Propranolol

Medication name

Propranolol ("Pro-PRAN-oh-lol")
Brand names

Angilol ("AN-ji-lol")

Bedranol ("BEH-jran-ol")
Medication type

Beta blocker

Tablets: Available in 10mg, 40mg, 80mg and 160mg strengths

Capsules: Long-acting capsules available in 80mg and 160mg strengths

Liquids: Available in 5mg/5ml, 10mg/5ml, 40mg/5ml and 50mg/5ml strengths

If you are 18 or over, the doctor can prescribe propranolol for you as a licensed medicine to help with some of the physical symptoms associated with anxiety, such as sweating and shaking.

If you are under 18, a specialist doctor may still consider this as a treatment option to help with symptoms of anxiety, although there is more evidence to support the use of other types of medicines, such as SSRIs like sertraline.

Read our guide to anxiety

About propranolol

Propranolol is a beta-blocker medicine that helps to reduce the symptoms of anxiety, including sweating and shaking. It doesn’t treat the feeling of anxiety, only the physical symptoms that come with it.

When you are anxious, your brain makes more of the chemicals noradrenaline and adrenaline. These chemicals can make your heart beat faster and make you shake and sweat. Propranolol blocks the effects of these chemicals.

Propranolol and everyday life

You will feel the effects of propranolol quickly – usually within a few hours.

Weight gain or loss is not a known side effect of propranolol, although a small amount of weight gain is reported by some people.

Talk to your doctor or pharmacist if you are concerned about your weight, or changes to your weight, while taking propranolol.

You may want to let your family and friends know you are taking propranolol so they can support you and help you look out for side effects.

For guidance on this, check out our page on getting support with your medication.

You can feel tired when you first start taking propranolol. This should get better after the first week or two.

Some people find that propranolol causes insomnia (difficulty getting to sleep), and disturbing dreams or nightmares.

If you have been taking propranolol for more than a month and you continue to feel very tired, sleepy or struggle to function during the day (which could be because you are not sleeping so well at night) you should go back to your doctor and discuss what changes could be made to help. This may include switching to a different medication.

Alcohol

You can continue to drink alcohol while taking propranolol, but having the two together might make you a little sleepier and unsteady on your feet.

During the first few days or weeks of treatment, it might be best to stop drinking alcohol until you see how the medicine affects you or until the side effects pass.

If you want to drink alcohol, remember that it may make you sleepier than usual. Make sure you can get home safely.

Drinking alcohol every day, or in large amounts, can make your symptoms worse and may mean you won’t get the maximum benefit from your medication.

Street drugs

The combination of propranolol and amfetamines might cause your blood pressure to rise, and propranolol might also reduce the effects of amfetamines.

The combination of propranolol and cocaine may increase the narrowing of blood vessels which provide blood to the heart. More research is needed to understand the effects this will have on your health, but it is recommended that the combination should be avoided.
There are many other street drugs, but we don’t know what effect taking them with pregabalin will have, so it’s best to be cautious.

There is no regulation of street drugs or ‘legal highs’, so even if there are no known issues with the medication you take, the supply you receive might be mixed with other substances that could be dangerous.

Smoking

Some small studies have shown that smoking cigarettes can reduce the amount of propranolol in your body.

If you smoke, you may need a higher dose of propranolol than someone who does not smoke.
Tell your doctor if you smoke to make sure you get the right dose for you.

If you stop smoking or switch to vaping or a nicotine replacement product, the level of propranolol in the body may rise, Tell your doctor if you stop smoking so that they can review your medication. You might need to reduce your dose of propranolol slowly over one week.

If you start or restart smoking, your dose may need to be reviewed. Go to your doctor for advice if you stop or start smoking, or if you switch to vaping or using a nicotine replacement product.

Get more advice on our drugs and alcohol guide.

Propranolol does not mix well with some other medicines, including herbal remedies. It may increase the side effects you can get, which could be dangerous.

Before you take propranolol, tell your doctor or pharmacist if you are taking any other medicines. Tell the pharmacist you are taking propranolol if you buy medicines over the counter for common illnesses, including things you put on your skin.

Look at the leaflet inside your medicine box for more information about other medicines that can interact with pregabalin. With some medicines your doctor may need to adjust the dose of your medicines if you take them together. Ask a doctor or pharmacist for more information if you have any questions.

There are multiple companies that manufacture this medicine and the non-active ingredients may vary between products and also between the different strengths of tablets that are available. Always let your pharmacist know if you have any food allergies or intolerances, and always check with them if you’re concerned about any of the ingredients in your medication.

If you have food allergies and carry an adrenaline injection (epi-pen), let your doctor know as propranolol could reduce the effectiveness of this.

Propranolol tablets may not be suitable for you if you have problems eating some sugars or dairy foods, as they contain lactose.

Some forms of propranolol may contain E220 (sulphur dioxide) which can, in rare cases, cause severe allergic reactions and difficulty breathing. Talk to your pharmacist or doctor if you are allergic to any food additives.

The oral solution also contains parahydroxybenzoates which may cause allergic reactions.

The liquid may also contain maltitol (a type of sugar related to fructose). If your doctor has told you that you cannot eat some sugars, check with your doctor before taking it.

Some propranolol liquids contain a small amount of alcohol, but not enough to affect your blood alcohol level.

Propranolol capsules contain gelatine and sucrose.

If you need to avoid animal products, please note that non-active ingredients used in the production of medicines may sometimes be of animal origin. Ask your pharmacist if you have any questions about the ingredients.

Further information about practical considerations for medicines if you need to avoid animal products can be found on the Vegan Society website.

Taking propranolol may affect your eyesight, and make you feel tired, dizzy or faint when you start taking it.

This could affect you if you drive a car, ride a bike, or do anything else that needs a lot of focus. It might be best to stop doing these things for the first few days until you know how it affects you.

Some people are given propranolol to help them relax and stop any shaking for their driving test, but they should test how they feel on propranolol a few days before they take the test.

Most people drive as normal while taking pregabalin. It you are worried about this or have any concerns you would like to discuss, speak to your doctor or pharmacist.

Pregnancy

There is no evidence to suggest that taking propranolol while you are pregnant is harmful.

If you become pregnant while you are on propranolol, you should carry on taking it and make an appointment to see your doctor as soon as possible. They can discuss the benefits and risks of continuing propranolol and help you to make a decision that is best for you and your baby.

They may refer you to a specialist perinatal mental health team to support you with this decision.

You can find out more information about taking propranolol during pregnancy at Bumps (Best Use of Medicines in Pregnancy).

Remember that untreated anxiety can also be harmful to you and your developing baby, so decisions about stopping or avoiding medication when you are pregnant need to be discussed carefully with your doctor. If you and your doctor agree that it is best for you to continue taking propranolol, it is recommended that you take folic acid while you are trying for a baby and during pregnancy. It is safe to take this together with propranolol.

Post-natal

Taking propranolol in the last few months of pregnancy can mean that your baby is born with a slower heart rate, lower blood pressure and blood sugar and some breathing difficulties. Let your midwife know if you’re taking propranolol and they will monitor your baby at birth.

Breastfeeding

Propranolol is passed to the baby in breastmilk in small amounts.

If your baby was born early, then breastfeeding while you are taking propranolol may not be recommended. Talk to your midwife and doctor about feeding options.

If you breastfeed while taking propranolol, seek urgent medical advice if your baby becomes restless, very sleepy or develops feeding problems.

A reported side effect of propranolol is nipple pain or Raynoud’s phenomenon, where blood flow is reduced to the nipple. You might feel a burning or throbbing sensation and the nipple may turn white. If you have any concerns, speak to your midwife.

Sex

Propranolol can have side effects that affect your sex life. These include:

problems getting an erection

Talk to your doctor is you get these symptoms.

Untreated anxiety can have a negative effect on your sex life, so if propranolol helps you to recover, positive effects can include improving your desire, experience and enjoyment of sex as your mood lifts and you become interested in life and relationships again.

Fertility

There is currently no evidence to suggest that propranolol will affect your fertility.

Talk to your doctor about your propranolol if you are trying to get pregnant or planning a family.

Propranolol is a banned substance in sports. If you play a sport to a high level and want to compete where testing will happen you must let the regulators know. You must not take propranolol during competitions. If you have any concerns about this, speak to your doctor.

Most people play sports as normal while taking propranolol, but if propranolol affects your concentration, eyesight or co-ordination, then you may want to wait to see if those effects go away before playing sports that need a lot of focus. If you have any corners, discuss this with your doctor.

Propranolol may affect your concentration, give you blurred eyesight or make you feel tired or dizzy.

Ideally, it’s best not to take propranolol for the first time just before your exams.

It is not possible to predict how the medication will make you feel, and if you do get any side effects, these are more likely to occur when you first start taking it.

You should talk to your doctor about any future exams if you are starting propranolol. You might decide together to delay starting it until you have done them.

If they are more than a week away, however, you might find that it is better to start propranolol to reduce your symptoms of anxiety, such as shaking or sweating.

Most people take exams as normal while taking propranolol, but if you have any concerns, discuss this with your doctor.

Information and safety considerations

Your doctor will consider any other medical conditions or symptoms you have before recommending a medicine for you.

Your medicine will come with a ‘patient information leaflet’. It’s important that you read this information. Speak to your pharmacist if:

you’re not given a leaflet
you don’t understand the information
you need it in a different format or language
you’re concerned about something you’ve read

The information leaflet also includes a list of warnings and precautions to consider before you take the medicine. If you think that any of these apply to you and are concerned that your doctor is not already aware of them, check with your doctor or pharmacist before you start to take your medication (or as soon as possible if you are already taking it).

Uses, warnings, safety and side effects

Taking propranolol

You should talk to your doctor about how long you will need to take propranolol for before you start treatment. Some people only need to take propranolol for a few days. Other people will take it regularly for months or even years.

If you are taking it for a long time, make sure that you see your doctor for a review at least once every six months.

You will get the best effect from propranolol if you take it at the dose prescribed by your doctor. This might be regularly, or it might be as needed before situations and events that you find it hard to cope with anxiety symptoms.

Your doctor might change your dose a few times at the beginning to find the right level for you.

You may have to take it up to three times a day.

It doesn’t matter what time you take it each day, but you should choose a time that you can always remember. This could be a mealtime or when you brush your teeth. If you take propranolol more than once a day, spread the doses as evenly as possible throughout the day.

If you can, take it before a meal or some food.

Swallow the tablet with a drink of water – if you chew it, it tastes bitter.

If you find it difficult to take it more than once a day, ask your doctor about the long-acting capsules because they only need to be taken once a day.

Swallow the capsules whole with a drink of water – they are specially made to release the medicine over a few hours into your body and should not be crushed or chewed.

The liquid forms of propranolol have an expiry date of three months after you open the bottle. If you only take the medicine when required, you might have medicine left after this time. Make a note of the date you open the bottle so you can return any unused medicine and reorder it after this time.

If you remember later, take it as soon as possible.

If you forget to take it until just before your next dose, just start again with the next dose. Do not try and catch up by taking a double dose.

If you take propranolol regularly and forget to take your tablets for a few days, you may start getting withdrawal symptoms, some of which can be dangerous to your heart. Please talk to your doctor or pharmacist and look out for any withdrawal symptoms.

If you want to stop taking propranolol, you should ask your doctor for help. Stopping this medicine quickly, or reducing the dose too much at once, may cause withdrawal symptoms that are dangerous to your heart.

Stopping propranolol suddenly can have a rebound effect while the body adjusts to the medicine not being in the system anymore. This can also affect your blood pressure and heart.

You can stop taking propranolol safely with your doctor’s help. Planning a gradual withdrawal together can help to minimise or prevent the withdrawal symptoms you experience, usually over two to four weeks.

It is more common to get withdrawal symptoms if you have been taking propranolol regularly over a long period of time. Low doses of propranolol, especially if only taken for short periods of time as needed are less likely to cause symptoms.

If withdrawal symptoms are experienced, most only get mild symptoms. These can include feeling queasy or sick, dizziness, disturbed sleep, sweating, shaking and anxiety.

Some of the symptoms you get may be like symptoms you had when you were unwell, so understandably, you might feel more anxious or upset by these. Not everyone experiences these, but it is important to be aware of them so you know what to look out for.

Other symptoms that may occur include:

chest pain
irregular heartbeat

If you experience these symptoms, contact your doctor immediately. If you are unable to contact your doctor, call NHS 111 for urgent advice.

If you do experience any withdrawal symptoms, they should stop after a few days. If they do not, or they are stopping you getting on with your life, discuss this with your doctor.

Warnings and safety

If you have taken more than the dose prescribed by your doctor, contact NHS 111 immediately to ask for advice, or ask a family member or friend to do this for you. This is important even if you don’t feel any different.

NHS 111 can give you advice and direct you to the best place to get more help if you need it.

If you have taken too much medication on purpose, or if after taking this you quickly feel unwell, call 999 or get someone to take you to A&E straight away. This includes any of the following signs:

slow heartbeat
dizziness
sickness
confusion
hallucinations (seeing, hearing or sensing things that are not there)
body spasms
breathlessness when you try to get up and do something
fainting or coma
you could also be in danger of a heart attack

If you need to go to A&E, do not travel alone or drive yourself there. Get your parent, family member or friend to go with you to support you and keep you safe on the way. If someone is not able to drive you there, call for an ambulance. Take your medication with you and tell doctors how much you have taken.

Serious side effects

Propranolol can cause rare but serious side effects, including allergic reactions.

Stop taking propranolol and go to a hospital straight away if you get any of the following symptoms:

swelling of the face, throat or tongue
itching skin lumps
a slow heartbeat or a heartbeat that is not regular
difficulty breathing (more likely if you have asthma or a history of asthmatic problems)
dizziness

Get your parent, family member or friend to take you or go with you to support you and keep you safe on the way. If someone is not able to drive you there, call for an ambulance. Take your medication with you.

Contact your doctor immediately but don't stop taking propranolol, if you get any of the following symptoms:

poor circulation with numb fingers and toes that are pale in appearance (if this symptom is concerning you)
feeling lightheaded, dizzy or fainting, especially when going form sitting to standing
any changes in vision
any changes or worsening of your mood or behaviour, confusion or memory loss
feeling or hearing things that are not real or believing things that are not true
bruising or bleeding more easily
severe muscle weakness

If you are due to have an operation with general anaesthetic, tell your doctor that you are taking propranolol. You may need to stop the medicine before the operation day.

If you are unable to contact your doctor, call NHS 111 for urgent advice.

Side effects and your health

Side effects are more common when you first start taking a new medicine. Many go away as you continue your medicine. If they don’t get better, or if you are worried by them and they are causing you distress, speak to your doctor, specialist team or pharmacist about them.

Common side effects of taking propranolol, affecting up to one in ten people, include:

slower heartbeat and pulse rate (this isn’t dangerous, but talk to your doctor if you are concerned about it)
colds hands and feet
numbness and spasm in your hands and fingers which is followed by warmth and pain (Raynaud’s disease)
disturbed sleep or nightmares
feeling tired

There are other side effects that you can get when taking this medicine. We have only included the most common ones here.

This list of side effects can look scary. You may not experience any of them, but it’s important to be aware of them so you know what to do if they do happen.

Unless your side effects are very severe or distressing, try to continue taking your medication until you can talk to your doctor. Your doctor can make changes to your medication to help if needed.

There is no routine monitoring recommended before starting or while you are taking propranolol, although your doctor will check your heart rate and blood pressure (as propranolol can affect these) and may recommend specific tests, like a blood test, to help them make decisions about your medication.

Depending on your medical history, your doctor may also check your heart using an electrocardiogram (ECG).