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Brands: INDERAL, INDERAL LA
Published 2025-12-22 · Last reviewed 2025-12-29 · 4 references
Content sourced from FDA labeling (DailyMed) and peer-reviewed literature.
Propranolol is a nonselective beta-adrenergic receptor blocker used for multiple cardiovascular and neurologic indications (hypertension, angina, atrial fibrillation rate control, post-myocardial infarction mortality reduction, migraine prophylaxis, essential tremor, and others on label).
In psychiatric practice, propranolol is most commonly used off label for performance anxiety and for antipsychotic-associated akathisia, where it targets tremor, tachycardia, and physiologic arousal.
Propranolol generally does not treat the core cognitive features of generalized anxiety (worry/rumination); it should not replace psychotherapy or SSRI/SNRI-based plans when anxiety is persistent.
Safety is driven by cardiopulmonary screening: propranolol is contraindicated in bronchial asthma and in significant bradycardia or conduction block (label). It can also worsen hypotension and fatigue.
Beta blockade can mask adrenergic symptoms of hypoglycemia; coordinate care in diabetes and counsel patients who have recurrent hypoglycemia.
The propranolol compare view, propranolol evidence feed, and propranolol print page can support safe, time-limited prescribing discussions.
Propranolol is inexpensive and familiar to clinicians, which can lead to “refill momentum” for off-label anxiety use. Keep prescribing indication-specific (event-limited performance anxiety or akathisia treatment plans) and reassess frequently; when anxiety is chronic, prioritize psychotherapy and SSRI/SNRI strategies.
View labelExactRefer to the Glossary entry on Neurotransmitters for background on receptor systems involved in serious mental illness.
Nonselective beta-adrenergic antagonism reduces sympathetic physiologic responses (tachycardia, tremor, palpitations) and can blunt the physical feedback loop that escalates situational anxiety.
In akathisia, beta blockade can reduce subjective restlessness and motor agitation, but symptom control should be paired with antipsychotic dose/timing optimization.
Beta blockers can reduce exercise tolerance and cause fatigue; these effects may be misattributed to depression or medication “over-sedation” unless discussed proactively.
Sources: FDA/DailyMed label; beta-blocker anxiety meta-analyses; akathisia trial evidence.