TaperCommunitypropranolol
Propranolol is a non-selective beta-blocker used for performance anxiety, akathisia, essential tremor, migraine prevention, and PTSD-related hyperarousal. It dampens the peripheral physical symptoms of anxiety (racing heart, tremor, sweating) without affecting cognitive symptoms.
10mg, 20mg, 40mg, 60mg, 80mg tablets; 60mg, 80mg, 120mg, 160mg LA capsules; oral solution
Tablets IR: 10mg, 20mg, 40mg, 60mg, 80mg; LA capsules: 60mg, 80mg, 120mg, 160mg; Oral solution: 4mg/mL, 8mg/mL
Category C
Non-selective antagonist at beta-1 and beta-2 adrenergic receptors. Blocks the peripheral sympathetic response.
Slow taper — abrupt discontinuation in cardiac patients can precipitate angina or arrhythmia. Step down by 25% per week.
For purely as-needed performance anxiety use, no taper is required. For daily use over months, a planned step-down avoids cardiovascular rebound.
1-3 days
5-10 days
2-4 weeks
Cardiovascular rebound usually resolves within 2 weeks
Toxicity
Bradycardia, hypotension, bronchospasm (especially in asthma), fatigue, cold extremities, sleep disturbance, vivid dreams. Masks hypoglycemia in diabetes.
Pharmacokinetics
Hepatic, primarily via CYP2D6 and CYP1A2.
~90%
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