Propranolol Safety Review: Why UK Experts Are Raising Concerns Over Its Use for Anxiety

A commonly prescribed medicine used to manage the physical symptoms of anxiety is facing renewed scrutiny in the UK following concerns about the risks associated with overdose.

Propranolol, a type of beta blocker, is prescribed for several conditions, including certain heart problems, migraines and symptoms associated with anxiety. However, health organisations have raised questions about whether its use for anxiety should be reviewed in light of evidence concerning intentional overdoses and serious harm.

The issue has attracted attention after data from the National Poisons Information Service (NPIS) showed hundreds of intentional propranolol overdose cases during 2022 and 2023, including cases that resulted in death. The data has prompted calls for greater awareness of the medicine's risks and a review of prescribing practices.

Why is propranolol being reviewed?

The Royal College of Physicians and Royal College of Pharmacy have raised concerns with the Medicines and Healthcare products Regulatory Agency (MHRA) about the continued use of propranolol for anxiety.

The organisations have highlighted the potentially serious consequences of propranolol overdose, particularly among people who may already be vulnerable to self-harm.

According to the NPIS report covering 2022 to 2023, the service received 459 enquiries involving propranolol. These included 321 intentional exposures involving 318 patients. Twelve cases had a fatal outcome.

The same report found that propranolol had been prescribed to the patient in 173 of the exposures. In 108 of those cases, the prescription was associated with treatment of anxiety symptoms.

These figures do not mean that propranolol is unsafe for everyone who takes it. Rather, they highlight why healthcare professionals are examining how the medicine should be prescribed, particularly for people who could be at increased risk of intentional overdose.

What is propranolol used for?

Propranolol belongs to a group of medicines known as beta blockers.

Unlike medicines that primarily target anxious thoughts or feelings, propranolol works mainly on some of the physical effects associated with anxiety. It slows the heart rate and can help reduce symptoms such as shaking and sweating.

The NHS says propranolol can also be used for high blood pressure, certain irregular heart rhythms, angina and migraine prevention, among other conditions. It is available only on prescription.

For anxiety, doctors may prescribe it to help with physical symptoms for a limited period. The NHS advises patients to discuss the risks and benefits with their doctor if treatment continues for more than a few months.

What happens in an overdose?

The concern surrounding propranolol is particularly related to what can happen when too much of the medicine is taken.

The NHS states that an overdose can be very serious. It can cause a significantly slowed heart rate, low blood pressure, dizziness, seizures and breathing difficulties. The severity can vary between individuals.

Research based on UK poison service data has also described intentional propranolol overdoses as potentially life-threatening and difficult to treat.

This is one reason why healthcare organisations have called for clinicians and patients to have a clearer understanding of the risks.

Importantly, the available data concerns overdose cases. It should not be interpreted as evidence that people who take propranolol as prescribed will experience these outcomes.

Who may need particular caution?

The NHS states that propranolol may not be suitable for some people. Patients are advised to tell their doctor if they have ever experienced depression or thoughts about harming themselves, as well as if they have certain heart, circulation or respiratory conditions.

This does not mean that everyone with a history of depression or anxiety will automatically be unable to take propranolol. Decisions about medicines depend on the individual's medical history, current symptoms and the reason treatment is being considered.

The prescribing decision should therefore be discussed with a doctor or pharmacist rather than based solely on information found online.

Why prescribing patterns matter

The discussion comes at a time when propranolol has become increasingly familiar as a treatment for physical anxiety symptoms.

The NPIS has previously reported an increase in propranolol-related enquiries. A more recent study examining intentional overdoses reported 363 overdoses involving propranolol among 359 patients during 2022 and 2023. The study also found that 52 of the patients were under 18.

Researchers have argued that these findings underline the importance of considering the safety profile of propranolol when prescribing it to people who may be vulnerable to self-harm.

The issue is not simply whether the medicine works for physical symptoms. It is also about whether the potential benefits and risks have been appropriately considered for each individual patient.

What should patients taking propranolol do?

People currently taking propranolol should not suddenly stop taking the medicine without speaking to their doctor.

The NHS warns that stopping propranolol suddenly after long-term treatment can cause problems, including an irregular heart rate, sweating and shaking. Doctors may reduce the dose gradually when stopping treatment.

Anyone concerned about their prescription should speak to their GP or pharmacist. They can discuss why propranolol was prescribed, whether it remains appropriate and whether another treatment should be considered.

Patients should also make sure their doctor knows about other medicines they take, particularly medicines that could affect their health when combined.

What is the MHRA doing?

The MHRA is reviewing available information concerning propranolol and the potential harms associated with overdose.

The purpose of such a review is to assess the available evidence and determine whether changes to regulatory advice or other measures are necessary.

A review does not automatically mean that a medicine will be withdrawn or that every patient should stop taking it. Regulatory decisions depend on an assessment of the evidence and the balance between benefits and risks.

For now, the issue is primarily about improving awareness and ensuring that prescribing decisions are made with the individual's circumstances in mind.

What are the signs of an emergency?

Anyone who has taken more propranolol than prescribed should seek urgent medical advice.

The NHS advises contacting NHS 111 after taking more than the prescribed amount. If someone has serious symptoms such as breathing difficulties, a seizure, a markedly slow heartbeat or other signs of serious illness, emergency medical help is required.

If an overdose was intentional or someone is in immediate danger, call 999 or go to an emergency department. The NHS specifically advises treating a serious drug overdose as a medical emergency.

People experiencing thoughts of self-harm can also contact the Samaritans on 116 123 for confidential support.

The bigger question for anxiety treatment

The renewed discussion around propranolol highlights a wider issue in healthcare: medicines should be assessed not only for whether they can relieve symptoms, but also for the risks they may pose in particular circumstances.

Propranolol remains an established medicine with several recognised medical uses. The current concern relates particularly to overdose and its use in people who may have an increased risk of self-harm.

For patients, the key message is not to make sudden changes to prescribed treatment based on headlines alone. Instead, concerns should be discussed with a qualified healthcare professional who can consider the individual's circumstances.

The MHRA review and continuing research should provide further information about how propranolol should be used for anxiety in the future.

Sources

• National Poisons Information Service, National Poisons Information Service Report 2022 to 2023.
• NHS, About propranolol.
• NHS, Who can and cannot take propranolol.
• NHS, How and when to take propranolol.
• NHS, Where to get help for self-harm.
• Peer-reviewed research on intentional propranolol overdoses reported to the UK National Poisons Information Service.

Health disclaimer

This article is for general information only and is not medical advice. It does not replace advice from a GP, pharmacist, specialist or other qualified healthcare professional. Do not stop, change or alter a prescribed medicine without professional advice. If you or someone else has taken an overdose or is experiencing a medical emergency, seek urgent medical help.