Propranolol prescription online

Propranolol works on hypertension, angina, and arrhythmias by lowering heart rate, decreasing the force of heart contractions, and reducing blood pressure. 

By blocking adrenaline from affecting the body, propranolol also prevents adrenaline’s physical effects that happen during stress or anxiety like sweating, increased heart rate and blood pressure, dilated airways, shaking, and increased alertness. 

Even though propranolol was first approved for angina pectoris, it’s been used to treat anxiety off-label since the 1960s. It’s recognized that the physical symptoms and overactive “fight-or-flight” response that come with anxiety, respond well to propranolol.

In 1 randomized, double-blind study, anxiety and depression scores were lower in participants taking propranolol than those taking a placebo. Another study found much lower anxiolysis scores (a measure used to determine the reduction of anxiety levels in response to treatment) in people taking propranolol compared to those not taking medication.

Propranolol tablets (also called propranolol hydrochloride tablets) come in 10-, 20-, 40-, and 80-milligram dosage strengths. The amount your provider will prescribe depends on what you take propranolol for. 

• For anxiety, there’s no official recommendation, but providers may prescribe 10 to 40 milligrams 30 to 60 minutes before an anticipated stressful event or 2 to 3 times a day for continuous symptom relief.
• For hypertension, people usually start with 40 milligrams twice a day and may gradually increase to a maximum dose of 120 to 240 milligrams a day, rarely even 640 milligrams. 
• For angina pectoris, people take from 80 to 320 milligrams a day divided over 2 to 4 doses.
• For atrial fibrillation, people take a daily dose of 10 to 30 milligrams 3 to 4 times a day.
• For myocardial infarction, people take an initial dose of 40 milligrams 3 times a day and increase to 60 to 80 milligrams 3 times a day after a month with a maximum daily dose of  180 to 240 milligrams a day divided in 2 to 3 doses.
• For migraine, people start with 80 milligrams a day in divided doses with a typical dose range of 160 to 240 milligrams a day.
• For essential tremor, people typically take 40 milligrams twice a day initially and work up to 120 milligrams per day or rarely 240 to 320 milligrams a day.
• For hypertrophic subaortic stenosis, typical dosing is 20 to 40 milligrams 4 times a day before meals and bedtime.
• For pheochromocytoma, the usual dose is 60 milligrams divided over 3 days for 3 days before surgery along with alpha-adrenergic blockade or 30 milligrams divided doses along with alpha-adrenergic blockade for inoperative tumors.

Extended-release propranolol and Inderal LA capsules come in 60-, 80-, 120-, and 160-milligram capsules. The starting dose for hypertension, angina pectoris, or migraine is 80 milligrams once a day. The usual dose for hypertension is 120 to 160 milligrams daily; for angina pectoris 160 milligrams; and for migraine 160 to 240 milligrams once a day. 

Inderal XL (InnoPran XL) comes in 80- and 120-milligram capsules. People start with 80 milligrams taken once a day at bedtime with or without food and may work up to 120 milligrams as needed. Full effects on blood pressure control may take 2 to 3 weeks. Inderal XL isn’t typically used for anxiety.

Extended-release propranolol, Inderal LA, and Inderal XL are less commonly prescribed for anxiety. But they can be used for generalized anxiety disorder (GAD) and chronic anxiety at a starting dose of 80 milligrams daily.

The typical first-line treatment for chronic anxiety disorders are antidepressants known as selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs), such as Zoloft (sertraline), Prozac (fluoxetine), Celexa (citalopram), and Lexapro (escitalopram). 

Most research finds that SSRIs are better at treating a broader range of anxiety symptoms compared to propranolol. One systemic review of multiple records on beta-blockers for anxiety found that there isn’t enough evidence of their effectiveness. They may still be effective for situational or acute anxiety accompanied by physical symptoms depending on the person. 

On drugs.com, user reviews rate propranolol a 7.5 out of 10 for anxiety and 9.7 out of 10 for performance anxiety. Those are higher ratings than for propranolol’s FDA-approved uses. They’re also higher than drug.com Zoloft reviews for panic disorder and social anxiety disorder, which are 7.6 and 7.3 respectively. 

Benzodiazepines like Xanax (alprazolam) are commonly used for acute anxiety, GAD, and panic disorders. In 1 small study on the effect of Xanax vs propranolol for panic disorder with agoraphobia, Xanax was found to be effective and results for propranolol were inconclusive. 

Drugs.com reviewers rate Xanax higher for anxiety than propranolol — 8.5 compared to 7.5. They also give Xanax a 9.1 rating for panic disorder where propranolol has a 9.7 rating for performance anxiety. 

Beta-blockers, like propranolol or atenolol, are commonly used for GAD accompanied by physical symptoms and situational anxiety with physical symptoms. In 1 clinical trial, propranolol and atenolol were both found effective for treating the symptoms of anxiety, but atenolol had greater cardiovascular effects compared to propranolol. On drugs.com though, reviewers rate atenolol higher for anxiety (8.0) than propranolol (7.5). 

Bottom line — the best medication for you, whether for anxiety or another condition, is best determined by working with a qualified healthcare professional who can assess your symptoms, recommend a treatment plan, and work with you to adjust your treatment plan as needed. If you’re looking for a provider to help, find one on Klarity Health where you can often have an appointment in as little as 24 hours.*

Note: Zoloft is FDA-approved to treat social anxiety disorder (SAD) and panic disorder (PD) as well as major depressive disorder (MDD), OCD, PTSD, and premenstrual dysphoric disorder (PMDD). Prozac is approved to treat PD, OCD, MDD, bulimia nervosa, and PMDD. Lexapro is approved to treat generalized anxiety disorder (GAD) and MDD. Xanax is approved to treat GAD and PD. Celexa is approved to treat MDD and used off-label for anxiety. Atenolol is approved to treat hypertension, angina pectoris, and acute myocardial infarction and used off-label for anxiety.

Zoloft, Prozac, Celexa, Lexapro, Xanax, and atenolol can all cause side effects that may include nausea, diarrhea, dry mouth, constipation, drowsiness or fatigue, dizziness, headache, insomnia, sedation, sexual dysfunction, agitation or anxiety, heart palpitations, and low blood pressure. Before taking any medication, discuss possible warnings, precautions, adverse reactions, and drug interactions with your provider or pharmacists and read the medication guide.