Propranolol Dosing for Performance Anxiety

Patient Selection Criteria

Beta-blockers are most effective for performance anxiety when somatic/autonomic symptoms predominate, such as tremor, palpitations, tachycardia, sweating, rather than purely cognitive anxiety symptoms, according to the American Heart Association guidelines 1

Before prescribing propranolol, exclude absolute contraindications including second or third-degree heart block, decompensated heart failure, asthma or reactive airway disease, and hypotension, as recommended by the American College of Cardiology 2
A baseline evaluation including heart rate and blood pressure measurement, cardiovascular examination with auscultation, and history screening for bronchospasm, diabetes, and concurrent medications affecting cardiac conduction is necessary, according to the American Heart Association guidelines 2
Routine blood work, ECG, or echocardiogram are not required in otherwise healthy adults without cardiac concerns, as stated by the American College of Cardiology 2

Never abruptly discontinue propranolol after chronic use, as this can precipitate rebound hypertension, tachycardia, or angina, according to the American College of Cardiology 2
Propranolol may mask hypoglycemia symptoms in diabetic patients, and patients should be counseled accordingly, as recommended by the American Diabetes Association 2
Monitor for hypotension and bradycardia, particularly if patients inadvertently take higher doses or use it more frequently than intended, according to the American Heart Association guidelines 2
Fatigue, bradycardia, hypotension, dizziness, and cold extremities are the most common side effects of propranolol, as reported by the American College of Cardiology 2