A beta blocker used well beyond the heart — migraine prevention, tremor, and the physical symptoms of anxiety.
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Propranolol is a non-selective beta blocker. It blocks the effect of adrenaline on beta receptors, slowing the heart, reducing the force of each beat, and damping the physical response to adrenaline generally.
Non-selective means it acts on beta receptors throughout the body, not just the heart — which explains both its wide range of uses and its most important contraindication.
Standard tablets are taken two or three times daily; modified-release capsules once daily.
With or without food, but be consistent — food affects absorption.
For migraine prevention, it needs taking every day whether or not you have a headache, and it takes six to twelve weeks to show its full effect. Judging it after a fortnight is the commonest reason people abandon a preventer that would have worked.
For situational anxiety, some people take it before a specific event. This should be agreed with a clinician rather than improvised.
Never stop it abruptly, particularly if you take it for heart problems — sudden withdrawal can cause rebound rapid heart rate, raised blood pressure and, in people with angina, chest pain. Taper it.
Common: fatigue, cold hands and feet, dizziness (especially on standing), and vivid dreams or disturbed sleep.
Also: slow heart rate, low blood pressure, nausea, and reduced exercise tolerance — which matters to anyone who trains, because it blunts the heart rate response.
It can mask the warning signs of hypoglycaemia in people taking insulin or sulfonylureas — the tremor and palpitations that normally signal a low are damped, which makes lows harder to detect. This needs care rather than avoidance.
Sexual side effects and low mood are reported and are worth raising rather than tolerating.
Care in diabetes, in pregnancy, and in anyone with Raynaud's, which it can worsen.
Salbutamol and other beta agonists are opposed by propranolol — the reason the asthma contraindication matters practically as well as theoretically.
Other interactions: verapamil and diltiazem (serious — combined effects on heart rate and conduction), other blood pressure medicines, insulin and sulfonylureas, some antidepressants, and NSAIDs which reduce its blood-pressure effect.
Monitoring: heart rate and blood pressure. No routine bloods are specifically required, though thyroid function is often relevant to why it was started.
Yes, where clinically appropriate, and it assesses well remotely.
For migraine: a proper history is what makes the diagnosis — pattern, triggers, and above all how many days a month you take painkillers. Medication overuse headache is the most commonly missed treatable cause of daily headache, and taking a preventer will not fix it.
For anxiety: we would be clear about what propranolol does and does not do. It reduces the physical symptoms; it does not treat the underlying anxiety. It works best alongside talking therapy rather than instead of it, and offering it as a standalone answer would be doing you a disservice.
What we always check first: whether you have asthma. This is the question that determines whether propranolol is safe at all, and it is not one to take a vague answer on.
This page is information, not an offer to supply.
Propranolol is very cheap and has been generic for decades. The drug cost plus dispensing fee on a private prescription is usually less than the England NHS prescription charge of around £10, and NHS prescriptions are free in Wales.
Standard tablets are taken two or three times a day; the modified-release capsule is once daily and costs several times more.
The once-daily version is worth it only if the multiple daily doses are the thing stopping you taking it. It is not more effective.
If it is being used for migraine prevention, budget for time rather than money: it needs eight to twelve weeks at an adequate dose before you can judge whether it works.
This is the one beta blocker point that genuinely matters: do not stop propranolol abruptly if you have been taking it regularly.
Sudden withdrawal causes a rebound — the heart becomes temporarily oversensitive to adrenaline, producing palpitations, tremor, anxiety and raised blood pressure. In anyone with underlying heart disease this can provoke angina or worse.
Reduce it over one to two weeks, longer if the dose is high or you have been on it a long time.
Occasional use — a single dose before a presentation or a driving test — carries no withdrawal risk and can simply be stopped. The taper applies to regular daily use.
For migraine prevention, the usual alternatives are candesartan, amitriptyline or topiramate, each with a different side-effect profile. Give any of them eight to twelve weeks.
For performance anxiety, there is often nothing to switch to — the alternative is a psychological approach rather than another drug, and it works better in the long run.
We do not prescribe benzodiazepines for this, and we do not start them remotely for anything else.
No — this is the most important thing on the page. Propranolol blocks receptors in the airways as well as the heart and can trigger severe, occasionally life-threatening bronchospasm.
Tell any prescriber about asthma, and about childhood asthma or a wheezy response to colds. It is regularly not asked about.
Not if you take it every day. Abrupt withdrawal causes rebound palpitations, tremor and raised blood pressure, and can provoke angina in anyone with heart disease.
Taper over one to two weeks. Occasional single doses can be stopped freely.
It blocks the physical symptoms — the racing heart, the shaking hands, the tremor in your voice — rather than the worry itself.
For performance situations that is often exactly enough. For persistent generalised anxiety it treats the wrong half of the problem, and therapy or an SSRI is the better answer.
Eight to twelve weeks at an adequate dose. Stopping at three weeks because nothing has changed is the commonest reason it is written off.
Keep a headache diary — success is fewer or milder attacks, not none.
Often, particularly at first. Fatigue, cold hands and feet, and vivid dreams are the usual complaints.
Most settle over a few weeks; cold extremities frequently do not, and that is a reasonable reason to switch.
Yes, but your heart rate will not rise the way it used to, so exercise feels harder at the same effort.
Judge intensity by how you feel rather than by a heart-rate monitor, which will read low.
It can mask the warning signs of a low blood sugar — the racing heart and shakiness — leaving sweating as the main clue.
Worth discussing if you take insulin or a sulfonylurea.
No. It causes no craving and no dose escalation. The taper is about the heart's adaptation, not dependence.
Clinically reviewed by Dr Mohammad Zubair Khan, GMC 7563469
Last reviewed
August 24, 2026
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