
Its a serious cardiac medication. I dont think its something that should be prescribed lightly, she said.
Dr. Anna Lembke, Stanford psychiatrist
Propranolol Is Popular With Many Performers
A 1987 survey by the International Conference of Symphony Orchestra Musicians, representing some of the largest orchestras in the U.S., found that 27 percent of their musicians were using beta-blockers for performance anxiety . Experts estimate that number is much higher today.
And a quick search on the internet will reveal many anecdotal stories of performers, and people from various other walks of life, who have used beta-blockers at some point to deal with social anxiety.
But what is Propranolol, and does it really help you overcome performance anxiety? And are there any alternatives?
Here, well discuss what Propranolol is, how it works within the body, and why some performers use it to deal with stage fright. Well also discuss some natural alternatives to beta-blockers that can also help you remain calm and focused during your performance.
But before we delve into why Propranolol may help some performers, lets take a look at why you experience performance anxiety.
Knowing why you get the jitters will help you better understand why beta-blockers, or other natural alternatives, may be effective against your stage fright symptoms.
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Standard Release Vs Sustained Release
Note that Propranolol tablets come in two forms: standard release and sustained release.
Standard release tablets are absorbed by the body and start working almost right away, whereas sustained release tablets dissolve slowly, and continue to be absorbed throughout the day.
Sometimes sustained release tablets are prescribed for conditions that require consistent treatment, as they dont need to be taken as often. However, for performance anxiety, you need immediate relief, so only standard release tablets should be considered.
Propranolol Faqs: 25 Common Propranolol Questions Answered
Medically reviewed by Patrick Carroll, MD
Searching for information about propranolol? Prescribed to millions of Americans in the United States alone, propranolol is a commonly used beta blocker used to treat heart conditions, anxiety, headaches and more.
Below, weve answered 25 of the most frequently asked questions about propranolol, covering everything from common propranolol dosage to propranolols primary effects, potential side effects, uses, half-life and more.
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How To Get Propranolol For Anxiety
Talk to your doctor about your symptoms and see if propranolol is a good fit for you. If your primary care physician is unsure whether it is appropriate, many psychiatrists are very open to using propranolol for anxieties so that could be another viable option to pursue. If you would prefer to not schedule an in-person appointment, Propranolol.com offers online consultations with U.S. board certified physicians who can issue prescriptions for propranolol when appropriate and have the fulfilled medication shipped discreetly to your home.
How Propranolol Works
As a beta blocker, propranolol is primarily used for cardiac conditions such as high blood pressure and heart rate irregularity. It’s also prescribed to treat a certain type of adrenal gland tumor . The way the drug helps to prevent migraine headaches is still not well-known. It is believed that propanolol helps stabilize the blood vessels in the brain, preventing their dilation. In addition, the drug may reduce the excitability of the brain as well as improve patients’ anxiety, helping decrease the frequency of the migraines.
Once released into the bloodstream, adrenaline binds to blood vessels surrounding the brain, causing them to constrict. Propranolol and other beta blockers reverse this effect, causing vessels to relax and allowing the free flow of blood to the brain.
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Who Should Avoid Beta
Propranolol is not for everyone. Before you take the drug, tell your doctor if you have:
- Advanced heart failure
- Low blood pressure
- Slow heart rate
If you have one of these conditions, you may still take propranolol, but there are more risks.
Your healthcare provider may need to adjust your dosage or talk through the costs and benefits before starting your new medication regimen.
Benefits Of Propranolol For Anxiety
There are many potential benefits associated with using propranolol as a treatment for anxiety . The most obvious benefit is that propranolol is highly effective as a treatment for somatic symptoms. Additionally, propranolol can be taken over a long-term with sustained anxiolytic efficacy, and isnt associated with significant unwanted side effects.
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When Not To Use Propranolol
Since it helps control heartbeat and also contributes to lowering of blood pressure, Propranolol use is not advisable for people suffering from heart problems or low blood pressure. Diabetic patients or those with complaints of any kind of respiratory or lung problem, such as asthma, are also not advised to use Propranolol, whose most popular and recognized brand is Inderal. This beta blocker is seen to interfere with a glaucoma screening test and to cause blurry vision, and is hence prohibited for use by those with vision problems. Those undergoing a surgery should also stop the drug a day before the operation. It also is not recommended for use by kidney patients.
Pregnancy and breastfeeding are other conditions under which Propranolol shouldnt be taken, except if prescribed by a doctor. Its believed that Propranolol taken during pregnancy can affect the development of the baby. So you shouldnt really try to experiment with this drug in case of mild anxiety problems, but should use it only in extreme cases of anxiety, and even then only after consulting your doctor.
Propranolol And Performance Anxiety
Propranolol is one of the most commonly used beta-blockers among performers.
It works as an effective short term relief from the physical symptoms of stage fright. If a musician takes Propranolol before going on stage, he or she might still feel the stress, but not the symptoms like trembling hands, racing heart rate, or nausea.
So, when people talk about taking beta-blockers for performance anxiety, it is important to note that theyre not talking about addressing the root causes of the fear, or a long-term solution.
Theyre talking about a short-term fix. But its a short-term fix that can be the difference between whether someone gets to keep pursuing a career in performing, or give up on their passion and move on to something else.
But useful as they may be, you shouldnt expect beta-blockers to cure your performance anxiety if you do choose to take them.,
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Medical Communitys View Of Off Label Propranolol Prescriptions
While many doctors view propranolol as a safe and effective treatment option for performance anxiety that has been used successfully for decades. Some feel as though there are better options available and it fails to address the underlying root cause of the patients anxiety, and thus is a poor long term solution to the problem. We recommend talking to a doctor to see if propranolol is right for your specific situation.
What Steps Should You Take First
Try nondrug approaches.“Cognitive behavioral techniques can help most people and may obviate the need for medicine,” Schneier says. That therapy teaches anxiety management and includes performance practice. You can sharpen your public speaking in workshops given by Toastmasters International. “Some people have anxiety because they haven’t mastered the skills,” he points out.Be evaluated by a doctor before using beta-blockers.“You should be screened for asthma and have an electrocardiogram to check for heart abnormalities,” Schneier says. Your doctor should also look for contributing causes of anxiety, such as alcohol withdrawal, thyroid problems, low blood sugar, mental disorders, and the use of stimulating medication or substances, including caffeine and nicotine.Sample a trial dose before the day of your performance.“Beta-blockers can cause lightheadedness if you have low blood pressure,” Schneier warns. “It’s a good idea to see how they affect you when you’re not up on stage.”
How To Take Propranolol
- Before you start the treatment, read the manufacturer’s printed information leaflet from inside the pack. It will give you more information about propranolol and will provide you with a full list of the side-effects which you may experience from taking it.
- Your doctor will tell you what dose is right for you, and this information will be printed on the label of the pack to remind you. Take propranolol exactly as your doctor tells you to. Propranolol tablets are usually prescribed to be taken in divided doses – so you may be prescribed two, three or four doses to take each day. Propranolol capsules have a more prolonged action and are prescribed to be taken once daily. Swallow the capsule whole with a drink of water – do not chew or open the capsules.
- Propranolol tablets and capsules are available in several different strengths. Each time you collect a fresh supply, it’s a good idea to check the strength on the packet to make sure they are the strength you are expecting.
- Try to take your doses at the same times of day each day, as this will help you to remember to take them regularly.
- If you do forget to take a dose, take it as soon as you remember unless your next dose is due. If your next dose is due then take the tablet/capsule which is due but leave out the forgotten one. Do not take two doses together to make up for missing one.