Consultants are demanding a crackdown on the prescribing of a well-liked nervousness treatment amid rising considerations that it might expose sufferers to life-threatening dangers.
Propranolol, a kind of drug known as a beta blocker, was initially developed to deal with hypertension.
Nevertheless, it’s now extensively prescribed to regulate the bodily signs of hysteria, together with a racing coronary heart, shaking and sweating.
It has turn out to be significantly standard amongst ladies, whereas social media is awash with claims that ‘the panic tablet’ is a fast repair for all the pieces from nerves earlier than a giant work presentation to marriage ceremony speeches and on a regular basis worries.
It has additionally obtained superstar endorsement, with Hollywood star Robert Downey Jr and former Great British Bake Off decide Dame Prue Leith each talking publicly about taking beta blockers to calm their nerves earlier than main appearances.
However the drug, which slows the center fee, may cause severe problems in some sufferers.
And now, main medical and pharmacy organisations are calling for harder nationwide prescribing steerage.
They warn that docs could also be underestimating the hazards of a medicine more and more seen as a innocent technique to calm nerves.
Actor Robert Downey Jr sparked a social media frenzy on the 2024 Golden Globes after revealing throughout his acceptance speech that he had taken a beta-blocker to calm his nerves
Former Nice British Bake Off decide Prue Leith revealed in 2023 that she had been prescribed propranolol to beat crippling stage fright throughout her first stay theatre tour
Rising alarm over deadly overdoses
In an open letter, proven under, they known as on NHS watchdog the Nationwide Institute for Well being and Care Excellence (Good) to assessment its steerage on treating nervousness – and explicitly state that propranolol is just not advisable for managing nervousness problems.
The drug is presently not talked about within the steerage in any respect.
Their greatest concern is the chance of probably deadly overdoses, significantly amongst sufferers who could already be weak to self-harm.
A study published last year in the British Journal of Clinical Pharmacology examined 363 intentional propranolol overdoses reported to the UK’s poisons data service over two years, together with 35 deaths.
Amongst sufferers whose purpose for being prescribed the drug was identified, greater than 9 in ten had been taking it for nervousness.
But its use continues to develop, with 8.4 million prescriptions disbursed within the UK within the 12 months to June 2026 – virtually 5 per cent greater than the earlier 12 months.
Individually, the medicines regulator, the MHRA, is now reviewing the hazards of propranolol and whether or not additional security measures are wanted – as overdose is just not the one potential danger related to the drug.
The hidden dangers of taking propranolol
Propranolol works by blocking the consequences of adrenaline, slowing the center fee and reducing blood stress.
In an open letter, medical and pharmacy organisations known as on NHS watchdog the Nationwide Institute for Well being and Care Excellence (NICE) to assessment its steerage on nervousness remedy
They’ve requested the watchdog to explicitly state that propranolol is just not advisable for managing nervousness problems. A bit has been redacted for security causes
Professor Penny Ward, an knowledgeable in prescription drugs at King’s School London, says: ‘It was initially licensed for the remedy of hypertension, however may also assist with among the signs of hysteria and panic.
‘By slowing the center fee, you shift folks right into a extra tranquil state.’
Nevertheless, this will trigger dizziness, weak point and fainting in vulnerable sufferers, significantly these with low blood stress or coronary heart rhythm issues.
It could additionally set off doubtlessly harmful bronchial asthma assaults by narrowing the airways, whereas making frequent reliever inhalers much less efficient.
In folks with diabetes, propranolol can masks the warning indicators of dangerously low blood sugar, together with shaking and a racing coronary heart.
Different uncomfortable side effects embrace fatigue, chilly fingers and toes, disturbed sleep and nightmares.
The drug may also work together with sure coronary heart drugs and antidepressants, doubtlessly rising the chance of problems.
And abruptly stopping propranolol after common use may cause a rebound enhance in coronary heart fee and blood stress, which will be harmful for folks with underlying coronary heart illness.
Prof Ward says: ‘It needs to be used appropriately, with individuals who do not have any contraindications to its use, which would come with not having bronchial asthma, for instance.
‘Anyone who has had a coronary heart assault prior to now or proof of a slowing coronary heart fee, shouldn’t use it both.’
Does propranolol really work for nervousness?
The considerations come amid wider questions over whether or not propranolol is an efficient remedy for nervousness in any respect.
Consultants recommend that whereas it’d assist alleviate among the bodily signs, similar to shaking and palpitations, it does little to ease the underlying psychological misery.
Sufferers take the drug however proceed to really feel frightened, anxious and overwhelmed.
A scientific assessment of eight trials involving roughly 200 individuals discovered inadequate proof to help use of propranolol for nervousness problems. And a 2024 paper in the British Journal of General Practice raised related considerations.
Its authors additionally examined why GPs continued prescribing the drug.
Analysis recommended a number of causes: clinicians thought-about it comparatively low danger, seen it as safer than sedative medication similar to benzodiazepines and believed sufferers appreciated its fast impact.
Small research have discovered that propranolol can cut back bodily signs earlier than anxiety-inducing occasions, together with public talking and musical performances.
Dr Philippa Kaye, a GP in north London and Day by day Mail columnist, says that security fears have to be taken severely and the view held by GPS – and the general public – that propranolol is low danger may have to alter.
She provides that the drug should not be seen as a fast repair or as a approach merely to not really feel nervous.
‘Nervousness and stress within the brief time period are a part of the conventional human expertise, and may even typically be useful,’ she says. ‘They will inspire us, sharpen our considering and assist us cope with troublesome conditions.
‘These emotions do not essentially have to be handled with treatment, whether or not that is a beta-blocker or anything.
‘However when nervousness turns into so extreme that it develops right into a psychological well being dysfunction, that is a special matter, and a few sufferers could profit from treatment.
‘While you expertise nervousness, your physique goes into fight-or-flight mode.
‘Your coronary heart begins racing, you start to sweat, your respiratory turns into quicker and your mind interprets all these bodily sensations as an indication that one thing is incorrect.
‘That may make you’re feeling much more frightened, making a vicious cycle.
‘Beta-blockers can assist interrupt that cycle. You may nonetheless have anxious ideas, however your physique would not react in the identical approach.
‘With out these bodily signs reinforcing the concern, the nervousness can turn out to be simpler to handle.
‘That is why they are often useful for some sufferers, significantly those that cannot take antidepressants similar to SSRIs, that are one other remedy for nervousness, or who would favor to not.
‘My concern is, with waits for speaking therapies like CBT being so lengthy, what else can we provide sufferers?’
Prof Ward provides: ‘Personally, I’d be cautious about stopping GPs prescribing this drug. It may be useful for people who’re unlucky sufficient to endure from power nervousness and a really fast coronary heart fee.
‘It would not damage to have one other take a look at steerage if there are security considerations, however folks typically suppose nervousness and panic dysfunction are usually not essential circumstances, and that is not the case.
‘They are often life-threatening in themselves due to the propensity of people who find themselves overwhelmed by their signs to search out life not value dwelling.
‘Withdrawing a remedy that some folks depend on might have very severe penalties.’
