Experts are calling for tighter controls on the prescribing of a widely used anxiety medication, warning that it may expose some patients to potentially fatal risks.
Propranolol is a beta blocker that was originally developed to treat high blood pressure.
It is now commonly prescribed to ease the physical effects of anxiety, such as a pounding heartbeat, trembling and sweating.
The drug has become especially popular among women, while social media promotes it as a quick solution for situations ranging from pre-presentation nerves and wedding speeches to everyday anxiety.
Propranolol has also gained high-profile backing. Hollywood actor Robert Downey Jr and former Great British Bake Off judge Dame Prue Leith have both spoken publicly about using beta blockers to steady their nerves before major appearances.
However, experts say the medication’s ability to slow the heart rate can lead to serious complications in some people, with an overdose posing a particular danger.
Leading medical and pharmacy organisations are now urging the introduction of stronger national guidance on prescribing the drug.
They fear doctors may be underestimating the hazards of a medicine increasingly regarded as a harmless way to control nervousness.
Actor Robert Downey Jr triggered a social media frenzy at the 2024 Golden Globes when he revealed in his acceptance speech that he had taken a beta blocker to settle his nerves
Former Great British Bake Off judge Prue Leith said in 2023 that she had been prescribed propranolol to overcome severe stage fright during her first live theatre tour
In an open letter, the organisations called on NHS watchdog the National Institute for Health and Care Excellence (Nice) to reassess its guidance on anxiety treatment and explicitly say that propranolol is not recommended for anxiety disorders.
The current guidance does not mention propranolol at all.
A central concern raised by the letter’s joint signatories – the General Pharmaceutical Council, Royal College of Pharmacy, College of Mental Health Pharmacy and Patient Safety Commissioner for England – is the risk of overdose.
A study published last year in the British Journal of Clinical Pharmacology reviewed 363 intentional propranolol overdoses reported to the National Poisons Information Service between 2022 and 2023. The cases included 35 deaths.
Nearly seven in 10 of those affected were women, and 52 cases involved children under the age of 18.
Where the original reason for taking propranolol was recorded, more than nine in 10 patients had been prescribed it for anxiety.
According to clinical audits by the Health Services Safety Investigations Body, an estimated 10 to 15 per cent of GP patients diagnosed with anxiety or depression are prescribed propranolol to help manage their symptoms.
The amount of propranolol dispensed in UK general practice has also been increasing steadily. There were 8.4 million prescriptions in the year to June 2026, almost 5 per cent more than in the previous 12 months.
Although the total number of people taking the medication is not known, figures obtained from the NHS Business Services Authority indicate that it is widely used by younger people in England.
During a single year, 97,362 people aged between 20 and 24 were prescribed propranolol, as were 59,717 teenagers aged 15 to 19.
Separately, this week the Royal College of Pharmacy and Royal College of Physicians Medicines Safety Joint Working Group have asked the medicines regulator to review official prescribing information for the drug.
They have questioned whether propranolol should continue to be licensed for treating anxiety at all, arguing that there is insufficient evidence it is effective.
The Medicines and Healthcare products Regulatory Agency (MHRA) has confirmed it is now investigating.
The risk of overdose is by far not the only safety concern linked to beta blockers.
Propranolol blocks the effect of adrenaline on the heart, reducing heart rate and blood pressure.
Professor Penny Ward, an expert in pharmaceuticals at King’s College London, says: ‘It was originally licensed for the treatment of high blood pressure, but can also help with some of the symptoms of anxiety and panic.
‘By slowing the heart rate, you shift people into a more tranquil state.’
However, this can cause dizziness, weakness and fainting in susceptible patients, particularly those with low blood pressure or heart rhythm problems.
It can also trigger potentially dangerous asthma attacks by narrowing the airways, while making common reliever inhalers less effective.
In people with diabetes, propranolol can mask the warning signs of dangerously low blood sugar, including shaking and a racing heart.
Other side effects include fatigue, cold hands and feet, disturbed sleep and nightmares.
The drug can also interact with certain heart medications and antidepressants, potentially increasing the risk of complications.
And suddenly stopping propranolol after regular use can cause a rebound increase in heart rate and blood pressure, which can be dangerous for people with underlying heart disease.
Prof Ward says: ‘It has to be used appropriately, with people who don’t have any contraindications to its use, which would include not having asthma, for example.
‘Anybody who has had a heart attack in the past or evidence of a slowing heart rate, should not use it either.’
The concerns come amid wider questions over whether propranolol is an effective treatment for anxiety at all.
Experts suggest that while it might help alleviate some of the physical symptoms, such as shaking and palpitations, it does little to ease the underlying psychological distress.
Patients take the drug but continue to feel frightened, worried and overwhelmed.
A systematic review of eight trials involving roughly 200 participants found insufficient evidence to support use of propranolol for anxiety disorders.
And a 2024 paper in the British Journal of General Practice, titled ‘Propranolol in anxiety: poor evidence for efficacy and toxicity in overdose’, raised similar concerns.
Its authors also examined why GPs continued prescribing the drug.
Research suggested several reasons: clinicians considered it relatively low risk, viewed it as safer than sedative drugs such as benzodiazepines and believed patients appreciated its rapid effect.
Small studies have found that propranolol can reduce physical symptoms before anxiety-inducing events, including public speaking and musical performances.
Dr Philippa Kaye, a GP in north London and Daily Mail columnist, says that safety fears must be taken seriously and the view held by GPS – and the public – that propranolol is low risk may need to change.
She adds that the drug shouldn’t be seen as a quick fix or as a way simply not to feel nervous.
‘Anxiety and stress in the short term are part of the normal human experience, and can even sometimes be helpful,’ she says. ‘They can motivate us, sharpen our thinking and help us deal with difficult situations.
‘Those feelings don’t necessarily need to be treated with medication, whether that’s a beta-blocker or anything else.
‘But when anxiety becomes so severe that it develops into a mental health disorder, that’s a different matter, and some patients may benefit from medication.
‘When you experience anxiety, your body goes into fight-or-flight mode.
‘Your heart starts racing, you begin to sweat, your breathing becomes faster and your brain interprets all these physical sensations as a sign that something is wrong.
‘That can make you feel even more frightened, creating a vicious cycle.
‘Beta-blockers can help interrupt that cycle. You might still have anxious thoughts, but your body doesn’t react in the same way.
‘Without those physical symptoms reinforcing the fear, the anxiety can become easier to manage.
‘That’s why they can be helpful for some patients, particularly those who can’t take antidepressants such as SSRIs, which are another treatment for anxiety, or who would prefer not to.
‘My concern is, with waits for talking therapies like CBT being so long, what else can we offer patients?’
Prof Ward adds: ‘Personally, I would be cautious about stopping GPs prescribing this drug. It can be helpful for individuals who are unfortunate enough to suffer from chronic anxiety and a very rapid heart rate.
‘It doesn’t hurt to have another look at guidance if there are safety concerns, but people often think anxiety and panic disorder are not important conditions, and that’s not the case.
‘They can be life-threatening in themselves because of the propensity of people who are overwhelmed by their symptoms to find life not worth living.
‘Withdrawing a treatment that some people rely on could have very serious consequences.’
