Propranolol side effects, benefit, dosage for anxiety, blood pressure, public speaking.. does it affect memory?
July 1 2017 by Ray Sahelian, M.D.

Propranolol, a type of medication known as a beta blocker, is used in the treatment of high blood pressure, angina pectoris (chest pain, usually caused by lack of oxygen to the heart due to clogged arteries), changes in heart rhythm, prevention of migraine headache, hereditary tremors, and tumors of the adrenal gland. Propranolol is also used to reduce the risk of death from recurring heart attack.

Propranolol helpful for stage fright

Propranolol, in a dosage of 20 mg or 40 mg, taken an hour or two before a speech, can be helpful in reducing stage anxiety or at times for social phobia. Some people may need a 60 mg dosage.

Propranolol helpful for fear and fearful memory

The beta-blocker propranolol can eliminate the fearful aspect of an emotional memory. Natural Neuroscience 2009.

Q. I am a student in high school, would you mind answering these questions for a project I am doing? What do you think about the use of the drug propranolol to mute the feelings of paralyzing fear in patients? Do you believe that changing how one feels about his / her past through medication is healthy / harmful or even possible? If it were harmful, how would it affect one’s life? One’s relationships? One’s interaction with others? What alternative ways are there to treat disabling fear? Do you believe this drug propranolol will become widespread in use? If so, in what type of patients, primarily? What are the possible side effects, psychological, social, and physical of using propranolol as a memory-altering drug?
   A. Patients with severe anxiety or fear should be treated and there are many ways to approach this condition including the use of medications. Propranolol is one such medication that works and when used for a few days or weeks should not have any major side effects. If terrible memories prevent a person from being productive at work or having good relationships with family members co-workers, and others, then the use of a medication that dampens the fears and anxieties would be a good thing. There are individuals who may be better off from having psychotherapy without the use of medications, while others may not benefit from talk therapy and do better with medications. Still others may find a combination of psychotherapy and medications to work best for them. Some people may find prayer, religion, meditation, exercise, outdoor activities, sports, yoga and other methods to be helpful, including the use of certain natural supplements such as 5-HTP or the occasional use of kava and passionflower herbs.

PTSD treatment
Neurobiol Learn Mem. 2016. Revisiting propranolol and PTSD: Memory erasure or extinction enhancement? Posttraumatic stress disorder (PTSD) has been described as the only neuropsychiatric disorder with a known cause, yet effective behavioral and pharmacotherapies remain elusive for many afflicted individuals. PTSD is characterized by heightened noradrenergic signaling, as well as a resistance to extinction learning. Research aimed at promoting more effective treatment of PTSD has focused on memory erasure (disrupting reconsolidation) and/or enhancing extinction retention through pharmacological manipulations. Propranolol, a β-adrenoceptor antagonist, has received considerable attention for its therapeutic potential in PTSD, although its impact on patients is not always effective. In this review, we briefly examine the consequences of β-noradrenergic manipulations on both reconsolidation and extinction learning in rodents and in humans. We suggest that propranolol is effective as a fear-reducing agent when paired with behavioral therapy soon after trauma when psychological stress is high, possibly preventing or dampening the later development of PTSD. In individuals who have already suffered from PTSD for a significant period of time, propranolol may be less effective at disrupting reconsolidation of strong fear memories. Also, when PTSD has already developed, chronic treatment with propranolol may be more effective than acute intervention, given that individuals with PTSD tend to experience long-term, elevated noradrenergic hyperarousal.

How should you take this medication, with or without food?
Propranolol works best when taken before meals.

Propranolol side effects, safety, danger, risk, caution
Propranolol side effects may include: Abdominal cramps, congestive heart failure, constipation, decreased sexual ability, depression, diarrhea, difficulty breathing, disorientation, dry eyes, fever with sore throat, hair loss, hallucinations, headache, light-headedness, low blood pressure, lupus erythematosus (a disease of the connective tissue), nausea, rash, reddish or purplish spots on the skin, short-term memory loss, slow heartbeat, tingling, prickling in hands, tiredness, trouble sleeping, upset stomach, visual changes, vivid dreams, vomiting, weakness, worsening of certain heartbeat irregularities.

Who should not take Propranolol beta blocker medication
If you have inadequate blood supply to the circulatory system (cardiogenic shock), certain types of irregular heartbeat, a slow heartbeat, bronchial asthma, or severe congestive heart failure, you should not take propranolol. If you have a history of congestive heart failure, your doctor will prescribe propranolol cautiously. If you suffer from asthma or other bronchial conditions, coronary artery disease, or kidney or liver disease, propranolol should be used with caution. Notify your doctor or dentist that you are taking propranolol if you have a medical emergency, and before you have surgery or dental treatment.

Possible food and drug interactions
If propranolol is taken with certain other drugs, the effects of either could be increased, decreased, or altered. It is especially important to check with your doctor before combining propranolol with the following:

Alcohol
Aluminum hydroxide gel (Amphojel)
Calcium-blocking blood pressure drugs such as Cardizem, Procardia, and Calan
Certain high blood pressure medications such as Diupres and Ser-Ap-Es
Cimetidine (Tagamet)
Epinephrine (EpiPen)
Haloperidol (Haldol)
Insulin
Lidocaine (Xylocaine)
Nonsteroidal anti-inflammatory drugs such as ibuprofen and Naprosyn
Oral diabetes drugs such as Micronase
Phenytoin (Dilantin)
Rifampin (Rifadin)
Theophylline (Theo-Dur and others)
Thyroid medications such as Synthroid

If you are pregnant or breastfeeding
The effects of propranolol during pregnancy have not been adequately studied. If you are pregnant or plan to become pregnant, inform your doctor immediately. Propranolol appears in breast milk and could affect a nursing infant. If propranolol is essential to your health, your doctor may advise you to discontinue breastfeeding until your treatment with propranolol is finished.

Recommended dosage for Propranolol
ADULTS: All dosages of propranolol, for any problem, must be tailored to the individual. Your doctor will determine when and how often you should take propranolol. If you are over 65, the doctor will probably start with a relatively low dosage. Propranolol is also available in a sustained-release formulation, called Propranolol LA, for once-a-day dosing.

Infants with hemangioma may benefit from this treatment.

Propranolol dosage for Hypertension
The usual starting dose is 40 milligrams 2 times a day. This dose may be in combination with a diuretic. Dosages above 80 mg a day increase the risk for side effects. When used for the treatment of high blood pressure, propranolol is effective alone or combined with other high blood pressure medications, particularly thiazide-type diuretics. Beta blockers decrease the force and rate of heart contractions, reducing the heart's demand for oxygen and lowering blood pressure.

Angina Pectoris
The usual daily dosage is 80 milligrams to 120 milligrams, divided into 2, 3, or 4 smaller doses. When your treatment is being discontinued, your doctor will reduce the dosage gradually over a period of several weeks.

Irregular Heartbeat
The usual dose is 10 milligrams to 30 milligrams 3 or 4 times a day, before meals and at bedtime. Propranolol may be used for irregular heart beats or very fast heart beats due to anxiety or or from overdose of certain herbs and supplements.

Heart Attack
The usual daily dosage is 100 milligrams to 200 milligrams divided into smaller doses. The usual maximum dose is 200 milligrams, although your doctor may increase the dose when treating heart attack with angina or high blood pressure.

Migraine
The usual starting dosage is 60 milligrams per day divided into smaller doses. Dosages can be increased gradually to between 120 milligrams and 200 milligrams per day. If this dose does not relieve your symptoms in 4 to 6 weeks, your doctor will slowly take you off the drug.

Tremors
The usual starting dose is 40 milligrams, 2 times per day. Symptoms will usually be relieved with a dose of 120 milligrams per day; however, on occasion, dosages of up to 200 milligrams per day may be necessary.

Before Adrenal Gland Surgery
The usual dose is 60 milligrams a day divided into smaller doses for 3 days before surgery in combination with an alpha-blocker drug.

Propranolol for Children
Propranolol will be carefully individualized for use in children and is used only for high blood pressure. Doses in children are calculated by body weight, and range from 2 milligrams to 4 milligrams per 2.2 pounds daily, divided into 2 equal doses. The maximum dose is 16 milligrams per 2.2 pounds per day. If treatment is stopped, Propranolol must be gradually reduced over a 7 day period.

Propranolol Overdosage
Overdose symptoms with beta blockers include: Extremely slow heartbeat, irregular heartbeat, low blood pressure, severe congestive heart failure, seizures wheezing.

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Q. I took a tablet of Sudafed once about five years ago and the side effects of a headache and a pounding heartbeat would not go away for weeks. A nurse prescribed to me propranolol to get rid of them so I took 2 to 4 tablets in two days, but the side effects of Propanolol has stayed with me since. I believe that my body is not strong enough to fight off medications after their initial effects wears off. I still feel the almost paralyzed effects of propanolol where it blocks beta receptors so that my body moves sluggishly and my heart beats very slowly...too slowly. It is hard to move because I feel almost paralyze from the effects of the medication. Are there anything to unblock the receptors that propanolol has blocked?
   A. I can't imagine the use of propranolol would have an effect several years later.

Can propranolol reduce libido or sex drive?
   Propranolol may reduce libido but more often causes difficulty with maintaining a full erection.

The people studied while taking propranolol for help with their bad memories. What dose were they given and for how long?
   There have been several studies using 40 to 80 mg a day.