take propranolol before presentation

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Can propranolol help with public speaking anxiety.

Considering that over 40 percent of US adults state (in certain surveys) that they have a signigicant fear of public speaking, it’s surprising that there isn’t a lot more talk in the media about overcoming and managing one of the nations largest collective phobias! Since the 60s, a heart-medication drug has been the secret tool for public speakers trying to get a handle on their performance anxiety/stage fright issues. That prescription drug is a beta-blocker called Propranolol, which is actually the most commonly prescribed beta blocker drug in the US. In this article, I’m going to take a look at why so many public speakers use Propranolol to help with their performance anxiety issues, I’ll share my personal experience with the drug, and you’ll find out what the side-effects and downsides are, as well as some alternatives.

Wondering if Propranolol can help manage your public speaking nerves? The prescription beta-blocker medication is used by performers and those suffering from anxiety to dampen the jitters and palpitations often associated with stage fright or performance anxiety. In this article I’m going to take a look at the role that Propranolol can take in preparing you for the stage, the sales presentation and/or the social event; while providing a first-hand account of the impact Propranolol can have on public speaking experiences.

Propranolol for public speaking Key Takeaways

If you're looking for a quick , scannable summary of the rest of this article, here are several key takeways about Propranolol for public speaking :

• Propranolol, a non-selective beta blocker, effectively manages performance anxiety by dulling physical anxiety symptoms, such as a rapid heartbeat and trembling, through a mechanism of surpressing — sometimes completely blocking — adrenaline release into the body.
• The recommended dosage of Propranolol for situational anxiety ranges from 10mg to 40mg, and it should be ingested about 30 to 60 minutes before a public speaking event for optimal effectiveness.
• While Propranolol can help performers transform their stage presence and reduce anxiety, potential side effects range from mild, like fatigue and nausea, to severe, such as allergic reactions and heart issues, necessitating consultation with healthcare professionals.

The Role of Propranolol in Managing Performance Anxiety

Propranolol is one of the most commonly prescribed non-selective beta-blocker medications in the US. Beta-blockers, full medical name beta-adrenergic blocking agents, work by blocking the effects of adrenergic hormones in the body, such as adrenaline [1] .

Doctors typically prescribe beta-blockers to treat various heart conditions, when other lifestyle adjustments fail to do the job. Some of the typical conditions for which a doctor might recommend a beta-blocker such as Propranolol include [2] :

• High blood pressure
• Irregular heartbeat
• Angina (chest pain)

Beta-blockers help those with cardiovascular issues by influencing the force with which your heart pumps blood. Sometimes, beta-blockers are also prescribed for conditions like migraines, and harmless tremors of the arms, hands, etc [3] .

Understanding Beta Blockers

There are two categories within beta blockers: selective and nonselective. Selective variants target only the heart’s beta-1 adrenoceptors while nonselective variants affect both beta-1 and beta-2 adrenoceptors throughout various bodily systems. For example, Propranolol is a broad-spectrum (non-selective) beta blocker that, alongside Metoprolol which is a selective type, helps alleviate performance-related anxiety by curbing adrenaline effects. This leads to slowed heart-rates and reduced blood pressure, tackling the major symptoms associated with anxiety and stage fright episodes.

Why is Propranolol popular with public speakers?

As stated above, Beta-blockers like Propranolol block the effects of adrenaline and prevent the hormone from binding to beta-receptors in the heart. This has an overall calming effect on the heart and the force with which it has to pump blood. Consequently, the heart can return to its regular workload, and blood pressure is stabilized [4] .

An exaggerated stress response, like what a speaker experiences when suffering from performance anxiety, typically correlates with a dramatic spike in adrenaline.

So, by blocking the effects of adrenaline, it is prevented from binding to beta receptors in the heart. So, beta-blockers essentially block the physical symptoms of performance anxiety.

When taking a beta-blocker, expect the drug to slow your heart rate, reduce a lot of trembling and sweating, and regulate your breathing and blood pressure. Beta-blockers can help you feel relaxed, essentially negating the stress response to help you get through any performance such as a speech or sales presentation.

You can easily see why a public speaker would find massive value in being able to block performance anxiety or stage fright, almost on-demand , using Propranolol .

It is important to note that each individual is different, especially when it comes to causes of anxiety. Individuals also vary widely in anxiety symptoms, the severity of those symptoms, and how we react to specific medications. So, how you respond to a beta-blocker can be different from someone else [5] .

Personal Experience using Propranolol for Public Speaking

I’ve shared in a few places on this site that I have used beta-blockers, including Propranolol (as well as others such as Metoprolol , Carvedilol/Coreg and others ), several times.

Because of the way beta-blockers work within the body, I’ve worked with and spoken to a lot of performers and public speakers who 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 [6] . That article, in-depth research into the field, plus plenty of personal accounts of Propranolol helping with stage fright & anxiety helped me understand why so many speakers are using Propranolol. In short: Propranolol is effective for nearly eliminating the effects of adrenaline during a speech , the side-effects are relatively minimal, and the only major downside (in my opinion) is a risk of becoming too reliant on the beta-blocker if you use it for every high-anxiety situation. If you can avoid becoming dependent on Propranolol, it’s a very effective tool for speakers!

Propranolol Dosage and Timing for Optimal Results

In the United States, Propranolol is classified as a prescription drug. So if you’re considering the use of Propranolol for public speaking and performance anxiety purposes, you will have to ask your doctor if it may be an option for you.

If the doctor decides to prescribe beta-blockers for you, then he or she will also let you know your recommended daily dosage. We strongly suggest sticking to the recommendations of your doctor. They know your medical history and all your other current medications and health issues. Going beyond what your doctor prescribes can have severe health consequences.

Purely for informational purposes, however: For most adults, an effective Propranolol dose is between 40-80 mg per day [7] .

For those using Propranolol before a speech, the best time to take it is 1-3 hours before they’re about to go on stage/give their speech. You want to give it enough time for the effects of Propranolol to kick in, but not so early that it is no longer useful. Again, consult with your doctor for when and how much Propranolol you should take before you have to give your speech.

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Potential Propranolol Side Effects and Precautions

Beta-blockers like Propranolol are generally considered safe for public speakers (or any performer). Especially when only taken occasionally. But Propranolol can come with some potential side effects , although not too common among public speakers who only use beta-blockers every now and then.

More common side-effects of Propranolol include [8] :

• Dryness in the eyes
• Below normal heart rate
• Tiredness or feeling weak

More severe Propranolol side-effects are rare, but if you experience any of the following, be sure to notify your doctor immediately:

• Allergic reactions like skin rash or hives
• Swollen face, lips, or tongue
• Trouble breathing

Alternatives to Propranolol for Public Speaking Anxiety

‘Glossophobia’ or Fear of public speaking does not have to be a chronic, lifelong affliction! We now have various strategies and tools available that can be used to overcome a fear of public speaking, including medications (like Propranolol, of course), mental strategies and dietary supplements.

Let’s take a look at a few alternative ways that people are fighting their public speaking fears:

Extensive Practice

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

Many people struggle with public speaking simply because it’s a new field to them. The fear of the unknown and lack of confidence may manifest itself in extreme fear or anxiety. However, once that person can get used to speaking in front of people, and develop confidence within these kinds of situations, the fear may go away [9] .

This is not a unique ‘secret’ that’s supposed to solve the fear of public speaking for everyone. For more serious cases of glossophobia/public speaking fear , other tools and strategies will be needed in addition to extensive practice. Particularly 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 [9] .

Breathing Exercises

Certain breathing techniques can be effective in stopping the onset of physical anxiety symptoms caused by a stress response in the body. While extensive public speaking practice is a long-term fundamental practice, 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 that I teach clients 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 are stressed or anxious [10] . Diaphragmatic breathing can also help reduce blood pressure and improve heart rate variability, which works to lessen the severity of symptoms one may experience with public speaking anxiety.

Natural Supplements

Some dietary supplements contain a mix of ingredients that support focus, calm and cognition, which may counteract the negative side-effects of performance anxiety and stage fright when giving speeches. Ideally the supplement should be all-natural as well, but that’s a personal preference of mine.

One example that I really like and recommend to clients is PerformZen , which contains GABA , L-theanine and Magnesium , as well as cognitive-enhancing ingredients Ginkgo Biloba , Vitamin B6 and Theacrine .

These ingredients have been shown to help induce a calming effect on the body, as well as keeping the brain as sharp as it needs to be during your performance. Not too long ago, I actually reviewed PerformZen in this article & interviewed the founder (as well as secured a limited-time discount for PerformanceAnxiety.com readers). See the review here .

Instant All-Natural Performance Anxiety Relief

PerformZen is a natural supplement uniquely crafted to overcome stage fright and performance anxiety so you can perform at your best on demand!

Summary: Should you integrate Propranolol into Your Speaking Routine?

Performance anxiety needs to be taken seriously if you want to perform at your best during key moments (like giving successful public speeches).

Beta-blockers like Propranolol can absolutely help relieve your public speaking anxiety issues, helping you to reclaim control of your fears and perform when it’s really important. You just need to understand that while Propranolol does provide temporary relief, it is not really a long-term solution (not to mention: there may be side-effects, and you will need a prescription).

I really suggest giving the alternatives a try before turning to Propranolol repeatedly and building a dependence: whether that’s ‘diaphragmatic breathing’ or a natural performance anxiety supplement like PerformZen .

But if you’re dead-set on trying Propranolol, speak with a medical professional first and give it a try. Assuming you use the beta-blocker safely, it really is a game-changer for your performance anxiety!

Yes, Propranolol has proven to be (very) effective in managing the physical manifestations of performance anxiety, particularly with regards to public speaking. It boasts a considerable success rate among those who utilize it for speaking purposes.

Approximately one hour prior to a public speaking event, which can provoke anxiety symptoms, it is advisable to take Propranolol. Doing so ensures that the medication has adequate time to activate and alleviate the symptoms of anxiety.

If you suffer from respiratory conditions like asthma, bronchitis, or emphysema, or if you experience slow heart rates, have low blood pressure, or have been diagnosed with liver or kidney disease; then Propranolol is not a suitable treatment for anxiety as it comes with significant risks for you.

Before contemplating the use of this medication for your anxiety issues, it’s critical to consult with your physician and thoroughly disclose any health complications.

• ^ https://www.nhs.uk/medicines/propranolol/
• ^ https://performanceanxiety.com/propranolol/
• ^ https://performanceanxiety.com/propranolol-metoprolol-anxiety/
• ^ https://www.mayoclinic.org/diseases-conditions/high-blood-pressure/in-depth/beta-blockers/art-20044522
• ^ https://performzen.com/propranolol-for-anxiety/
• ^ https://www.sciencedirect.com/science/article/abs/pii/S0140673665908639
• ^ https://reference.medscape.com/drug/inderal-inderal-la-propranolol-342364
• ^ https://www.healthline.com/health/propranolol-oral-tablet
• ^ https://performzen.com/beta-blockers-public-speaking/
• ^ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5455070/

Take a look at our other beta blocker articles:

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Anita Letara

PerformanceAnxiety.com Owner & Lead Writer

Anita is the owner and lead writer for PerformanceAnxiety.com. A seasoned musician and public speaker herself, she is no stranger to the very real fear and anxiety that can strike right before a high-pressure situation. That's why Anita is passionate about writing content that helps people learn about and overcome their anxieties & social fears so that they can perform at their best when it counts and live anxiety-free lives.

What Is Propranolol? Propranolol For Anxiety & Other Conditions

Reviewed on 28 Aug 2022

Situational anxiety (also known as performance anxiety, social anxiety, or social phobia) is a common mental health condition that causes an intense fear of certain social situations. It can also produce distressing physical symptoms such as a rapid heart rate or sweating — but using medicines such as beta blockers for anxiety can help alleviate these physical symptoms.

It’s normal to feel nervous or anxious before a high-pressure situation where you have to perform, of course, whether you’re giving a presentation or just answering interview questions. But if the intensity is such that you’re overwhelmed and can’t perform as well as you could (or even proceed at all), anxiety treatments like Propranolol can help.

In this guide, we’ll be looking at Propranolol in more detail, covering things including uses of Propranolol and how you can find the correct Propranolol dosage. Most vitally, we’ll answer the most common questions asked about it, including “How does Propranolol work?” and “How quickly does Propranolol work for anxiety?”, giving you the knowledge you need.

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:

• Panic disorder
• 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.

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:

• 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.

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

If you stop taking the medication suddenly, you could experience these withdrawal symptoms:

• An irregular heartbeat

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.

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.

• 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/

Related Guides

Everything you need to know about propranolol and alcohol.

Propranolol Side Effects: What To Expect From the Anxiety Medication

How to improve mental health: looking after your wellbeing.

Authored by

Scott is one of the two founders of The Independent Pharmacy. He is a registered pharmacist and the registered manager of our service with the CQC.

Reviewed by

Andy is a co-founder and the Superintendent Pharmacist and Director at The Independent Pharmacy.

• Review Date: 28 August 2022
• Next Review: 28 August 2024
• Published On: 21 September 2020
• Last Updated: 2 April 2024

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All About Propranolol for Performance Anxiety

Reviewed by Kristin Hall, FNP

Written by Our Editorial Team

Published 12/21/2021

Updated 02/24/2022

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.

Related Articles

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.

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.

talk to a psychiatry provider. it’s never been easier

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.

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.

• 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

Editorial Standards

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. See a mistake? Let us know at [email protected] !

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 .

Kristin Hall, FNP

Kristin Hall is a board-certified Family Nurse Practitioner with decades of experience in clinical practice and leadership. 

She has an extensive background in Family Medicine as both a front-line healthcare provider and clinical leader through her work as a primary care provider, retail health clinician and as Principal Investigator with the NIH . 

Certified through the American Nurses Credentialing Center , she brings her expertise in Family Medicine into your home by helping people improve their health and actively participate in their own healthcare. 

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Drugs for public speaking fear: Should I take Beta Blockers?

Beta blockers are a class of drugs for anxiety that block the action of adrenaline in the body. Therefore the physical symptoms of the stress response   are reduced. I’m often asked if they should they used for public speaking fear?

Firstly, beta blockers are not officially drugs for anxiety, but cardiac medications . However, by reducing some of the symptoms associated with public speaking anxiety, like the ‘shakes’, the idea is that they can help you concentrate on the task at hand.

For example, since they can lower heart rate, beta blockers have been used by Olympic marksmen to provide more aiming time between heartbeats. Some musicians use beta blockers to reduce the adrenaline-driven shaking  during auditions and performances. And it’s rumored that many politicians use them for important speeches.

The 3 questions are:

• Do they really work?
• Are they safe?
• What’s the best way to manage public speaking anxiety?

1. Do they really work?

What can they do.

Nobel prize-winning scientist, James Black , invented beta-blocker drugs to block the effect of adrenaline on the heart. So beta-blockers can reduce the adrenaline-related physical symptoms associated with the stress response. Some scientific studies show that beta blockers significantly reduce symptoms like shaking hands that can hinder some musicians playing. Those in the studies said they felt better about their performance after taking beta blockers, and music critics consistently judged their performances to be better.

One of my clients – a senior manager in the entertainment industry – has used beta blockers for important presentations with no side effects. He said the physical symptoms he usually felt (heart racing and shaking of hands) made him spend too much time thinking about the nerves and how to control them. So he was more formal and stuck closer to ‘script’.

With the beta blockers reducing those symptoms, he felt free to be more conversational and expansive. So, he found the experience positive, however…

What can’t they do?

… he pointed out that they are useless if you’re not prepared . Public speaking fear is built on uncertainty – and if you feel uncertain about your preparation, your anxiety will increase. Some of the work we did together focused on message and structure which provides a foundation of clarity – as well as providing a ‘roadmap’ for the delivery of a speech or presentation. If you’re standing there thinking ‘I’m not sure what my point is here’, they won’t improve things.

Beta blockers can’t help anxiety of a purely psychological nature. If your public speaking anxiety shows itself mainly in psychological ways (e.g. general uncertainty or negative inner voices), beta blockers will not help you.

Reduced energy levels

Another thing to consider is that many people feel adrenalin helps them focus, giving them an edge that adds intensity to the performance. Australian actress Cate Blanchett has said, ‘a little bit of fear keeps one on one’s toes’.

When I was 19 and playing football semi-professionally, I saw a specialist about the migraine headaches I would get after each match.‘Post exertional headaches are a documented condition’, he said. I remember feeling a wave of relief that modern medicine understood my pain and would have a cure. He placed a vial of pills on the table.

‘These are drugs to reduce heart rate and blood pressure, which should therefore reduce your headaches.’ ‘But won’t that reduce my energy and physical performance on the field – the same effect as me not exerting myself as much?’

‘Well, yes.’

I didn’t use them.

2. Are they safe?

Beta blockers are prescription medications for good reason. There’s a fairly long list of side effects , including:

Rash, anaphylactic shock (sudden unconsciousness or death), cold extremities, fainting, dizziness, fatigue, headache, depression, sleep disturbances, nightmares, hallucinations, short term memory loss, high or low blood sugar, stomach ache, flatulence, constipation, nausea, diarrhea, dry mouth, vomiting, heartburn, bloating, impotence or decreased libido, difficulty urinating, bronchospasm, cough, wheezes, naal stuffiness, joint pain, and muscle cramps.

Although this is an exhaustive list, many performers who take beta blockers in small doses and or special occasions have found no side effects at all from their use.

The positive view…

According to a 2004 New York Times article, the editor of the Harvard Medical Letter, Michael Craig Miller, thinks there is little risk in taking them because they only affect physical, not cognitive anxiety. “Stage fright is a very specific and time-limited type of problem. There’s very little downside except whatever number you do on yourself about taking the drugs” he said.

The cautionary view…

An opposing view can be found in the comments left by musicians at www.hornplayer.net :

• “A common side effect is loss of concentration, and my playing rapidly went downhill because of this… I ended up sounding as if I were sight reading. As soon as I figured out the connection, I quit the pills for good; I never really needed them, anyway.”
• “…in performance, I had 3 quite severe panic attacks, something I never had experienced prior to that year or since. If you ever read any of the books on prescription drugs, a caution often added is that certain drugs may produce the opposite effect from that intended, so – be careful and check it out, as it’s a very individual thing.”

3. What’s the best way to manage public speaking anxiety?

The real objective when speaking in public is to think clearly – and speak clearly. So a better question than ‘are drugs good’ is ‘what’s the best way to mange stage fright?’

Many people believe they can’t think clearly because the physical symptoms are overloading your system. The irony is that the intensity of your physical symptoms is a result  of not thinking clearly.

Half of the physical symptoms are due to the initial stress response, while the other half are the result of the way you think about the situation .

The physical symptoms are real, but their  intensity  is directly related to the way you process them. For example, if you believe that your shaking hand (a minor symptom of the adrenaline released to give you energy for your speaking event) means that you are ‘losing control of your body!’, all your physical symptoms will increase with the drama of that thought . In other words, the stress response increases when we perceive a threat to our safety.

So symptoms can be reduced if we come to the conclusion that there is no real threat . So, when you know WHAT to do and HOW to do it (tip: natural style), your mind is efficiently directed and speaking anxiety is manageable.

Now, it’s possible that one drug-induced positive experience will help you come to that conclusion. But there are some risks associated with that path.

You could also learn the Vivid Method which demystifies public speaking anxiety and shows you how to redirect your attention to stay in control.

You see, nerves are okay. They’re manageable. They’re a useful signal. If you rely on medication you are saying your nerves are out of your control, treating your body as the enemy and the signals as a demon to be exorcized.

This fight or flight response (and your public speaking fear) can be minimised when we understand what’s going on and realise it’s something we can influence – something we can manage. —– If you’d like to develop your presentation skills, consider:

• Presentation Skills Training
• Presentation Skills public course
• Message Development Sessions

Want to be a great speaker? Get the kindle ebook from amazon.com:  What’s Your Message? Public Speaking with Twice the Impact, Using Half the Effort

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How Long Does Propranolol Last for Anxiety?

What is propranolol.

• How Long It Takes to Work
• How Long Does It Last?
• Side Effects
• Managing Anxiety

Propranolol is a beta-blocker medication. It is approved by the Food and Drug Administration (FDA) to treat high blood pressure , irregular heart rhythms (arrhythmias) , and angina .

However, it is sometimes also used off-label to reduce the physical symptoms of performance anxiety and stage fright.

How long propranolol lasts will depend on its dosage form. In its immediate-release form, which is what is typically prescribed for performance anxiety, propranolol may start working within one to two hours of taking it. After one dose, propranolol's effects can last for six to 12 hours. In its extended-release form, propranolol's effect can last up to 24 hours.

This article will describe propranolol's use for anxiety, how long its anxiety-reducing effects last, and what to expect when taking it.

Getty Images / cometary

Propranolol belongs to the medication group called beta blockers.

It is a prescription medication taken by mouth. It is available under the brand name Inderal LA in an extended-release (ER) formulation. It is also available generically in its immediate-release form.

Propranolol is most commonly used for high blood pressure, irregular heart rhythms (arrhythmias), and angina (chest pain caused by decreased blood flow to the heart). It is also used for migraine prevention, essential tremors, heart attacks, and pheochromocytoma (a rare, noncancerous tumor in the adrenal gland).

However, propranolol is also sometimes prescribed off-label for performance anxiety and stage fright symptoms.

Propranolol blocks stress hormones such as adrenaline and other hormones on the body's beta receptors. In other words, it works by blocking the “fight or flight” response.

Blocking the “fight or flight” response helps with the physical symptoms of anxiety, such as a fast heart rate, shaking, and sweating. Therefore, propranolol is sometimes taken before situations that induce anxiety, such as public speaking or before an exam.

How Long Does It Take Propranolol to Work for Anxiety?

Propranolol can be taken before a situation that could cause performance anxiety or stage fright. Its anxiety-reducing effects are noticeable within one to two hours after taking it.

How Long Do the Effects of Propranolol Last?

Propranolol's effects can vary depending on the preparation and what it is used for.

Immediate and extended-release formulations are available. The immediate release has the benefit of working faster than the extended-release formulation, which peaks in the blood about six hours after dosing. Propranolol immediate-release (IR) is a tablet used before a situation that can cause anxiety, such as speaking in front of a crowd:

• Peak effects (the highest amount of medication in the blood): The medication is most effective one to four hours after taking it. 
• Duration (how long it lasts): Effects will remain for six to 12 hours. 
• Half-life (the time it takes your body to remove half of the medication): It will take the body three to six hours to remove half of the medication.

When Should I Take Propranolol?

Propranolol IR comes in 10-milligram (mg), 20-mg, 40-mg, 60-mg, and 80-mg tablets. Take it before the stressful situation occurs, as directed by your healthcare provider.

For performance anxiety, propranolol should be taken about 60 minutes (one hour) before the situation occurs.  

What Are the Side Effects of Propranolol?

It is important to understand that all medications have side effects, but not all people will have those side effects. Some people experience little or no side effects.

Common Side Effects

Common side effects of propranolol may include:

• Slower heart rate
• Feeling tired
• Lightheaded
• Lower blood pressure
• Trouble sleeping
• Loose or watery stools
• Hard or difficult to pass stools
• Cold hands and feet
• Stomach pain or cramps
• Vivid or strange dreams 

Severe Side Effects

Call your healthcare provider immediately if you have serious side effects. Call 911 if your symptoms feel life-threatening or if you think you have a medical emergency. Serious side effects and their symptoms can include the following:

• Bronchospasm in those with chronic obstructive pulmonary disorder (COPD) or asthma (narrowing or tightening of the muscles in your lungs).
• Can also mask the signs and symptoms of low blood sugar , such as fast heart rate or tremors.

What Are Other Methods for Managing Anxiety?

Anxiety is a mental health condition that can affect your ability to live a happy, productive life. Propranolol can help control physical symptoms of anxiety but it does not treat the underlying cause of the anxiety.

Talk to your healthcare provider if your treatment does not control your symptoms. The proper treatment is essential for overall mental well-being. 

Methods For Managing Anxiety That Are Not Medications

Cognitive- behavioral therapy (CBT) is an option that does not involve the use of drugs to manage anxiety symptoms. This form of therapy combines different interventions, including:

• Talking to a therapist about your feelings, thoughts, and habits that may cause anxiety.
• Learning more about anxiety to become more self-aware.
• Exposing the person to situations that can cause worry in a safe and manageable way.
• Learning new ways to relax in stressful situations, such as breathing techniques.  
• Coping skills to help control anxiety. 
• Changing thoughts and beliefs that cause anxiety. 
• Working to make your personal relationships better. 

Support groups are also available to help you cope with anxiety.

Other Medications Used to Manage Anxiety

Propranolol is one of many medications that can be used to treat anxiety. Other anxiety medication options include:

• Selective serotonin reuptake inhibitors (SSRIs) such as Prozac (fluoxetine)
• Serotonin-norepinephrine reuptake inhibitors (SNRIs) such as Cymbalta (duloxetine),
• Benzodiazepines such as Xanax (alprazolam)

Finding the right treatment for managing your anxiety symptoms may be a trial-and-error process. You can work closely with your healthcare provider to find the right medication for you.

Propranolol is a prescription beta-blocker medication that can help with performance anxiety. It works by blocking the effects of adrenaline, which can make you feel scared or nervous.

It mainly helps with physical symptoms like a fast heart rate. The effects of propranolol start within an hour and can last for six to 12 hours if using the immediate-release formulation. However, it's important to know that propranolol is better for specific types of anxiety, like being afraid of speaking in public, and may not work as well for general anxiety.

It's best to talk to a healthcare provider to determine if it's the right choice for you and to learn about possible side effects. Several nonmedication options are also available.

Frequently Asked Questions

Propranolol is a type of drug also called a beta blocker. There are several beta blockers available. Some common examples are Lopressor (metoprolol) and Tenormin (atenolol). However, unlike propranolol, these medications are not typically used for anxiety.

No. Taking your dose with a high-protein meal may increase the bioavailability of propranolol. However, this will not affect how long it takes for the drug to take effect.

The author would like to recognize and thank Norma Ponce, PharmD for contributing to this article.

Szeleszczuk L, Frączkowski D. Propranolol versus other selected drugs in the treatment of various types of anxiety or stress, with particular reference to stage fright and post-traumatic stress disorder . Int J Mol Sci . 2022;23(17):10099. doi:10.3390/ijms231710099.

Mishriki AA, Weidler DJ. Long-acting propranolol (Inderal LA): pharmacokinetics, pharmacodynamics and therapeutic use . Pharmacotherapy . 1983;3(6):334-41. doi:10.1002/j.1875-9114

DailyMed. Label: Inderal LA- propranolol hydrochloride capsule, extended release .

DailyMed. Label: Propranolol hydrochloride tablet .

Tyrer P. Current status of beta-blocking drugs in the treatment of anxiety disorders . Drugs . 1988;36(6):773-783. doi:10.2165/00003495-198836060-00006

Anxiety & Depression Association of America. Clinical practice review for GAD .

Gautam S, Jain A, Gautam M, Vahia VN, Gautam A. Clinical practice guidelines for the management of generalised anxiety disorder (GAD) and panic disorder (PD) .  Indian J Psychiatry . 2017;59(Suppl 1):S67-S73. doi:10.4103/0019-5545.196975

Walle T, Fagan TC, Walle UK, Oexmann MJ, Conradi EC, Gaffney TE. Food-induced increase in propranolol bioavailability--relationship to protein and effects on metabolites . Clin Pharmacol Ther . 1981;30(6):790-795. doi:10.1038/clpt.1981.239

What’s The Right Propranolol Dosage For Anxiety?

Most of us have experienced performance anxiety at least once.

Speaking up in a meeting to deliver an opposing opinion you know you'll get pushed back on. Promising to deliver a killer best man's speech, even though public speaking is secretly your biggest fear .

The realization that a roomful of people is waiting to watch us speak or perform can be flat-out alarming.

Rapid heartbeat, sweaty palms, rushed breathing, flushed cheeks - the list of physical symptoms that scream out to everyone around us that we're scared is endless.

Many people assume that it takes a major intervention to relieve performance anxiety during these crucial situations.

For instance, it's not all that rare to see someone sneaking in a shot of whisky before they pick up the mic. In some cases, people will even turn to anxiety medications, like Xanax , to help them keep their cool.

The problem with these "treatment options", however, is that they come with side effects that blur your concentration and make it even more impossible to focus on the delivery of your content.

Beta-blockers, on the other hand, offer short-term relief without having to sacrifice your clarity and focus.

In fact, many are surprised to learn that the typical Propranolol dosage for anxiety is actually quite low, with most doctors recommending taking a small dose of 10–20 mg one hour before a pivotal moment like a presentation, job interview, or crucial exam.

This is a fraction of the normal dosage recommended for other conditions beta-blockers are used for like migraines, high blood pressure, and heart conditions.

How Does Propranolol Work For Anxiety?

When your body goes into fight-or-flight mode as a response to stress, norepinephrine (what you probably know as adrenaline) 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 we’re 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.

How Do I Know The Right Dosage For Me?

Like we mentioned above, doctors tend to prescribe 10-20 mg of Propranolol as an off-label prescription to be taken an hour before a big moment. This micro-dose, taken only when needed, is usually enough to achieve the relief from performance anxiety that beta-blocker prescriptions provide.

However, it’s important to give your doctor a full medical history as well as an updated list of any medications and supplements you’re taking to help figure out the right dosage for you.

As with any medication, the exact dosage will vary based on your height, weight, body composition, and a variety of other factors.

Though beta-blocker medications can cause some common side effects, taking the correct dosage recommended by your doctor can help minimize or eliminate them altogether.

Be sure to read through your treatment plan to make sure you're following full instructions from your doctor.

Though Propranolol is largely considered to be a safe medication, it simply isn't the right solution for everyone. You can complete an online visit with a board-certified doctor to discuss your performance anxiety and understand if a beta-blocker prescription is right for you.

Reviewed by Dr. Alex Dimitriu

Dr. Alex Dimitriu is a Stanford-trained physician with dual board certification in psychiatry and sleep medicine. The included content is not intended to replace medical advice. Always be sure to discuss any prescription medications with your doctor.

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Can This Drug Cure Performance Anxiety?

Beta-blockers, used primarily as a treatment for heart disease, may help calm the nerves of anxious orators.

When we think about performance-enhancing drugs, our minds immediately turn to famous athletes using banned substances to build muscles and heal faster. Lance Armstrong, Mark McGwire, Marion Jones—the list of athletes whose legacies are tainted by alleged (or, in some cases, admitted) drug use seems to grow longer every year.

But athletes aren’t the only ones ingesting pharmaceuticals to do their work better.

For people whose jobs require public speaking or presentations, a class of drugs called beta-blockers can be a powerful tool to calm the nerves and reduce the jitters that detract from performance.

Beta-blockers were discovered by Scottish pharmacologist James Black in 1962 as a treatment for heart disease. The chemicals work by inhibiting the body’s response to adrenaline, lowering blood pressure and reducing the risk of heart attack. By the 1970s, doctors had begun using them to reduce performance anxiety, particularly in musicians. However, that remains a secondary use; beta-blockers are still used primarily to improve people’s circulatory systems. For his work, Black won the Nobel Prize, and upon his death in 2010, The New York Times credited him with “extending the lives of millions of people.”

I began hearing about their usefulness in public speaking from writer friends who found themselves anxious on book tours. “All of my bad things that usually happened when I’d speak—the sweating, the fast breathing—didn’t happen,” one best-selling author told me after trying the pills. “I don’t know if it’s psychosomatic or not, but the pills just tamp down all of the physical sensations.”

Another friend looks at beta-blockers as an insurance policy. He doesn’t think of himself as a nervous speaker, but occasionally he’ll suffer feelings of panic at the podium. “Beta-blockers just subtract the possibility that your body is going to rebel against you,” he says. “The medicine helps immeasurably, and I’ve become an evangelist for it. It’s improved my career by making me a more confident public speaker.”

So when I began working on a book about how people get psyched up to perform better at work, I decided to give beta-blockers a try.

On a winter evening, I’m sitting in the crowded waiting room of a medical office. I’m here to see a certified nurse specialist, to try to get a prescription for propranolol , the generic beta-blocker my friends have been using.

In her office, the nurse taps on an iPad, asking for my biographical information—name, address, employer, insurance.

She asks about my emotional well-being and professional life. I tell her that I spend most days writing and editing, but that my job does require occasional public speaking. In my last job, my employer asked me to make periodic appearances on television; although these opportunities have waned since I changed jobs, I still go on camera every once in a while. When I do, I experience the classic markers of performance anxiety : the dry mouth, the tight throat, and the rapid heartbeat. When my kids have seen me on TV, they’ve teased me about compulsive blinking. I tell the nurse about my friends who take beta-blockers before speeches. “They say it takes the physical signs of nervousness off the table, and it’s made a big difference in their careers,” I say.

The nurse nods approvingly. She’s had patients who’ve had great results with propranolol. In fact, she suddenly scowls and looks annoyed. Earlier that morning, she’d seen a patient who was distressed because she’d become extremely nervous during a job interview. In retrospect, the nurse says she wishes she’d recommended propranolol, and she makes a note to call the patient after I leave to discuss it. After a few more minutes of conversation, she electronically sends the prescription to CVS, where I pay a $7 co-pay for 30 tablets of propranolol, renewable three times.

A few weeks later, I’m scheduled to fly to California to moderate a panel discussion in front of an audience of 75 people. It’s a chance to try out my new pills, and I’m excited—but I inadvertently leave the bottle in my car at the airport. At the conference, I’m well prepared and not particularly nervous; I lead the discussion drug-free without a hitch.

While I wait for more chances to try the drug, a friend texts me in a panic. He’s recently taken a new job, and the next morning he has to make a one-on-one presentation to his firm’s CEO. He cuts to the chase. “You know those pills you were telling me about for performance anxiety? Can I grab some from you before I get on the plane?”

I say no, fearing it would be illegal to share them. He pressures me. I come up with a compromise. “Okay, I’ll drop some pills off late tonight,” I tell him. Then I drive to CVS, buy a bottle of vitamin B12, and leave five tablets in an envelope taped to his door. I text him careful instructions: Take one pill 90 minutes before the presentation, and another 15 minutes beforehand if he still feels nervous.

Later, he texts me from the plane: “What is this medication called?” “Propranolol,” I lie. He googles it and starts reading online reviews. “Wow, people really rave about this stuff,” he says.

After the meeting, I text him: “How did it go?” “Really well,” he replies. “Those pills are magic.”

My friend’s experience illustrates how hard it is to know how well these drugs really work: Because we want them to work, the odds of a placebo effect is high—and because the pills’ effect is signified by the absence of something, it’s difficult to know if the pills really kept you from feeling nervous. It’s similar to the flu vaccine: If you get the shot, and you don’t get the flu that year, can you say for certain that the immunization prevented the illness?

Placebo or not, I notice an effect when I start trying them. Although I don’t have any other public speaking opportunities in the weeks after I obtain the prescription, I take the pills a few times before important interviews at work. I tend not to get nervous during interviews ... except, occasionally and unpredictably, I’ll start sweating. I remain sweat-free while on beta-blockers, with no rapid heartbeat or shallow breathing—though it’s hard to say how much to credit the drug for that.

The beta-blockers have a more noticeable effect in an unlikely setting: a two-day, 20-man annual golf tournament I play in with friends each year. I’m the worst golfer in the group, but on the first day, I play poorly even by my low standards. The next morning, on the driving range, I pop a propranolol. On the first tee, I’m unusually calm. (There’s a reason the PGA bans players from taking beta-blockers.) I still post the day’s poorest score, but I play far better than I usually do. The lack of nervousness is especially noticeable on tee shots and important putts—and with my handicap giving me strokes against my opponents, I keep my match competitive until the 16th hole. By then the drugs have worn off, and as I stand over a putt, I feel the familiar jitteriness—one I hadn’t felt that morning. Nonetheless, even my opponents notice the difference. “Dan played out of his mind today,” one announced over drinks at the clubhouse after the round.

I can only hope the pills work that well at my next public speaking opportunity.

This article is adapted from McGinn’s recent book, Psyched Up: How the Science of Mental Preparation Can Help You Succeed .

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Reconsolidation-based treatment for fear of public speaking: a systematic pilot study using propranolol

James w. b. elsey.

1 Department of Clinical Psychology, University of Amsterdam, Amsterdam, Netherlands

Anna I. Filmer

Harriet r. galvin, jennifer d. kurath.

2 University Hospital Zurich, Department of Psychiatry, Zurich, Switzerland

Linos Vossoughi

Linnea s. thomander, melissa zavodnik, merel kindt.

3 Kindt Clinics, Amsterdam, Netherlands

Associated Data

Code for performing the brms analyses in R can be provided upon request.

Pharmacological manipulation of memory reconsolidation opens up promising new avenues for anxiety disorder treatment. However, few studies have directly investigated reconsolidation-based approaches in subclinical or clinical populations, leaving optimal means of fear memory reactivation unknown. We conducted a systematic pilot study to assess whether a reconsolidation-based treatment could tackle public speaking anxiety in a subclinical sample ( N  = 60). As lab studies indicate that the duration of reactivation may be important for inducing reconsolidation, we investigated several speech lengths to help inform further translational efforts. Participants underwent a stress-inducing speech task composed of 3-min preparation, and from 0 to 9 min of public speaking, in 1-min increments. They then received either 40 mg of propranolol ( n  = 40) or placebo ( n  = 20), double-blind, allocated 4:2 for each speech duration. Participants performed a second speech 1 week post treatment, and were followed up with questionnaires 1- and 3 months later. Both self-reported speech distress and questionnaire measures of public speaking anxiety showed clear reductions following treatment. However, propranolol did not reliably outperform placebo, regardless of speech duration at treatment. Physiological responses (heart rate and salivary cortisol) to the public speaking task remained stable from treatment to test. These findings highlight the challenges facing the translation of laboratory research on memory reconsolidation into clinical interventions. Lack of explicit controls for factors beyond duration, such as ‘prediction error’, could explain these null findings, but positive results in clinical interventions are needed to demonstrate that taking such factors into account can deliver the promises of reconsolidation-based therapy.

Introduction

Recent findings in the neuroscience of learning and memory suggest that, contrary to being immutably etched into the architecture of the brain 1 , emotional memories may be susceptible to change. Since the seminal work of Sara and colleagues 2 , 3 and Nader, Schafe and LeDoux 4 , numerous studies over the past two decades have found that reactivation can render a memory vulnerable to interference 5 , 6 . Based on such findings, researchers have proposed the concept of memory reconsolidation ( 3 cf. 7 ): “the reactivation-dependent induction of a transient, unstable state of a previously consolidated memory, during which the memory trace may be modified or disrupted, and requiring a time-dependent process of restabilization in order to persist” ( 4 , 5 p. 798). Though it remains a contentious issue whether reconsolidation actually occurs in humans or non-human animals 5 , 8 , the potential clinical implications of reconsolidation have been a cause of considerable excitement 9 – 11 . If reconsolidation (or some alternative process leading to reactivation-dependent amnesia) can be harnessed and employed in clinical settings, it would be a major breakthrough in the treatment of mental illness, possibly allowing for rapid and long-lasting reductions in symptoms without the need for repeated drug administration or extensive psychological therapy. To date, however, relatively few studies have aimed at translating experimental models of reconsolidation into clinical interventions. In the present experiment, we aimed to assess the feasibility and efficacy of a reconsolidation-based intervention in tackling a naturally occurring fear of public speaking in otherwise healthy young adults. We use the term ‘reconsolidation-based’ to indicate that this intervention is based on the concept of reconsolidation, and not as a definitive statement that reconsolidation underpins any observed effects.

Although behavioural approaches aimed at harnessing reconsolidation are being pursued 12 , 13 , pharmacological approaches in humans achieve the closest parallels to what we believe are the most convincing demonstrations of retrieval-induced amnesia in animal models, from which reconsolidation was derived. Targeted administration of potent protein synthesis inhibitors used in animals is not feasible for human studies, but well-tolerated, non-toxic drugs, such as the beta-adrenergic receptor antagonist propranolol, can achieve comparable effects 2 , 14 . It is thought that blockade of adrenergic receptors may affect intracellular signalling pathways that ultimately lead to long-term potentiation—the proposed neural substrate of memory 15 , 16 .

When administered in time to disrupt reconsolidation, propranolol has proven effective in neutralising conditioned defensive responses in multiple human fear-conditioning studies (e.g., refs. 17 , 18 , see ref. 5 for a comprehensive review), though not always successful 19 , 20 . Propranolol has also been the typical drug choice in efforts to alleviate post-traumatic stress disorder (PTSD) with reconsolidation-based procedures 21 – 23 . These efforts have sometimes been disappointing 24 , but nevertheless highlight the potential of reconsolidation-based pharmacological interventions in tackling strong and naturally occurring emotional memories. However, given that PTSD patients often have highly complex presentations with comorbidity, and great heterogeneity even within PTSD symptoms, PTSD might not be the most instructive disorder to focus translational efforts upon.

While far from simple, more circumscribed anxiety disorders, such as specific phobias, could provide more tractable targets for reconsolidation-based treatments, helping to bridge the gap between experimental models and more complex disorders, while still representing a very strong, durable and naturalistic emotional memory. To reactivate a naturalistic fear memory in spider-fearful participants, Soeter and Kindt 25 briefly exposed participants to a live tarantula. This ‘memory reactivation’ was immediately followed by oral propranolol administration. Participants treated with propranolol + reactivation showed dramatic reductions in fear of spiders, and were typically able to touch or even hold spiders at least up to 1 year after the intervention. In contrast, those receiving placebo + reactivation or propranolol alone showed no changes in their fear. These control conditions demonstrate that the fear reduction cannot be explained by a general fear-dampening effect of propranolol, or by mere exposure. Similar effects have been reported in case studies of other animal phobias 26 , but we are not aware of controlled studies of pharmacological reconsolidation-based treatments for specific fears or phobias since then. In the present experiment, we aimed to extend this approach to a circumscribed social fear: fear of public speaking.

Fear of public speaking is a ‘performance only’ subtype of social anxiety disorder (SAD), characterised by extreme fear in, and avoidance of, public speaking situations, without more general social impairment as a result of anxiety 27 . Relative to pervasive SAD, those who specifically fear public speaking typically develop their fear later, may have less comorbid issues and personality problems and have lower genetic risk 28 – 30 . Public speaking can provide a good test case for reconsolidation-based treatments, as the feared object/situation is clearly different from animal phobias, yet sufficiently similar in the form of anxiety response and proposed aetiology as to not reflect a massive stretch beyond existing applications. Furthermore, fear of public speaking is itself a worthy target of novel interventions. It is one of the most common fears and, in the extreme, can result in missed educational, social and workplace opportunities 31 . Taken together, these considerations suggest that public speaking anxiety could be both a valuable and informative target for the translation of reconsolidation-based interventions.

One major difficulty for the translation of reconsolidation-based treatments is that the optimal means of reactivation—that is, in what manner feared stimuli are represented to participants, or the way in which participants are required to confront their fears—are not well-understood. Reactivation does not always cause reconsolidation, and may instead lead to mere retrieval, or to the generation of a new memory trace. Experimental studies suggest that something beyond merely representing the feared stimulus may be needed to render memory vulnerable to interference. Several animal 32 and human 33 , 34 fear-conditioning studies suggest that reconsolidation may only be triggered when reactivation includes ‘prediction error’: that is, the reactivation violates some expectation learned during the initial conditioning procedure (e.g., the presence or magnitude of the learned outcome differs from expectations). Yet, if multiple prediction errors occur, then extinction is likely to be triggered 35 , 36 . Studies also suggest that a limbo phase lies between reconsolidation and extinction: at some moderate level of prediction error, neither reconsolidation nor extinction are induced, and the memory simply remains stable 35 , 36 . The duration of reactivation has also been suggested as a key ingredient for triggering reconsolidation. In some cases, it appears that duration is relevant insofar as it allows for varying degrees of prediction error to occur 37 , whereas others suggest that duration itself is key, regardless of prediction error 38 . Similarly to prediction error findings, brief reactivations typically induce reconsolidation, long reactivations (20–30 min) provoke extinction and a ‘limbo’ phase lies in between. What length of reactivation is desirable in different clinical contexts is unknown. Although we would not expect any single form of reactivation to always trigger reconsolidation for everyone, the experimental studies above suggest that certain means of reactivation can be more or less effective in triggering reconsolidation (i.e., reactivations that provide an opportunity for prediction error, and/or are not of especially long duration).

As a first attempt in public speaking, we aimed for a standardised and easily replicable procedure, using the well-studied Trier Social Stress Test (TSST) 39 to provoke social-evaluative fear. For this pilot investigation, we systematically varied the length of reactivation, in the hope of identifying what (if any) length of reactivation might be most productive to focus on in a larger randomised controlled trial. Drawing on the success of Soeter and Kindt’s 25 spider study, in which reactivation-dependent amnesia was observed by combining a relatively simple and brief fear-provoking spider confrontation with propranolol administration, we did not directly manipulate prediction error. Instead, we encouraged participants to drop some safety behaviours, such as seeking reassurance from the audience, and to try to continue to talk even if they felt they were ‘blanking’. As with a frightening confrontation with a spider, this type of reactivation can provide many opportunities for prediction error occurrence, such as the expectation that the audience will laugh, or that one will have a panic attack (limitations of this approach will be considered in the ‘Discussion’).

In brief, participants with high fear of public speaking were required to undergo a public speaking task of variable duration, and then received either 40 mg of oral propranolol or placebo, so as to disrupt the putative post-reactivation process of reconsolidation. A diagram of the experimental procedure is provided in Fig. ​ Fig.1. 1 . Participants undertook another speech 1 week later to assess treatment effects, and were followed up by a questionnaire 1- and 3 months later to assess longer-term impact. The primary outcome variables were a questionnaire measure of public speaking anxiety, as well as self-reported distress induced by the public speaking challenge, and self-rated speech performance. Stress-induced changes in cortisol and heart rate were also assessed in Session 1 (S1) vs. Session 2 (S2). Details of all procedures, measures and the analytic approach, are provided in the ‘Methods' section. To our knowledge, this is the first attempt to tackle fear of public speaking using a reconsolidation-based approach, and can provide useful guidance for further controlled attempts to tackle this and other fears in future experiments.

BP Blood pressure, HR Heart rate.

Manipulation check

Analysis of alpha amylase, heart rate (HR) and blood pressure (BP) measured at the beginning of S1 and 90 min after pill ingestion generally indicated a successful effect of propranolol, whereby declines over time were greater for the propranolol relative to the placebo group, with the exception of diastolic blood pressure. Bayes Factors for the inclusion ( BF Inclusion ) of a Condition*Time interaction were 104.22, 61.39, 8.90 and 0.85, for alpha amylase (log-transformed), HR, BP Systolic and BP Diastolic , respectively. A means table is presented in the Supplementary Materials . State anxiety decreased over this time ( BF Inclusion_Time  = 2.49e + 13), but decreases did not vary by Condition ( BF Inclusion_Pill*Time  = 0.66). Hence, propranolol affected physiology but not subjective anxiety.

Baseline measures

Bayesian t - and Mann–Whitney U tests indicated no confounds in baseline variables between groups (Table ​ (Table1). 1 ). There was also no evidence for correlations (Pearson’s r and Kendall’s tau ) between Duration and any baseline measure (only the Liebowitz Social Anxiety Scale—Fear section [LSAS Fear ] showed weak evidence). The additional single items indicate that participants tended to experience the speech as slightly worse than expected, and tended to ruminate over the experience afterwards. Responses to these items did not differ between groups (all BF 10  < 0.4). There was a clear tendency for longer durations to produce greater rumination. There was only slight and inconsistent evidence that Rumination might relate to change in some main outcome variables (Rumination Wait marginally associated with greater change in Global Perception of Speech Performance [GPSP]: tau = −0.22, BF 10  = 2.53; Rumination Day marginally associated with less change in Personal Report of Public Speaking Anxiety [PRPSA]: tau = 0.21, BF 10  = 2.82). Sex was proportionally distributed across propranolol (33 females) and placebo groups (17 females) ( BF 10 for independent multinomial contingency test = 0.25). Given these findings from baseline variables, we did not consider any as confounds for the main analyses.

Baseline characteristics of participants by group.

BF 10 Bayes Factor for difference between groups/relationship with Duration, prop Propranolol group, r Pearson’s r , SD standard deviation, t Bayesian independent samples’ t test, tau Kendall’s tau, U Bayesian Mann–Whitney U test, LSAS Liebowitz Social Anxiety Scale, ASI anxiety sensitivity index, PRPSA personal report of public speaking anxiety, STAI-S/T state-trait anxiety inventory—state/trait, PHQ-9 patient health questionnaire 9, RSES Rosenberg Self-esteem Scale.

Self-report outcome measures

Posterior parameter estimates for each model are fully presented in the Supplementary Materials . Candidate models for predicting primary and secondary outcome variables were assessed with Pareto Smoothed Importance Sampling Leave-One-Out Cross Validation (PSIS-LOO) 40 . In brief, LOO cross-validation repeatedly leaves out individual datapoints when estimating model parameters, then assesses the models’ errors in predicting each left-out point. In doing so, it aims to account for possible model overfitting. The output of this process is estimated by PSIS-LOO. The key output of PSIS-LOO is the difference in Expected Log Pointwise predictive Density (ELPD Difference). Relative to the best-performing model—set to ‘0’—models that perform worse in cross-validation will have reliably negative ELPD Difference scores. Based on this metric, including Session as a predictor typically improved model performance vs. the Intercept-only model (Fig. ​ (Fig.2). 2 ). For LSAS Avoid , models did not convincingly outperform the Intercept alone. Additional predictors (interactions with Condition/Duration) resulted in no or negligible improvement of model performance.

ELPD expected log pointwise predictive density vs. best model, S session, C condition, D duration, *interaction between predictors.

Corroborating these findings, BF Inclusion for predictors when the data are analysed in JASP in either a two-way (Session by Condition) Bayesian mixed-measure ANOVA, or a linear regression on change scores, with Condition, Duration and their interaction as predictors, overwhelmingly supports an impact of Session for PRPSA (7.08e + 8), Distress Anticipatory (1099.51), Distress Max (2.64e + 8), GPSP (2.54e + 9), LSAS Fear (7424.54) and LSAS Avoid (26.10) (Supplementary Table S3 ). The results point against inclusion of Condition, Condition*Session, Duration and Duration*Condition ( BF Inclusion <1). Meagre evidence is found for an effect of duration on change in Distress Max ( BF Inclusion  = 2.35), which does not appear to vary by Condition.

Fitted means (estimated means from the posterior distribution of regression parameters) of the Session*Condition model indicate that PRPSA scores for the propranolol and placebo groups are predicted to decrease from S1 to a 3-month follow-up (3 m), with negligible difference in change between groups (Fig. ​ (Fig.3). 3 ). Change over time may be most parsimoniously explained by Session alone, estimating a drop of 14.48 (18.07–10.81, 95% central posterior density interval [PDI]).

Comparison of Placebo and Propranolol groups suggests no benefit of receiving propranolol vs. placebo. Points show raw scores. The dashed line reflects the initial cut-off score for inclusion.

Similarly, for GPSP, Distress Anticipatory and Distress Max , the estimated average S1–S2 changes from the Session*Condition*Duration model, indicating that scores on all measures are expected to decrease, but this change is not different between groups (Fig. ​ (Fig.4). 4 ). By subtracting estimates of the effect of duration in S2 vs. S1 for each condition, and then comparing these differences, we can also estimate any possible Session*Condition*Duration interaction directly. There is clear evidence against an interaction, with this ‘difference in differences’ estimated at 0.01 (−0.37–0.39, 95% PDI), 0.00 (−1.89–1.88, 95% PDI) and −0.18 (−2.01–1.64, 95% PDI), for GPSP, Distress Anticipatory and Distress Max , respectively. The favoured Session-only model predicts declines of 3.95 (2.92–4.95, 95% PDI), 11.10 (6.46–15.78, 95% PDI) and 19.45 (14.63–24.38, 95% PDI), for these variables. For the secondary self-report outcome variables of LSAS Fear and LSAS Avoid , the favoured Session-only model predicts modest drops in scores from S1 to 3-m follow-up of 4.41 (2.60–5.06, 95% PDI) and 2.66 (0.84–4.46, 95% PDI).

The solid black line and points represent mean change across durations. Dashed lines reflect fitted means for each duration. Grey points show raw scores.

Physiological measures

No treatment-related effects were apparent for physiological measures. For HR, including Timepoint, improved model predictions vs. Intercept alone (ELPD Difference  = −253.3, SE = 14.3). Including interactions with Session (ELPD Difference  = −1.1, SE = 1.9) or Session and Condition (ELPD Difference  = −3.7, SE = 3.4) provided no improvement. The time-point model simply predicts baseline HR at 72.61bpm (95% PDI = 69.32–75.81), increasing by 20.06bpm (95% PDI = 17.66–22.51) during speech preparation, and 42.07bpm (95% PDI = 39.50–44.59) during the first minute of speech, irrespective of session. Analysis as a mixed-measure ANOVA in JASP likewise indicated overwhelming evidence favouring inclusion of Timepoint ( BF Inclusion  = 1.61e + 15), with clear evidence against Session*Timepoint*Condition ( BF Inclusion  = 0.01).

For log-cortisol responses, no models convincingly outperformed the Intercept alone in PSIS-LOO cross-validation (vs. Timepoint*Session*Condition model: Intercept ELPD Difference  = −7.8, SE = 5.8, Timepoint ELPD Difference  = −1.5, SE = 4.0, Session*Timepoint ELPD Difference  = −2.0, SE = 3.8). For the treatment-relevant model involving a Timepoint*Session*Condition interaction, all parameters’ 95% PDIs, excluding the Intercept, spanned 0, indicating insufficient evidence of an effect of any predictor. Analysing log-cortisol in JASP as a mixed-measure ANOVA similarly failed to provide evidence for any treatment effect (Timepoint*Session*Condition BF Inclusion  = 0.56), with a weak indication that the propranolol group’s cortisol levels might have been greater in S2 (Session*Condition BF Inclusion  = 2.09).

Our study aimed to assess the feasibility of tackling fear of public speaking using a pharmacological, reconsolidation-based intervention. Taken together, our findings indicate that participants experienced a moderate decline in fear of public speaking from S1 to S2, and further general improvement in questionnaire measures of public speaking anxiety at 1- and 3-month follow-ups. Physiological measures indicated that propranolol exerted its expected influence over beta-adrenergic activity. However, changes in public speaking anxiety were not contingent upon receiving propranolol. We would therefore suggest that well-known phenomena such as placebo effects (e.g., expecting one’s fear to decrease allowing one to become more confident), or practice/exposure effects (e.g., being familiar with the task at the second performance, or practicing a speech under difficult experimental circumstances increasing one’s confidence when speaking with a more receptive audience outside of the study), underpin the observed anxiety reductions, rather than any novel phenomena such as reconsolidation. These findings contrast with previous results in spider-fearful participants 25 , where fear levels of control participants remained stable, and rapid and substantial decreases in fear of spiders were observed in reactivation + propranolol participants. Physiological responses to the stressor were not affected by the treatment.

In addition to manipulating whether participants received propranolol or placebo, we varied the duration of reactivation. Only maximal distress indicated a possible influence of speech duration (not varying with Condition), with participants who performed longer speeches experiencing greater declines in distress. As participants gave this rating after their speeches, this could be an artefact of the shorter duration of test-session speeches vs. treatment for those participants receiving 5–9-min reactivations. Shorter test speeches may have relieved these participants, who might have anticipated longer talks. Although we cannot strictly eliminate the possibility that longer speeches could produce reconsolidation-like effects, this seems unlikely given the effectiveness of much shorter reactivations in Soeter and Kindt 25 , clinical case observations and lab experiments. We therefore tentatively suggest that the reactivation employed may be ineffective in triggering reconsolidation.

While in Soeter and Kindt 25 , a brief fear-provoking exposure appears to have been sufficient to trigger reconsolidation, inducing reconsolidation is a delicate balancing act involving learning history, prediction error and possibly duration and other factors. Some participants may have found that the modified TSST confirmed their fears (it was slightly worse than expected, on average), as panel members provided no feedback. In addition, it should be considered that a substantial part of public speaking anxiety is both anticipatory and retrospective (e.g., post-event rumination) 41 , 42 . Participants did appear to ruminate on the experience afterwards, and might also have begun feeling anxious in anticipation of the task. Given these possibilities, one could consider giving positive feedback to participants, which may help both to provide some form of prediction error (an unambiguously positive response) and to curb negative post-event processing (due to satisfaction with one’s performance). It could also be that the TSST situation is too contrived to render a naturalistic fear memory vulnerable to interference (a difficulty that may be insurmountable if participants’ core fears involve failing classes or being ostracised by their peers, rather than the speaking scenario itself). Using a more realistic speech setting with more audience members, but without them having to maintain neutral expressions, is also possible, as well as requiring participants to give their speeches unexpectedly.

However, we remain largely ignorant of the parameters causing successful reconsolidation-based interventions for naturalistic and clinical fears. Prediction error can be easily operationalised in experimental studies where learning and reactivation are precisely controlled, but not in naturalistic fears. People with specific fears can express a wide range of expectations related to their fear, and it is not clear which—if any—should be focused on in an intervention. Nevertheless, our findings do suggest that merely provoking social-evaluative anxiety in individuals with fear of public speaking is unlikely to be sufficient for inducing reconsolidation.

Though we have focused on the idea that the current means of fear memory reactivation did not induce reconsolidation as the most likely explanation for the null effects, it could also be considered whether the pharmacological manipulation itself, or its timing, may be at fault. Research in fear-conditioning paradigms from our lab has consistently found 40 mg of propranolol to be an effective dosage for fear neutralisation, irrespective of participant body mass 43 , and that the drug can be administered up to 1 h post reactivation 18 . Administering 40 mg of propranolol shortly after reactivation was also effective in tackling a long-standing fear of spiders 25 , and in reducing PTSD symptoms in a case series 23 . However, recent research suggests that factors, such as the learning context’s familiarity and the strength of learning, can affect the timing of the consolidation window 44 . Different tasks might similarly affect the reconsolidation window, rendering our drug delivery approach suboptimal. Given this possibility, one option for future experiments might be to administer propranolol 30–45 min before reactivation, meaning that it would be unlikely to have any subjective effects during reactivation, but would be physiologically active more rapidly afterwards. Alternative drugs altogether have also been investigated for their reconsolidation-disrupting potential in clinical settings 45 .

In conclusion, this systematic pilot study did not achieve reconsolidation-like effects for public speaking anxiety. Consideration of why this was unsuccessful can be instructive. Although we suggest that alternative means of reactivating participants’ social-evaluative fears could prove more fruitful, it remains possible that such anxiety disorders are not amenable to pharmacological reconsolidation-based procedures. The outcomes of placebo participants in this study also emphasise the importance of including control participants in studies of reconsolidation-based interventions, as it cannot be assumed that non-specific changes in clinically relevant measures will not occur even with very short interventions. Finally, our findings highlight that despite the great promise of reconsolidation-based interventions, clinical translation is highly complex.

Materials and methods

Participants.

Participants were recruited via campus flyers and online advertisements, which linked to an online-screening questionnaire. Potentially eligible participants underwent a telephone screening, and an in-person blood pressure/heart rate (BP/HR) check if these values were uncertain. Included participants were required to be medically fit to receive a 40-mg dose of propranolol (for full criteria, see Supplementary Materials ), have a Patient Health Questionnaire (PHQ-9) 46 score <10 and Personal Report of Public Speaking Anxiety (PRPSA) 47 score of ≥120 at screening and the first study session (S1). According to McCroskey’s 47 norms, 120 represents the high end of ‘moderate’ anxiety, with 134 rated as ‘high’. This slightly lower cut-off was based on assessing pilot participants, who displayed high anxiety but not always extreme PRPSA scores. For comparison, PRPSA scores of high-fear participants undergoing an exposure intervention for public speaking anxiety by another research group averaged at 133.2, with approximately half of participants scoring in the ‘moderate’ range, and half in the ‘high’ range 48 . Average scores in our sample were 138–139. Telephone screenings further ensured that participants were highly anxious about public speaking. Additional criteria were fluency in English as a second language, being aged between 18 and 28, current enrolment in a bachelor’s or master’s programme, not reporting any mental health issues besides fear of public speaking and not undergoing any other mental health treatment.

During telephone screening, participants underwent a Structured Clinical Interview for DSM-5 (SCID) social anxiety disorder, determining that participants were not experiencing clinical social anxiety outside of public speaking situations, and that they were experiencing clinically significant anxiety related to public speaking situations. Interviewers (INITIALS_BLINDED_FOR_REVIEW) were trained in administration of this SCID-5 section by the first author, who underwent group training by Dr. Michael First. DSM requirements were relaxed for some criteria. Specifically, in our experience, most anxious participants have ‘cognitive insight’ that their fears are not rational/justified, but nevertheless suffer from severe anxiety. Participants who recognised that they would not suffer disproportionate negative social consequences due to poor speech performance (item F33), but who still experienced consistent and severe public speaking anxiety, were considered to have public speaking anxiety. Secondly, as students only intermittently face public speaking situations and cannot be expected to suffer daily from this fear, we considered interference surrounding a public speaking event, rather than daily interference. Hence, participants may be described as having a subclinical, circumscribed social anxiety.

In a minority of exceptional cases ( n  = 6), S1 speech panel members suggested exclusion of a participant who otherwise met inclusion criteria because they either had failed to perform the speech task with sufficient seriousness or did not appear legitimately anxious. These exclusion decisions were made before participants returned for the second study session (S2). Supplementary Materials include a flow diagram indicating all reasons for exclusion at different stages of this pilot.

Sixty participants (50 female) aged 18–28 (mean = 21.80, SD = 2.52) were included. These 60 include a 3-min propranolol participant who did not want to return for their second speech, but completed S2 questionnaires online. The final sample included 40 propranolol and 20 placebo participants. The initial design included only 10 placebo participants, who intended to ensure that experimenter’s attitudes did not change dramatically if a fully placebo-controlled trial followed this pilot. Observation of unexpected placebo effects in another study prompted the inclusion of 10 more placebo participants after our pilot had commenced, in order to estimate possible placebo effects. Participants received €40/4 credits for participation, plus €5/.5 credits for 3-month follow-ups. All procedures were approved by the University of Amsterdam ethics review board under code 2016-CP-7282, and all participants gave informed consent.

Propranolol

Propranolol (40 mg) was administered orally in pill form, within 5 min of speech termination in S1. Propranolol pills were made by Accord Healthcare Ltd. (UK), and provided along with placebo pills by Huygens Apothecary (NL). This dosage has been effective in multiple experimental reconsolidation studies, irrespective of participant body mass 43 , and also effectively used in tackling another subclinical, naturalistic fear 25 , as well as in a case series of patients with PTSD 23 . Two department members pseudorandomly allocated participants to receive either propranolol ( n  = 40) or placebo ( n  = 20). Each duration from 0 to 9 min was allocated six participants with a 4:2 ratio of propranolol:placebo. Pills were administered double-blind. Given the uneven propranolol:placebo ratio, analyses were not blind.

Materials and measures

Several validated self-report measures (see Supplementary Materials for psychometric properties) were used to assess baseline participant characteristics and change over time.

Primary outcome measures

Public speaking anxiety was assessed using the PRPSA 47 . Scores on this 34-item self-report scale range from 34 to 170, with higher scores indicating greater speech anxiety.

Anxiety experienced while performing the public speaking task was assessed using Subjective Units of Distress/Discomfort (SUDS) 49 . Participants rated their distress from 0 (no distress) to 100 (extreme distress) at two occasions in each in-person session: once immediately before entering the speech room (Distress Anticipatory ), and once to report their maximal distress after exiting the speech room (Distress Max ). Participants were familiarised with the meaning and use of the SUDS in the pre-task interview period. The participant who did not return for their S2 speech received distress scores of 100.

Participants’ impressions of their public speaking performance (e.g., ‘Appeared confident’) were assessed using the Global Perception of Speech Performance-Self-rating (GPSP) 50 . Sum scores on this 5-item self-report scale can range from 0 to 20. Higher scores indicate poorer perceived performance.

Secondary outcome and baseline measures

The Liebowitz Social Anxiety Scale (LSAS) 51 , 52 was included as a secondary outcome measure to determine if any changes in fear of public speaking might also extend to a generalised social anxiety measure. Notably, scores cannot completely disambiguate fear in public speaking vs. other performance/general social situations, and so any reductions in the total score should be considered a tentative indication of possible general social anxiety effects. Scores on the 24-item LSAS Fear and LSAS Avoid subscales of this self-report measure can range from 0 to 72. Higher scores indicate greater anxiety in or avoidance of several social situations. Scores combining both subscales in our sample averaged below 50, whereas the average of those diagnosed with or undergoing treatment for general social anxiety typically stand between 70 and 80 53 , 54 , consistent with our intention to recruit those with more circumscribed/subclinical social anxiety.

The PHQ-9 46 was used to screen out participants experiencing ‘moderate’ or greater depressive symptoms (i.e., scoring ≥10). Scores on this 9-item self-report scale can range from 0 to 27. Higher scores indicate more depressive symptoms over the past 2 weeks.

Baseline assessments were also made for anxiety sensitivity, self-esteem and state-trait anxiety, using the Anxiety Sensitivity Index (ASI, range = 0–64) 55 , Rosenberg Self-Esteem Scale (RSES, range = 10–40) 56 and Spielberger State-Trait Anxiety Index (STAI, range = 20–80) 57 . Higher scores on these self-report scales respectively indicate higher anxiety sensitivity, self-esteem and state/trait anxiety. Additional STAI-State measurement at the end of S1 enabled assessment of whether propranolol affected participants’ subjective anxiety.

Four single-item measures were included to gain insight into participants’ experience of the procedure for future designs. Participants indicated their confidence in the treatment approach in S1, from 0 (‘none at all’) to 10 (‘complete confidence’). As a rough index of prediction error, participants used a sliding scale to indicate their experience of the task relative to expectations, from −100 (‘much worse’), through 0 (‘as expected’), to +100 (‘much better’). At the conclusion of S2, participants used two sliding scales to retrospectively report how much they ruminated over their first speech during the waiting period (Rumination Wait ) and the rest of the day (Rumination Day ), from 0 (not at all) to 100 (constantly).

SCID-5 social anxiety

Participants underwent an assessment of social and public speaking anxiety using the SCID-5 social anxiety section, covering diagnostic criteria for social anxiety disorder.

Propranolol manipulation checks

To confirm propranolol’s adrenergic influence, participants gave two saliva samples (using ‘Code Blue’ Sarstedt Salivettes, Germany)—first at the beginning of S1 during the initial medical screening, then 90 min after pill ingestion—which were assessed for alpha amylase content. Blood pressure and heart rate (BP/HR) were also assessed at these times to measure cardiovascular effects of propranolol, using an Omron Corporation (Japan) sphygmomanometer.

Stress-related outcome measures

Three cortisol samples were taken per session. The cortisol baseline was taken while participants watched a 3-min nature video segment after baseline questionnaires. Post-stress samples were taken 17.5 min after task preparation began and 17.5 min after speech completion, coinciding with the timing of peak cortisol levels 39 while factoring in variability from different speech durations. For very short speech durations, the timing for post-stress cortisol samples sometimes overlapped, resulting in one sample being collected. S2 took place 15–45 min after S1 (on another day), to control for daily fluctuations in cortisol. One propranolol participant whose sessions occurred >2 h apart was excluded from cortisol analysis. Samples were collected using an oral salivette (‘Code Blue’ Sarstedt, Germany) and frozen to at least −20 °C within an hour of collection. Quantification of salivary analytes was performed by Dresden LabService GmbH, as detailed in the Supplementary Materials .

Continuous HR measurement using a Polar H10 monitor via Heart Rate Variability Logger iOS app 58 was included as an exploratory measure. HR collected from Polar devices shows near- perfect correlation with electrocardiography 59 . Our analyses used the average HR for the middle 2 min of the pre-speech baseline period (during the nature video), for the 3-min speech preparation period, and for the first minute of their speech. Timepoints required ≥66.67% complete second-by-second measurements for inclusion (six datapoints were excluded).

Modified TSST

At S1 and S2, participants underwent a modified TSST 39 . Stress induction began as in the typical TSST, with participants instructed that they would deliver a speech to a small audience trained in behavioural analysis, and they should make the best impression possible. A camera would record them for later analysis. Participants were required to pitch themselves as candidates for their ideal job/a competitive study programme (counterbalanced across sessions), and to maintain this role for the entire speech.

One modification to the TSST was intended to limit the use of certain safety behaviours, which can prevent prediction error. Participants were instructed not to seek to alleviate pressure on themselves by asking the audience questions, or by giving up if they thought they were running out of things to say (these instructions are not given in the typical TSST). A further modification was that instead of 5 min of speaking and 5 min of arithmetic as in the typical TSST, participants were informed that they would speak for up to 10 min. S1 speeches ranged from 0 to 9 min, in 1-min increments. This range of durations was intended to allow sufficient time for participants to experience some sort of prediction error (e.g., the audience does not laugh, they do not have a panic attack), but not so long that extinction could be expected to occur. To enable comparison directly across durations at S2, the second speech was kept constant at 4.5 min, reflecting the average of all the other speech lengths, and closely matching the speech length of the usual TSST. Panel members for S2 were blind to the S1 speech duration (except for 0-min participants, in case these participants needed further instruction, which was not ultimately required).

As in the standard TSST, one panel member asked the speaker questions after approximately 3 min. The two panel members were a smartly dressed man and woman, who maintained a neutral demeanour. Panel members changed from S1 to S2 to reduce exposure effects if the exact same audience were present at both speeches. Speeches were terminated by the experimenter knocking on the door from outside the speech room. The panel then thanked the participant and asked them to exit.

S1 : Figure ​ Figure1 1 provides a schematic representation of the S1 protocol, including timing of saliva samples and main events. Sessions began with medical screening, pre-propranolol BP/HR and salivary alpha amylase measurement, and attaching the continuous HR monitor, followed by questionnaire completion. Pre-stress cortisol and continuous HR was then measured. Participants then briefly discussed their first, worst and most recent public speaking situations, during which the SUD scale was explained and utilised to familiarise them with its use. The modified TSST was then performed, with associated SUDs and performance ratings. This was followed by propranolol/placebo administration (double-blind). Post-task questionnaires were very brief, meaning that propranolol was administered within 5 min of speech termination. A 90-min rest period with light reading material, allowing propranolol to reach peak bioavailability 60 , then followed. The two post-stress cortisol samples were taken during this rest period. At the close of the session, participants completed the STAI-S and had their BP/HR and salivary alpha amylase measured again.

S2 : Test sessions were arranged for between 6 and 9 days after the treatment session, 15–45 min after the S1 time. Participants fitted the HR monitor and completed the STAI-S. Pre-stress cortisol and continuous HR were then assessed. The 4.5-min modified TSST was then performed with associated SUDs and performance ratings. An approximately 20-min rest period took place after the TSST to allow the two post-stress cortisol samples to be taken, after which participants completed the PRPSA and LSAS.

One- and three-month follow-ups

Participants were contacted via email 1- and 3 months after their treatment sessions to complete the PRPSA and LSAS online.

Analytic approach

Analyses were performed using R package brms 2.9.0 61 for Bayesian estimation of hierarchical regression models of outcome variables, and JASP 62 . We believe that Bayesian estimation is better suited to pilot investigations than typical hypothesis testing, as it produces highly informative parameter estimates for differences between groups/conditions, as well as uncertainty around them, which is not provided by assessments of statistical significance. Uncertainty is in this case expressed as a 95% central posterior density interval (the range between 2.5 and 97.5 percentiles of the posterior). As this was a pilot investigation in which we hoped to indentify a possible effect to focus on in a future randomised controlled trial, formal power analyses were not performed. However, our parameter estimates and model comparison findings suggest that an absence of power does not underpin the null findings: differences of close to zero between conditions were consistently found, and Bayes factors suggested evidence against the inclusion of a propranolol effect. In addition to parameter estimation, we performed cross-validation using the R Package loo 2.1.0 40 , 63 , which can aid in evaluating the predictive value of different experimental variables. Weakly informative default priors in brm s were used to analyse questionnaire responses. Physiological analyses did not converge using default priors. We specified slightly more constrained priors, detailed fully in the Supplementary Materials . For analyses of self-report outcome variables, we assessed models, including Session (S1–S2 or S1–3m follow-up), Condition (Placebo vs. Propranolol), Duration (0–9 min) and their interaction. Graphical comparison of change in outcome variables by Session from 0 to 9 min suggested that only a slight linear effect of duration was plausible. Duration was therefore only included as a linear predictor. For physiological outcome measures, Session, Condition, Timepoint (the 3 timepoints noted for cortisol/ambulatory HR collection within each session) and their interaction were included as predictors. Duration was not included, facilitating estimation/interpretation of the three-way categorical interaction. All analyses in brms nested repeated measures within participants.

JASP was used for analyses of baseline variables, manipulation checks and complimentary computation of Bayes Factors for outcome variables. All JASP analyses used default priors outlined by Wagenmakers et al. 64 .

Supplementary information

Acknowledgements.

We greatly appreciate the help of members of the Amsterdam Emotional Memory Lab, the UvA Psypoli, as well as Tim Schoenmakers and Lauren Kuhns, who served as panel members at various points in this study.

Code availability

Conflict of interest.

This work was supported by salaries from the University of Amsterdam and the ERC Advanced Grant 743263 of Merel Kindt. Merel Kindt is the co-founder of Kindt Clinics , a private clinic that provides reconsolidation-based treatments. The authors declare no conflicts of interest.

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Change history

The original HTML version of this Article was updated shortly after publication to correct a typo in the acknowledgement of the Amsterdam Emotional Memory LAb (the word “memory” was misspelled).

Supplementary Information accompanies this paper at (10.1038/s41398-020-0857-z).

• Heart Health
• Propranolol

Propranolol for public speaking - staggered dosage?

Posted 9 years ago , 4 users are following.

What have people experienced when preparing for a public speaking event where you are unsure of the specific time you are to be presenting?

I have a window of around 2.5hrs and do not know what to do with taking the medication in this case...please help!!!

0 likes, 6 replies

Anna1980 ana12345

Posted 9 years ago

I find that it usually takes about an hr to kick in and keeps me calm for a few hours after that so is suggest just taking it 2.5 hrs before ...

Hope this helps!

ana12345 Anna1980

I think I find the 10mg don't really seem to have much of an effect, at least not a very noticable one, then again I haven't been able to test it in a stressful situation as such,

john66404 ana12345

anna4546 ana12345

Report or request deletion, thanks for your help.

We want the community to be a useful resource for our users but it is important to remember that the community are not moderated or reviewed by doctors and so you should not rely on opinions or advice given by other users in respect of any healthcare matters. Always speak to your doctor before acting and in cases of emergency seek appropriate medical assistance immediately. Use of the community is subject to our Terms of Use and Privacy Policy and steps will be taken to remove posts identified as being in breach of those terms.

Propranolol (Oral Route)

Description and brand names.

Drug information provided by: Merative, Micromedex ®

US Brand Name

• InnoPran XL
• Propranolol HCl Intensol

Descriptions

Propranolol is used alone or together with other medicines to treat high blood pressure (hypertension). High blood pressure adds to the workload of the heart and arteries. If it continues for a long time, the heart and arteries may not function properly. This can damage the blood vessels of the brain, heart, and kidneys, resulting in a stroke, heart failure, or kidney failure. Lowering blood pressure may reduce the risk of stroke and heart attacks.

Propranolol is also used to treat severe chest pain (angina), migraine headaches, or hypertrophic subaortic stenosis (thickened heart muscle).

This medicine may also be used to treat irregular heartbeats, tremors, or pheochromocytoma (adrenal gland tumor). It may also be used to reduce the risk of death in patients who have heart attacks.

Propranolol oral solution is used to treat proliferating infantile hemangioma.

This medicine is a beta-blocker. It works by affecting the response to nerve impulses in certain parts of the body, like the heart. As a result, the heart beats slower and decreases the blood pressure. When the blood pressure is lowered, the amount of blood and oxygen is increased to the heart.

This medicine is available only with your doctor's prescription.

This product is available in the following dosage forms:

• Capsule, Extended Release

Before Using

In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For this medicine, the following should be considered:

Tell your doctor if you have ever had any unusual or allergic reaction to this medicine or any other medicines. Also tell your health care professional if you have any other types of allergies, such as to foods, dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully.

Appropriate studies have not been performed on the relationship of age to the effects of propranolol capsules, extended-release capsules, and tablets in the pediatric population. Safety and efficacy have not been established.

Appropriate studies performed to date have not demonstrated pediatric-specific problems that would limit the usefulness of propranolol oral solution in children.

Appropriate studies performed to date have not demonstrated pediatric-specific problems that would limit the usefulness of propranolol oral solution to treat proliferating infantile hemangioma in children 5 weeks to 5 months of age. However, safety and efficacy have not been established in children older than 1 year of age.

Appropriate studies performed to date have not demonstrated geriatric-specific problems that would limit the usefulness of propranolol in the elderly. However, elderly patients are more likely to have age-related liver, kidney, or heart problems, which may require caution and an adjustment in the dose for patients receiving propranolol.

No information is available on the relationship of age to the effects of propranolol oral solution in geriatric patients.

Breastfeeding

There are no adequate studies in women for determining infant risk when using this medication during breastfeeding. Weigh the potential benefits against the potential risks before taking this medication while breastfeeding.

Drug Interactions

Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking this medicine, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.

Using this medicine with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.

• Fezolinetant
• Mavorixafor
• Rizatriptan
• Thioridazine

Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

• Bupivacaine
• Bupivacaine Liposome
• Desvenlafaxine
• Diatrizoate
• Dronedarone
• Epinephrine
• Escitalopram
• Eslicarbazepine Acetate
• Fexinidazole
• Haloperidol
• Indacaterol
• Iobenguane I 131
• Lercanidipine
• Levalbuterol
• Mepivacaine
• Oxymetazoline
• Rivastigmine
• Terbutaline
• Venlafaxine

Using this medicine with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

• Aceclofenac
• Acetyldigoxin
• Albiglutide
• Aluminum Carbonate, Basic
• Aluminum Hydroxide
• Aluminum Phosphate
• Amtolmetin Guacil
• Calcium Carbonate
• Canagliflozin
• Chlorpromazine
• Chlorpropamide
• Cholestyramine
• Choline Salicylate
• Dapagliflozin
• Deslanoside
• Dexibuprofen
• Dexketoprofen
• Dihydroergotamine
• Dihydroxyaluminum Aminoacetate
• Dihydroxyaluminum Sodium Carbonate
• Dulaglutide
• Empagliflozin
• Ertugliflozin
• Etofenamate
• Floctafenine
• Flufenamic Acid
• Flurbiprofen
• Fluvoxamine
• Glimepiride
• Indomethacin
• Insulin Aspart, Recombinant
• Insulin Degludec
• Insulin Detemir
• Insulin Glargine, Recombinant
• Insulin Glulisine
• Insulin Human Inhaled
• Insulin Human Isophane (NPH)
• Insulin Human Regular
• Insulin Lispro, Recombinant
• Linagliptin
• Liraglutide
• Lixisenatide
• Lumiracoxib
• Meclofenamate
• Mefenamic Acid
• Metildigoxin
• Morniflumate
• Nateglinide
• Niflumic Acid
• Nimesulide Beta Cyclodextrin
• Oxyphenbutazone
• Phenoxybenzamine
• Phentolamine
• Phenylbutazone
• Piketoprofen
• Pioglitazone
• Pramlintide
• Pranoprofen
• Proglumetacin
• Propyphenazone
• Repaglinide
• Rifapentine
• Rosiglitazone
• Salicylic Acid
• Saxagliptin
• Sitagliptin
• Sodium Salicylate
• St John's Wort
• Tiaprofenic Acid
• Tolbutamide
• Tolfenamic Acid
• Vildagliptin

Other Interactions

Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur. Using alcohol or tobacco with certain medicines may also cause interactions to occur. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.

Using this medicine with any of the following is usually not recommended, but may be unavoidable in some cases. If used together, your doctor may change the dose or how often you use this medicine, or give you special instructions about the use of food, alcohol, or tobacco.

Other Medical Problems

The presence of other medical problems may affect the use of this medicine. Make sure you tell your doctor if you have any other medical problems, especially:

• Anaphylactic reaction (severe), history of—May increase risk for repeated anaphylactic reactions.
• Angina (severe chest pain) or
• Glaucoma or
• Heart attack, recent or
• Muscle problems (eg, myopathy, myotonia)—Use with caution. May make these conditions worse.
• Bradycardia (slow heartbeat), without a pacemaker or
• Cardiogenic shock (shock caused by heart attack) or
• Heart block, without a pacemaker or
• Heart failure, decompensated or
• Sick sinus syndrome (type of abnormal heart rhythm), without a pacemaker or
• Tremors due to Parkinson's disease—Should not be used in patients with these conditions.
• Asthma, or history of or
• Bradycardia (slow heartbeat), severe or
• Bronchospasm, history of or
• Hypotension (low blood pressure) or
• Infants weighing less than 2 kilograms or
• Pheochromocytoma (an adrenal problem) or
• Premature infants with corrected age younger than 5 weeks of age—Hemangeol® should not be given to patients with these conditions.
• Infection or
• Poor oral food intake (eg, not eating, vomiting) or
• Stress—Hemangeol® may increase the risk of low blood sugar in patients with these conditions.
• Diabetes or
• Hyperthyroidism (overactive thyroid) or
• Hypoglycemia (low blood sugar)—May cover up some of the signs and symptoms of these diseases, such as a fast heartbeat.
• Kidney disease or
• Liver disease—Use with caution. The effects may be increased because of slower removal from the body.
• Lung disease (eg, bronchitis, emphysema)—Use with caution. May cause difficulty with breathing in patients with this condition.
• Patients who are fasting (eg, surgery, not eating regularly, vomiting)—May increase risk of hypoglycemia (low blood sugar).
• Tachycardia (fast heartbeat) or
• Wolff-Parkinson-White syndrome (rare heart condition)—May cause very slow heartbeat in patients with these conditions.

Take this medicine only as directed by your doctor. Do not take more of it, do not take it more often, and do not take it for a longer time than your doctor ordered. Your dose may need to be changed several times in order to find out what works best for you.

This medicine should come with a Medication Guide and patient directions. Read and follow these instructions carefully. Ask your doctor if you have any questions.

In addition to the use of this medicine, treatment for your high blood pressure may include weight control and changes in the types of foods you eat, especially foods high in sodium (salt). Your doctor will tell you which of these are most important for you. You should check with your doctor before changing your diet.

Many patients who have high blood pressure will not notice any signs of the problem. In fact, many may feel normal. It is very important that you take your medicine exactly as directed and that you keep your appointments with your doctor even if you feel well.

Remember that this medicine will not cure your high blood pressure, but it does help control it. You must continue to take it as directed if you expect to lower your blood pressure and keep it down. You may have to take high blood pressure medicine for the rest of your life. If high blood pressure is not treated, it can cause serious problems such as heart failure, blood vessel disease, stroke, or kidney disease.

Swallow the long-acting oral capsules and tablets whole. Do not break, chew, crush, or open them.

Propranolol extended-release capsules should be taken at bedtime (10 pm). This medicine may be taken with or without food. However, you should take it the same way each time.

Measure the concentrated oral solution, Intensol™ with the dropper that comes with the package. You may mix the concentrated solution with water, juice, soda, applesauce, or pudding to make it easier to swallow, then take the mixture right away.

Measure the oral liquid with the dosing syringe that comes with the package. It should be given directly into the child's mouth, during or right after eating or breastfeeding. It may also be mixed with a small amount of milk or fruit juice and given with a baby's bottle. Do not shake before use.

The dose of this medicine will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of this medicine. If your dose is different, do not change it unless your doctor tells you to do so.

The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.

• Adults—180 to 240 milligrams (mg) per day, given in divided doses.
• Children—Dose is based on body weight and must be determined by your doctor.
• Adults—At first, 40 milligrams (mg) three times a day. Your doctor may increase your dose as needed.
• Children—Use and dose must be determined by your doctor.
• Adults—60 milligrams (mg) per day, given in divided doses for 3 days before having surgery. In patients who cannot have surgery, the usual dose is 30 mg per day, given in divided doses.
• Adults—At first, 80 milligrams (mg) once a day. Your doctor may increase your dose as needed. The dose is usually not more than 320 mg per day.
• Adults—80 to 320 milligrams (mg) per day, given in divided doses.
• Adults—At first, 80 milligrams (mg) once a day, given at bedtime. Your doctor may increase your dose as needed. However, the dose is usually not more than 120 mg per day.
• Adults—At first, 80 milligrams (mg) once a day. Your doctor may increase your dose as needed.
• Adults—At first, 40 milligrams (mg) two times a day. Your doctor may increase your dose as needed.
• Adults—80 to 160 milligrams (mg) once a day.
• Adults—20 to 40 milligrams (mg) three or four times a day, given before meals and at bedtime.
• Adults—10 to 30 milligrams (mg) three or four times a day, given before meals and at bedtime.
• Adults—At first, 80 milligrams (mg) once a day. Your doctor may increase your dose as needed. The dose is usually not more than 240 mg per day.
• Adults—At first, 80 milligrams (mg) per day, given in divided doses. Your doctor may increase your dose as needed.
• Children 5 weeks to 5 months of age—Dose is based on your child's body weight and must be determined by the doctor. The starting dose is usually 0.6 milligram (mg) (0.15 milliliters [mL]) per kilogram (kg) of your child's body weight 2 times a day, taken at least 9 hours apart. Give the dose during or immediately after a feeding. Do not administer the dose if the infant is vomiting or not eating. After 1 week, the doctor will increase the dose to 1.1 mg (0.3 mL) per kg of body weight two times a day. After 2 weeks, the doctor will increase the dose to 1.7 mg (0.4 mL) per kg of body weight 2 times a day, taken for 6 months.
• Children under 5 weeks of age—Use is not recommended.

Missed Dose

If you miss a dose of this medicine, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not double doses.

Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light. Keep from freezing.

Keep out of the reach of children.

Do not keep outdated medicine or medicine no longer needed.

Ask your healthcare professional how you should dispose of any medicine you do not use.

Throw away any unused Hemangeol® after 2 months.

Precautions

It is very important that your doctor check your progress at regular visits to make sure this medicine is working properly. Blood tests may be needed to check for unwanted effects. .

This medicine may increase the risk of heart or blood vessel problems (eg, bradycardia, hypotension). Check with your doctor right away if your child has blurred vision, chest pain or discomfort, confusion, lightheadedness, dizziness, or fainting, slow or uneven heartbeat, sweating, trouble breathing, or unusual tiredness or weakness.

This medicine may cause serious allergic reactions, including anaphylaxis, which can be life-threatening and require immediate medical attention. Call your doctor right away if you have a rash, itching, hoarseness, trouble breathing, trouble swallowing, or any swelling of your hands, face, or mouth while you are using this medicine.

Serious skin reactions can occur with this medicine. Check with your doctor right away if you have blistering, peeling, or loose skin, red skin lesions, severe acne or skin rash, sores or ulcers on the skin, or fever or chills while you are using this medicine.

Propranolol may cause heart failure in some patients. Check with your doctor right away if you are having chest pain or discomfort, dilated neck veins, extreme fatigue, irregular breathing, an irregular heartbeat, swelling of the face, fingers, feet, or lower legs, or weight gain.

This medicine may cause changes in your blood sugar levels. Also, this medicine may cover up signs of low blood sugar, including fast heartbeat and increase the risk for serious or prolonged hypoglycemia (low blood sugar). Check with your doctor if you have these problems or if you notice a change in the results of your blood or urine sugar tests. Call your doctor right away if you have anxiety, blurred vision, chills, cold sweats, coma, confusion, cool, pale skin, depression, dizziness, fast heartbeat, headache, increased hunger, nausea, nervousness, nightmares, seizures, shakiness, slurred speech, or unusual tiredness or weakness.

Make sure any doctor or dentist who treats you knows that you are using this medicine. Do not stop taking this medicine before surgery without your doctor's approval.

This medicine may cause some people to become less alert than they are normally. If this side effect occurs, do not drive, use machines, or do anything else that could be dangerous if you are not alert while taking propranolol.

Do not interrupt or suddenly stop taking this medicine without first checking with your doctor. Your doctor may want you to gradually reduce the amount you are taking before stopping it completely. Some conditions may become worse when the medicine is stopped suddenly, which can be dangerous.

Propranolol will add to the effects of alcohol and other central nervous system (CNS) depressants. CNS depressants are medicines that slow down the nervous system and may cause drowsiness. Some examples of CNS depressants are antihistamines or medicine for hay fever, allergies, or colds, sedatives, tranquilizers, or sleeping medicine, prescription pain medicine or narcotics, barbiturates or medicine for seizures, muscle relaxants, or anesthetics, including some dental anesthetics. Check with your doctor before taking any of these medicines while you are using this medicine.

This medicine may increase risk of stroke in PHACE syndrome patients with severe blood vessel problems in the brain. Talk to your child's doctor about this risk.

Make sure any doctor or dentist who treats you knows that you are using this medicine. This medicine may affect the results of certain medical tests.

This medicine may cause erectile dysfunction in some males. Check with your doctor right away if you have decreased interest in sexual intercourse, inability to have or keep an erection, or loss in sexual ability, drive, or performance. If you have questions about this, talk to your doctor.

Do not take other medicines unless they have been discussed with your doctor. This includes prescription or nonprescription (over-the-counter [OTC]) medicines and herbal or vitamin supplements.

Side Effects

Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor immediately if any of the following side effects occur:

More common

• Chest tightness
• cough producing mucus
• difficulty with breathing

Incidence not known

• black, tarry stools
• blistering, peeling, or loosening of the skin
• blood in the urine
• bloody nose
• bloody stools
• blurred or loss of vision
• body aches or pain
• burning, crawling, itching, numbness, prickling, "pins and needles", or tingling feelings
• chest pain or discomfort
• cold sweats
• confusion about identity, place, and time
• constipation
• cool, pale skin
• cracks in the skin
• decreased awareness or responsiveness
• decreased urine output
• depersonalization
• difficulty with swallowing
• dilated neck veins
• disturbed color perception
• dizziness, faintness, or lightheadedness when getting up suddenly from a lying or sitting position
• double vision
• dryness or soreness of the throat
• fast, pounding, slow, or irregular heartbeat
• fever and chills
• general feeling of discomfort, illness, or weakness
• halos around lights
• heavier menstrual periods
• irregular breathing
• lightheadedness, dizziness, or fainting
• loss of heat from the body
• mental depression
• mimicry of speech or movements
• muscle or joint pain
• nervousness
• night blindness
• noisy breathing
• overbright appearance of lights
• paleness or cold feeling in the fingertips and toes
• peculiar postures or movements, mannerisms, or grimacing
• pinpoint red or purple spots on the skin
• puffiness or swelling of the eyelids or around the eyes, face, lips, or tongue
• quick to react or overreact emotionally
• rapidly changing moods
• rectal bleeding
• red skin lesions, often with a purple center
• red, irritated eyes
• red, swollen skin
• reddening of the skin, especially around the ears
• seeing, hearing, or feeling things that are not there
• severe sleepiness
• short-term memory loss
• skin irritation or rash, including rash that looks like psoriasis
• skin rash, hives, or itching
• slurred speech
• stomach pain and tenderness
• sores, ulcers, or white spots in the mouth or on the lips
• swelling of the eyes, face, fingers, feet, or lower legs
• swollen glands
• tender, swollen glands in the neck
• tingling or pain in fingers or toes when exposed to cold
• tunnel vision
• unusual bleeding or bruising
• unusual tiredness or weakness
• voice changes
• weight gain

Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

• hyperventilation
• irritability
• restlessness
• sleepiness or unusual drowsiness
• trouble sleeping
• unusual dreams

Less common

• Decreased appetite
• loss of strength or energy
• muscle weakness
• pain or discomfort in the chest, upper stomach, or throat
• stomach cramps
• unusual drowsiness, dullness, or feeling of sluggishness
• vivid dreams

Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.

Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.

Portions of this document last updated: Aug. 01, 2024

Original article: https://www.mayoclinic.org/drugs-supplements/propranolol-oral-route/proper-use/DRG-20071164

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Propranolol for Performance Anxiety User Reviews

Brand names: Inderal LA, Hemangeol, Inderal XL InnoPran XL

Propranolol has an average rating of 9.7 out of 10 from a total of 469 reviews for the off-label treatment of Performance Anxiety. 97% of reviewers reported a positive experience, while 0% reported a negative experience.

Propranolol rating summary

469 ratings from 501 user reviews .

Compare all 1 medications used in the treatment of Performance Anxiety .

Reviews for Propranolol

• Top reviews
• Most recent
• Most helpful
• High rating
• Time on medication
• Taken for 1 to 2 years
• March 28, 2021

"For those of you like me who suffer severe performance/social anxiety, including rapid heartbeat, shaking, struggling to speak, etc., this drug is a perfect fix. It stops your body from being overrun with adrenaline, which enables you to come across calm and composed. It's so effective. Good luck to all those who suffer from this condition as it can really impact one's life."

• November 14, 2014

"Used it today for a work presentation and it worked. At some point later in the day I had to hold back the tears thinking about how my life would have been different had I known about this medicine. I'm 42 years old and wish I knew about this 20 years ago."

• Taken for 2 to 5 years
• March 15, 2021

"Ever since a bad nervous, shaking breakdown ad hoc impromptu talk in my 9th grade speech class activated by my teacher in high school at age 15, I've been petrified of public speaking. I dropped classes in high school and college where there was a presentation required. I limited my career advancement where presentations would be required. Over the years I advanced anyway and would be required to manage and speak in front of large groups. I still had the same dread and potential bad side effects. I finally researched and found this drug at 53 years old. I'm now 55 years old and a senior manager. I needed this 40 years ago. Tell your doctor it's for performance anxiety; apparently used by many musicians and artists over the years. I wish it was more well known back in the day. For those doing presentations. 20mg 1.5 hours before, 20mg 1 hour before, 20mg 30 minutes before. All will be good!"

Frequently asked questions

• How quickly does propranolol work?
• What's the maximum dose of propranolol?
• November 1, 2019

"I have an intense fear of public speaking. I get such a bad adrenaline rush; my voice shakes, and I feel like I'm going to pass out. Then propranolol came up with my doctor. Now, when I know I'll be public speaking, I take 30 mg anywhere from 30 mins to an hour before, and my symptoms are gone. No signs of my terror, I am cool and confident. Also, I was reading a really interesting article where propranolol can actually help you eradicate anxiety. Essentially, my brain used to associate public speaking with adrenaline rushes and embarrassment. Now my brain doesn't have to fear it, and I've spoken publicly with propranolol quite a few times. Now I don't need it nearly as much. It used to be that I couldn't even speak up in a small meeting. Now I'm able to do that with ease even without propranolol, because my body isn't conditioned to have that adrenaline rush, and I'm more confident. I hope to continue to speak publicly with propranolol and hopefully come to a day I don't need it anymore."

• Taken for 1 to 6 months
• October 18, 2019

"Well, I tried to write a review about this drug and ended up writing 2100 characters when the max is 1000 so it all got deleted LOL. Long story short, I could not shut up about this drug because it is an absolute life-saver. Senior in college and had to drop countless number of classes because I couldn't so much as introduce myself to the class. Fast forward to yesterday, I just did my first presentation using propranolol and WOW. 40 mg an hour before and cured physical symptoms of the stress and anxiety of public speaking - no sweating, no shaking, no nothing. Just a whole lot of confidence. Got to keep this short but remember YOU ARE NOT ALONE. Plenty of people are going through this anxiety too. THIS DRUG is A LIFE-SAVER!!"

Are you taking this medicine?

• Add your review
• Learn more about Propranolol
• Taken for 10 years or more
• October 13, 2023

"Back in 1976, when I was in my early 20s, I was at a low point in my life due to my social anxiety. My doctor prescribed propranolol 10 mg several times a day. The drug helped me tremendously, controlling my shaky hands, racing heartbeat, sweating when faced with presentations and even just social interactions. I have had a successful career making many presentations to large groups with no symptoms. I'm now retired and playing guitar and singing in a band. I could have never done these things without propranolol. It is a miracle drug."

• February 14, 2020

"For some reason or another, I have a deathly fear of public speaking and presentations. Such a fear that I would do anything to get out of speaking in front of classmates. On the first day of this semester, the professor announced that each person was to stand up one by one and tell the class about themselves. I walked out of the classroom and emailed the professor that I forgot my laptop somewhere and went to go find it before it was stolen (total lie). While presenting, my heart pounds, I lose my breath, my voice quivers, etc. It is beyond embarrassing, and I stress days before I know I'm going to present. I finally went to my doctor after reading the reviews on this website and was prescribed propranolol. I took it today and felt great during my talk in a 200-person lecture hall. This medicine keeps your body so calm the entire time. Your heart doesn't pound, you breathe normally, your voice doesn't shake. It's such a relief, and I'm so happy I found out about it."

• December 29, 2014

"Propranolol launched my career! I suffered from severe fight-or-flight syndrome during presentations, interviews, meetings, and even phone calls. Symptoms included rapid heartbeat, shortness of breath, sweating, weak voice, etc. I started taking these almost a year ago and have since been promoted to a director position. I present to our entire organization and lead meetings with our executive team - symptom-free! I use 10 mg for meetings and up to 40 mg for presentations and interviews. I have also used 10 mg before a golf tournament and the 1st tee box jitters were completely gone. The rest of my game still sucked, but it felt good not to dribble the first one off the tee!"

• August 25, 2011

"I am actually a physician (weird, I know), and always had a problem with anxiety. At one point, it was truly affecting my life. I could cope and work, but like many of us, I constantly had the fear of 'panicking' or 'losing control.' It started to affect my work, so I actually became a patient and asked my doctor for some help. I've never had trouble dealing with the stress mentally, but the physical symptoms just drove me crazy and made the anxiety worse. I'd get shaky, warm, uncomfortable, etc., etc. On THE FIRST DAY I took 10mg, my life changed. Every single negative body symptom I experienced was gone. My confidence came back, and honestly, I'm a better physician because of it. Simply amazing."

• February 3, 2020

"40 odd years of blushing and a fear of blushing - gone. I’ve read countless self-help books, meditated, was on Zoloft for years, changed my diet, seen a psychologist, etc. Didn’t work. Beta blockers work, I feel like I am myself. A couple of days of an upset stomach was the only side effect but it’s now gone. Thank you, Science."

• December 26, 2015

"Miracle medicine. I'm a surgeon and started taking it during residency for the equivalent of stage fright doing surgery. Over 20 years there is no question of its efficacy (and safety). It has allowed me to do mission trips and complicated procedures under the most stressful situations. I use it less over the years but still do because it still has a very strong calming effect without sedating or clouding the sensorium. It's as close to a miracle medicine as I have ever seen."

• Taken for 6 months to 1 year
• March 26, 2024

"I do a lot of public speaking and developed terrible situational performance anxiety during Covid, although I struggled on and off over the years. My primary symptoms were breathlessness and extreme sweating (literally pouring down my face and getting in my eyes). It was terrible, but something I thought I had to live with. Researched the problem and found out about propranolol and what it could do. I talked to my doctor who was happy to prescribe it. Just 10 mg an hour before and I am calm and in control again. Absolutely no sweating or breathlessness. No side effects at that low dose. I highly recommend this medication for performance anxiety."

• March 9, 2021

"Even raising my hand in class was something that I feared so much, let alone presentations in front of other people. I tried so many ways to reduce the feeling of fight or flight every time that I'd have to speak, but let me tell you, taking a few deep breaths before presenting did absolutely nothing for me. But this MEDICATION is like a gift from God. It got rid of my shaky hands, shaky voice, fast heart rate. I could think clearly, and although you can still get a little nervous in your head, none of the symptoms show, and speaking goes so smoothly! It makes me want to sign up for every presentation ever...seriously. So glad I found out about it :)"

• July 15, 2023

"I've used this drug PRN for over 10 years now and it is simply a career saver and, as a result, a life saver. Without it, I would not be able to do the job I do nor obviously earn the good money I make to support my family. Prior to being prescribed this medication, I suffered from extreme public speaking and performance anxiety. I would use Diazepam but, while numbing the nerves, I felt that it made me quite dumb. So I would slur and even once nearly fell over, having bumped into some chairs after leaving a meeting room at the conclusion of the meeting. My anxiety was that bad, I used to make up the most lame excuses to avoid even the most rudimentary meetings, and presenting was completely out of the question. I'm positive that I was the office joke. All that changed with this med. I sometimes find myself in my current role presenting to over 100 people. Pffff. Simple these days. I come across polished and confident. Absolutely love it. The only drug I'll ever use."

• April 28, 2015

"Used propranolol recently for a best man speech as I suffer terribly with anxiety and panic attacks. Words cannot describe how well this worked for me. I was still mentally nervous, but physically I was in complete control with no stutter, breathing problems, or heart palpitations. I actually enjoyed it and I could have spoken all night. I never review anything online but just felt I wanted to share my experience as I know how horrible performance anxiety can be."

• Taken for less than 1 month
• January 15, 2020

"Finding this thread and getting a script for Propranolol has literally given me back my confidence when presenting and saved my career! I never had an issue with public speaking until a bad episode 3 years ago crippled my confidence. Since then, I've been promoted to a very senior level in a tech organization, and regular speaking is required. I would dread having to give a talk for weeks in advance, feel sick at the idea, and wonder if those symptoms would present themselves again. I have used it 3 times in the last month for 3 big presentations, and I nailed every single one! I'm even happier around the office because now I can just focus on my material and know I can relax when I get up to speak. I wasted 3 years on therapy and all sorts, when this was my last shot at the dice. I'm so grateful for how it has helped me."

• January 10, 2024

"Why is this not a listed anxiety drug!!! I have tried therapy to no avail and this drug saved my career. My job involves presenting, however, I developed pre-covid a crippling response when I stand to introduce myself. A severe rush of adrenaline, every inch of me screaming RUN RUN RUN. Sweaty, shaky, unable to speak or breathe, heart pounding. The feeling was terror. I unfortunately ran out of a big presentation in front of the board and had to leave my old job. I then found propranolol and all symptoms gone when I pop a 40mg pill 1h then 30min before. Lucky I found it when I did."

• March 28, 2014

"I used to be a singer but had to quit because of worsening panic attacks (including twitching face muscles - the shame). I hated myself for quitting but saw no other choice. I was working as an EFL teacher and eventually had to quit that too because facing a class suddenly became overwhelming. Staff meetings were impossible, presentations at training sessions were out of the question, until even talking to my small class made me want to run far far away. So I became a freelance copywriter so I could stay at home and not face anyone. I was alone for about 6 years. About 6 months ago somebody told me about propranolol. My new job starts Monday. Thank you, thank you thank you, modern medicine, from me and my family, for giving me my life back"

• November 29, 2014

"I started getting panic attacks when I was 12. Every time I had to present something to my class, it felt like I was having a heart attack and my hands and voice would shake uncontrollably. I couldn't get through the presentations most of the time, and the kids would make fun of me. It was dreadful. Finally, when I was 14, I saw the doctor who prescribed this. It was a life-changer. There was a speech I had to give as an 8th-grade project, and while I was up at the podium, I could actually organize all my thoughts. No shaking. No heart palpitations. No sweaty hands. I could have stayed up there for hours! I even remember thinking, 'this stuff really works!' I'm 23 now and started taking it for work-related situations."

• November 2, 2014

"Was very anxious and became depressed after my father was diagnosed terminally ill. I started a new job which didn't help with the stress. Was having often panic attacks. Now I feel amazing. I now have my life back. Without this I think I would have had to be hospitalized. Thank goodness. Life is good again."

• September 13, 2019

Inderal (propranolol) "This drug is a miracle! Imagine every time you're about to present in front of people - the panic creeping in, heart racing, visible trembling almost to the point of convulsion with a lump in your throat and cracking voice. Imagine what everyone's thinking as you choke trying to spit out words on a piece of paper, who knew reading could be so difficult. Think about the embarrassment and how incompetent you feel when in reality you actually exude confidence. Why is my body attacking me? Why is it impossible to simply read off a piece of paper and not turn into a shaking wreck. This was me...and I had tried many therapies I read online before, trust me. Long story short...I was cured first dose of Inderal and never looked back. I hope others find relief."

• September 20, 2016

"This drug saved my life. I am 40+ PhD senior manager in a major company and I have had speaking anxiety with big crowds that goes way beyond normal nerves. I have tried every type of therapy and public speaking training. 18 months ago I gave a review to 70 people that went so badly (I will spare details) and left me so full of shame. I went home and considered ending my life as I could see no way out or ability to face my wife and beautiful children. I saw a doctor who gave me propranolol and now I am a flawless speaker who is referred to as one of the strongest speakers in the company! Preparation and knowledge are 100% critical, but this drug removes clinical, crippling inhibitions and lets me show who I really am. Life-saving!"

• February 6, 2014

"My entire life, I have had a fear of public speaking that is so intense I would literally shut down and stop talking in the middle of a presentation. My heart feels like it is going to jump out of my chest, my mind goes completely blank, I turn red-faced, and my body and voice begin to tremble uncontrollably. I failed college courses, changed jobs, and altered my entire life just to avoid speaking in public. It was such a difficult and embarrassing problem that filled me with so much shame. One day, a friend told me about propranolol and so I went to the Doctor. The Doc prescribed and I can now present like a professional with zero anxiety. Simply put, this medicine changed my entire life and I would recommend it to anyone with anxiety."

• July 2, 2023

"Okay... wow... just wow. I have been struggling with social anxiety my whole life: blushing, trembling, not good in groups, shaky voice, and hands. Because of some bad experiences, I have a major fear of having these symptoms and making a complete idiot of myself. I now take 10-15 mg an hour before the social event and all the symptoms are gone! I felt such relief after this. There is hope! No more lying awake for days because a social event comes up. It doesn't help with the anxiety itself, but propranolol keeps your body relaxed so your head stays relaxed too. Wish I knew about this 25 years ago. This is actually saving my career at this point..."

• September 23, 2023

"Anxiety ruling my life, scared to go to work, on my days off not wanting to go anywhere. I spoke to the doctor and he prescribed me Propranolol. Almost immediately I felt different, the shaking stopped. I felt different, more calm. It's early days, but is this the answer to all my prayers? We will see."

Reviews may be edited to correct grammar/spelling or to remove inappropriate language and content. Reviews that appear to be created by parties with a vested interest are not published. This information is not intended to endorse any particular medication. While these reviews may be helpful, they are not a substitute for the expertise, knowledge, and judgement of healthcare professionals.

More about propranolol

• Check interactions
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• Reviews (1,353)
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• Support group
• Drug class: group II antiarrhythmics
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• En español

Patient resources

• Propranolol drug information
• Propranolol (Intravenous) (Advanced Reading)
• Propranolol Sustained-Release Bead Capsules
• Propranolol Injection
• Propranolol Oral Solution

Other brands

Inderal , Inderal LA , Hemangeol , Inderal XL , InnoPran XL

Professional resources

• Propranolol monograph
• Propranolol (FDA)
• Propranolol Injection (FDA)
• Propranolol Oral Solution (FDA)
• Propranolol Tablets (FDA)

Related treatment guides

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r/publicspeaking is a place for anything and everything to do with the art of public speaking. Whether you want to share a video of a great speech or want some help with a school speech assignment r/publicspeaking is the place for you!

Propranolol

Hello everyone!

I absolutely hate public speaking. I think it stems from several traumatic experiences in school during my childhood. Ever since it’s been a snowball effect, where I anticipate a bad speech because I’ve never been able to get a grip of myself to even give a good presentation. I suffer mostly from a shaky voice and racing heart. I am deathly afraid of people hearing how nervous I sound.

Anyway, I have signed up to be lead on a committee and have to get in front of groups and facilitate meetings. I also have to give a speech for a wedding. Double whammy.

I don’t usually go to the doctor but I will be making an appointment to see a gynecologist soon for a regular check up.

I would like to try propranolol. Will a gynecologist be likely to prescribe it to me? Or will she refer me to, say, a psychiatrist? I’d like to get this prescription ASAP so time is of the essence.

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