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AI-Generated response:

indications for propanolol use in anxiety

Answer generated on June 4, 2024

The AI-generated responses are for illustration purposes only and should not be used for medical purposes.

Propranolol is used off-label for the treatment of anxiety, particularly for performance-related anxiety and panic attacks, with dosages ranging from 10 to 80 mg orally, taken 1 hour prior to the anxiety-producing event.[1-3]

  • Propranolol is a non-cardioselective β-blocker that can dampen the peripheral physiological symptoms of anxiety such as palpitations and tremor.[1]

  • It is particularly noted for its effectiveness in situations like stage fright and may also be considered for use in post-traumatic stress disorder (PTSD).[3]

  • The typical oral dosage for adults is 10 to 80 mg, and it should be administered one hour before the anxiety-inducing situation.[1]

  • For geriatric patients, it is recommended to start with low initial doses and carefully titrate the dosage due to unpredictable responses to beta-blockers.[1]

  • It is important to note that the use of propranolol for anxiety is considered off-label, and its effectiveness in controlling the psychological components of anxiety is less established.[1]

Additional info

Propranolol's role in anxiety management is primarily through its beta-blocking effects, which help reduce somatic symptoms such as increased heart rate and tremors associated with anxiety episodes. This makes it particularly useful for acute anxiety situations like public speaking or performances, where these physical symptoms are prominent. However, it is less effective for the psychological aspects of anxiety, such as fear or worry, which are better addressed by other types of medications like SSRIs or SNRIs.[1-2] The decision to use propranolol should consider these factors, especially given its off-label status for anxiety, ensuring that it fits within the overall management plan for the patient's anxiety or stress-related condition.

References

Reference 1

1.

Elsevier ClinicalKey Drug Monograph

Content last updated: April 2, 2024.

Indications And Dosage Oral dosage (immediate-release tablets or oral solution) Adults: 10 to 80 mg PO, given 1 hour prior to the anxiety-producing event. For geriatric patients, begin with low initial doses, followed by careful dosage titration; geriatric patients have unpredictable responses to beta-blockers.

Indications And Dosage 1. agitation 2. angina 3. anxiety 4. atrial fibrillation 5. atrial flutter 6. burns 7. heart failure 8. hemangioma 9. hypertension 10. idiopathic hypertrophic subaortic stenosis (IHSS) 11. migraine prophylaxis 12. pheochromocytoma 13. portal hypertension 14. premature ventricular contractions (PVCs) 15. reduction of cardiovascular mortality 16. scleroderma renal crisis 17. supraventricular tachycardia (SVT) 18. tetralogy spells 19. thyrotoxicosis 20. tremor 21. unstable angina 22. variceal bleeding prophylaxis

Mechanism Of Action Propranolol has two roles in the treatment of thyrotoxicosis; these actions are determined by the different isomers of propranolol. L-propranolol causes beta-blockade and can ameliorate the symptoms associated with thytotoxicosis such as tremor, palpitations, anxiety, and heat intolerance. D-propranolol blocks the conversion of T4 to T3, but the therapeutic effect of this action is minimal. Propranolol has been used in the management of hereditary or familial essential tremor. Beta-blockade controls the involuntary, rhythmic and oscillatory movements of essential tremor. Tremor amplitude is reduced, but not the frequency of tremor. The mechanism of action is unclear, but the antitremor effect may be mediated by blockade of peripheral beta2 receptor mechanisms. Propranolol can dampen the peripheral physiologic symptoms of anxiety. Beta-blockade can attenuate somatic symptoms of anxiety such as palpitations and tremor, but it is less effective in controlling psychologic components, such as intense fear. These effects are thought to be due to improvement in somatic symptoms secondary to beta-blockade, although the mechanism of action is unclear.

Reference 2

2.

Elsevier ClinicalKey Derived Clinical Overview

• Selective serotonin reuptake inhibitors/serotonin norepinephrine (SSRIs/SNRIs) are typically first-line • High-potency benzodiazepines, either as monotherapy or for augmentation (less favored) • Monoamine oxidase inhibitors (MAOIs) were historically used but are now less favored • Beta-blockers (propranolol, atenolol) can be especially useful for performance-related anxiety • Gamma-amino butyric acid (GABA) analogues (e.g., pregabalin, gabapentin)

Reference 3

3.

Szeleszczuk Ł, Frączkowski D. International Journal of Molecular Sciences. 2022;23(17):10099. doi:10.3390/ijms231710099. Copyright License: CC BY

Publish date: September 6, 2022.

Propranolol, a non-cardioselective β blocker, is most commonly recognised for its application in the therapy of various cardiovascular conditions, such as hypertension, coronary artery disease, and tachyarrhythmias. However, due to its ability to cross the blood-brain barrier and affinity towards multiple macromolecules, not only adrenoreceptors, it has also found application in other fields. For example, it is one of the very few medications successfully applied in the treatment of stage fright. This review focuses on the application of propranolol in the treatment of various types of anxiety and stress, with particular reference to stage fright and post-traumatic stress disorder (PTSD). Both mechanisms of action as well as comparison with other therapies are presented. As those indications for propranolol are, in most countries, considered off-label, this review aims to gather information that can be useful while making a decision about the choice of propranolol as a drug in the treatment of those mental conditions.

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