Propranolol (Inderal)
Beta-blocker antihypertensive
- Panic Disorder2
- Performance anxiety1
- Prevention of PTSD after trauma2
- Tremor1
- Akathisia1
- Migraine prevention
- Aggression (in autism, dementia, psych patients)2
Features
Dosing
Most uses: 80 mg to 240 mg dosed TID or QD in ER form.
May treat panic at just 20 mg, but average dose in panic 180 mg.
Aggression: Target on high side (up to 600 mg/day in some studies!)
LA form preferred (to prevent withdrawal anxiety, duration 12 hr).
Performance anxiety: Take 20-80mg prn 1-2 hr before performance (try in a safe place first).
For PTSD prevention: 20mg 1 tid x1day then 2 tid x7 days, then lower to 1 bid x4 days then 1 qd x 4 days then stop.
Management
Augments SSRIs in panic.
May prevent PTSD if given within 12 hours of trauma for 10 day course (but hydrocortisone works better).
TOLERABILITY: Rare problems.
RISKS: Bradycardia, hypotension, and worsening of Raynaud’s phenomena (cold fingers/toes).
EMR Text
Panic
Propranolol use based on randomized controlled trials in panic disorder (Rouhzendeh S et al, J Pharm Health Care Sci. 2025;11(1):57).
Propranolol side effects, including bradycardia, hypotension, and Raynaud’s phenomena, reviewed with patient.
Akathisia
Propranolol use based on randomized controlled trials in akathisia (Gerolymos C et al, JAMA Netw Open. 2024;7(3):e241527).
Propranolol side effects, including bradycardia, hypotension, and Raynaud’s phenomena, reviewed with patient.
Tremor
Propranolol use based on randomized controlled trials in tremor (Alharbi O et al, Cureus. 2024;16(12):e76016).
Propranolol side effects, including bradycardia, hypotension, and Raynaud’s phenomena, reviewed with patient.
Aggression
Propranolol use based on controlled trials in aggression in various populations, including psychiatric patients, autism, children, and dementia (London EB et al, J Clin Psychopharmacol. 2024;44(5):462-467).
Propranolol side effects, including bradycardia, hypotension, and Raynaud’s phenomena, reviewed with patient.