Carvedilol vs Propranolol: Which Should I Take?

Living with anxiety is challenging, but finding the right medication shouldn’t be. Many different medications are used to treat anxiety, and each class of medications is used to target specific symptoms. 

In this article, we will compare two commonly prescribed medications, Carvedilol and Propranolol, which are primarily used to treat the physical symptoms of anxiety. We will take a deeper look into the similarities and differences between these two medications so that you can be better informed when discussing anxiety treatment options with your healthcare provider. 

If you are struggling with anxiety, let Klarity help. We offer a unique telehealth platform that allows you to receive quality care for your mental health, all from the comfort of your own home. Schedule an appointment today, and we’ll connect you with a licensed healthcare provider in your state who can discuss Carvedilol vs. Propranolol and determine if one is right for you.

Propranolol and Carvedilol are the Same Class of Drugs (Beta Blockers)

Propranolol and Carvedilol belong to the same class of medications called beta-blockers and are used to treat the physical symptoms of anxiety. These two drugs similarly act on the body but have key differences we discuss below. 

What Are Beta Blockers?

Beta-blockers are a large group of medications that are most commonly used for the treatment of cardiac conditions. These medications work on the cardiovascular system to lower heart rate and blood pressure, which is why these drugs are also useful in treating the physical symptoms of anxiety, such as racing heart or tremors. 

How Do Beta Blockers Work?

Beta-blockers are named after their mechanism of action. This class of medication works by blocking the activity at beta receptors, which are found throughout the body. There are two types of beta-receptors, beta-1, and beta-2, which are most notably found in the heart and blood vessels. 

Epinephrine is the primary neurotransmitter released from beta-receptors and is involved in the “fight or flight” response when the body perceives danger. This system is overactive in those who suffer from anxiety, so beta blockers work to block the release of epinephrine at beta-receptors, which ultimately slows the heart rate and lowers blood pressure. 

Propranolol and Carvedilol Can Help Treat Physical Symptoms of Anxiety

Anxiety can be defined as uncontrollable or unwanted thoughts or fears that are out of proportion to the given situation. Beta-blockers are used to treat the physical symptoms of anxiety, which may include: 

• Increased or irregular heart rate 
• Increased rate or work of breathing 
• Tremor 
• Feeling lightheaded or dizzy 
• Restlessness 
• Headaches 
• The uneasy feeling in your stomach 

What Else Does Propranolol Treat?

Propranolol is most commonly used to treat cardiovascular issues and is FDA-approved for the following conditions: 

• High blood pressure 
• Irregular heartbeat or arrhythmias 
• Migraine headaches 
• Essential tremor 

Off-label Uses for Propranolol  

When there is a condition that is considered an “off-label” use, this indicates that the medication has not been FDA-approved for that given health issue. This does not mean the medication is not effective for off-label use, but rather that the drug manufacturer has not undergone the FDA-approval process for the given indication. For a drug to be FDA-approved, there is an extensive process that requires a great deal of time and resources. 

Off-label uses for Propranolol include: 

• Physical symptoms associated with anxiety 
• Performance anxiety 
• Portal hypertension 
• Thyroid storm 

What Else Does Carvedilol Treat?

Carvedilol is also primarily used to treat various cardiovascular conditions and is FDA-approved for the following conditions: 

• High blood pressure 
• Mild to severe chronic heart failure 
• Left ventricular dysfunction after a heart attack 

Off-label Uses for Carvedilol 

The term “off-label” simply refers to any indication for a medication that has not been approved by the FDA. Below are some common off-label uses for Carvedilol. 

Off-label uses for Carvedilol include: 

• Physical symptoms associated with anxiety disorders 
• Heart rate control in those with atrial fibrillation
• Chest pain 
• Portal hypertension in those with cirrhosis or liver damage
• Prevention of bleeding in those with esophageal varices or abnormal vein formation due to liver damage

Doses, Dosage Form, and Side Effects of Carvedilol 

Common Carvedilol Doses and Forms

Carvedilol is the generic formulary for the name-brand medication, Coreg. It is available in both tablets and extended-release 24-hour tablets.  

The dose of Coreg varies from person to person, but the dose is usually split into multiple doses throughout the day. The medication is typically started at a low dose and then titrated weekly until the desired dosage is reached. 

Extended-release 24-hour capsules are available in the following dosages:

• 10 mg 
• 20 mg 
• 40 mg 
• 80 mg 

Tablets are available in the following dosages: 

• 3.125 mg 
• 6.25 mg 
• 12.5 mg 
• 25 mg 

Common Carvedilol Side Effects

There are a few side effects associated with Carvedilol that should be taken into consideration before starting the medication. Most are mild, but you should contact your healthcare provider if you begin to experience severe or bothersome adverse effects. 

Some of the most common side effects of Carvedilol include: 

• Dizziness or lightheadedness upon standing 
• Fatigue 
• Drowsiness 
• Nausea, vomiting, or diarrhea 
• Headache 
• Dry cough 
• Dry eyes
• Sexual dysfunction, including impotence or reduced libido 

Serious side effects include: 

• Dangerous drop in blood pressure 
• Chest pain 
• Irregular heartbeat 
• Difficulty breathing 
• Signs of heart failure, such as swelling 
• Fainting or loss of consciousness 
• Serious allergic reaction, which may present with hives, rash, and difficulty swallowing or breathing 

Common Carvedilol Drug Interactions

Some medications should be avoided when taking a beta-blocker like Carvedilol. It is important to disclose all medications you are currently taking with your healthcare provider before starting a new drug, including all over-the-counter medications and supplements. 

Common drug interactions with Carvedilol include: 

• MAO inhibitors 
• Certain blood pressure and antiarrhythmic medications 
• Asthma or COPD medications 
• Some diabetes medications 
• Antiviral medication used to treat HIV 
• Opioids 
• Antifungals, like Fluconazole 
• Some anti-nausea medications  

How Much Does Carvedilol Cost?

Coreg or generic Carvedilol is typically covered by most commercial health insurance plans and is affordable to those without insurance with the use of coupon codes and generic formularies. 

The cost of Coreg varies in price depending on generic vs. name-brand formularies, dosing, and which pharmacy you use. The average cost of a 30-day supply with the use of a coupon code is around $2-6. Coupon codes are available at most large name-brand pharmacies. 

Doses, Dosage Form, and Side Effects of Propranolol   

Common Propranolol Doses and Forms

Propranolol is the generic formulary for the brand-name drug Inderal and is available as an oral or injectable solution, tablet, and extended-release capsule. The dosing for this medication varies from person to person and can range between 40 mg to 320 mg per day. 

Tablets and extended-release capsules are the most common formularies used to treat anxiety. Like most psychiatric medications, Propranolol is started at a low dose and can be titrated up weekly until the desired dosage is reached. 

Propranolol tablets are available as: 

• 10 mg 
• 20 mg
• 40 mg 
• 60 mg 
• 80 mg 

Propranolol extended-release capsules are available as: 

• 60 mg 
• 80 mg 
• 120 mg 
• 160 mg 

Common Propranolol Side Effects

Since Propranolol and Carvedilol are both beta-blockers, they have a similar side effect profile. The majority of the side effects associated with Propranolol are mild, but if you begin to experience severe or bothersome adverse effects after starting the medication, contact your healthcare provider immediately.  

Some of the most common side effects of Propranolol include: 

• GI upset, including stomach pain, nausea, vomiting, diarrhea, or constipation
• Dizziness or lightheadedness upon standing
• Fatigue 
• Dry eyes or vision changes
• Insomnia or unusual dreams 
• Changes in mood
• Sexual dysfunction, including impotence or reduced libido 

Serious side effects include: 

• Shortness of breath or difficulty breathing 
• Signs of heart failure, such as swelling or sudden weight gain
• Numbness or tingling of the extremities
• Signs of inadequate circulation, including blue or cold fingers or toes 
• Dangerous drop in blood pressure and/or heart rate
• Fainting or loss of consciousness 

Common Propranolol Drug Interactions

As with any medication, several drugs interact with Propranolol and should be avoided when starting this medication. As always, it is important to disclose all medications that you are currently taking with your healthcare provider, including all over-the-counter medications and supplements. 

Some common drug interactions with Propranolol include: 

• Alpha-blockers, such as Prazosin 
• Anticholinergics
• Some SSRI antidepressants, including Fluoxetine, Paroxetine, Fluvoxamine 
• Certain high blood pressure medications
• Antipsychotics, including Haloperidol and Chlorpromazine 
• Antiarrhythmics 
• Thyroid supplements    

How Much Does Propranolol Cost?

The cost of your monthly prescription will depend on your insurance coverage, dosage, and which pharmacy you use. If you are under or uninsured, the medication is still relatively affordable with the use of a generic formulary and coupon codes, which are available at most large pharmacies. 

When using coupon codes, a 30-day supply of Propranolol typically runs between $1-10. Propranolol is covered by the majority of health insurance plans as well. 

Do I Need A Prescription for Propranolol or Carvedilol?

Yes, you will need a prescription for either Propranolol or Carvedilol from a licensed healthcare provider. As described above, these medications can cause adverse side effects and interact with other drugs. Due to the potential dangers associated with these medications, you must be closely monitored when starting either Propranolol or Carvedilol. 

Beta Blocker Drug Warnings

Before starting a beta-blocker medication, there are a few potential warnings to take into consideration. Of note, it is essential to avoid beta-blockers if you are pregnant or have serious cardiovascular issues. 

Pregnancy and Breastfeeding on Beta Blockers

Beta-blockers can cross the placenta in pregnant women and can cause health complications to the fetus. Therefore, these medications should be avoided throughout pregnancy. 

Propranolol and Carvedilol are considered to be relatively safe while breastfeeding due to the small amounts found in breastmilk. When comparing the two medications, Propranolol is preferred while breastfeeding over Carvedilol. 

Carvedilol vs. Propranolol Frequently Asked Questions

Comparing two medications from the same class can get confusing, and it is normal to have additional questions. Below we have answered some of the most frequently asked questions about Carvedilol vs. Propranolol:

What is Carvedilol?

Carvedilol or Coreg is a beta-blocker medication that is commonly used to treat cardiovascular issues, as well as the physical symptoms associated with anxiety. 

What is Propranolol?

Propranolol or Inderal is another beta-blocker that is prescribed to treat cardiovascular issues, such as high blood pressure, and the prevention of irregular heartbeat. Similar to Carvedilol, Propranolol is used to treat the physical symptoms associated with anxiety. 

Are Carvedilol, Propranolol, and other Beta Blockers the same drug?

No, although Carvedilol and Propranolol belong to the same class of drugs called beta-blockers and similarly act on the body, they all have distinct differences, and each is considered to be a unique drug. 

What’s better for anxiety? Carvedilol or Propranolol?

Although both medications can be beneficial for the treatment of the physical symptoms of anxiety, Propranolol appears to be more effective than Carvedilol. 

Can I drink alcohol on Carvedilol or Propranolol?

You should avoid drinking alcohol while taking a beta-blocker medication because alcohol can decrease the effects of the drug and increase the risk of experiencing adverse side effects. 

Does it matter what time of day I take Carvedilol or Propranolol?

Your healthcare provider will instruct you on how to take your beta-blocker medication. You may be prescribed a daily dose, multiple doses throughout the day, or even instructed to take the medication as needed when you experience symptoms. It is important to take your medication as prescribed. 

Start your Anxiety Treatment Today With Healthcare Providers on Klarity

Comparing different anxiety medications, such as Carvedilol vs. Propranolol can be overwhelming. It’s often hard to determine which one is right for you, which is why you should not try to self-medicate and instead consult with a licensed healthcare provider.

At Klarity, we believe that everyone deserves access to affordable care for their mental health. We offer a unique telehealth service with no subscriptions or health insurance necessary and, most importantly, no hidden fees. 

Start by taking our free self-evaluation and schedule an appointment on Klarity today.