Atenolol vs Metoprolol for Anxiety: Which Beta Blocker works best for Anxiety?

Metoprolol (commonly sold under the brand name Lopressor) and Atenolol (commonly sold as Tenormin) are both selective Beta-1 blockers, designed to block the effects of epinephrine (adrenaline), and are typically prescribed to treat various cardiac-related heart conditions. However, beta blockers like Atenolol and Metoprolol are also used off-script to prevent anxiety symptoms. We look at how both Metoprolol and Atenolol work, what the side-effects are and then finally investigate which of the two beta blockers is most effective against performance anxiety symptoms.

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Metoprolol and Atenolol are two well-known beta blockers available that are used to cope with anxiety symptoms, especially for people who experience social anxiety or performance anxiety.

Both Metoprolol and Atenolol are traditionally used in the treatment of various types of cardiac-related conditions, including angina pectoris and hypertension, or high blood pressure [1].

The same mechanisms of action that make these medications good for high blood pressure, hypertension and other heart-related conditions also make them good for managing several types of anxiety; particularly performance anxiety. That’s why prescription drugs like Atenolol and Metoprolol are so commonly used off-script by performers (musicians, public speakers, actors, students about to take exams, etc) to help with their performance, social and general anxiety symptoms.

If you’re someone that gets a severe case of the jitters before a public talk, speech, presentation, or social event, you might be considering using medications like atenolol or metoprolol. Perhaps you’ve heard from a colleague, or read on online forums, about how these medications saved the performing careers of others?

But which one should you pick – Atenolol or Metoprolol?

In this article we’ll talk about everything you need to know about Metoprolol and Atenolol. We’ll cover the basics like the different recommended dosages for anxiety, potential side effects, etc.

Then we will discuss how these medications work to prevent symptoms of performance anxiety, and which one might be a better choice for you.

If you’re reluctant to continually use prescription drugs to get you through performances or social gatherings, we’ll even recommend some alternatives so that you have different options.

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What are Beta Blockers?

Atenolol and Metoprolol are part of a class of drugs known as beta-blockers. Beta-blockers, put simply, are prescription medications used to treat a variety of heart conditions and cardiac-related conditions.

Beta-blockers (also known as beta-adrenergic blocking agents) effectively slow down the heart and reduce blood pressure [2]. Beta-blockers work by suppressing (or ‘blocking’) the effects of epinephrine, or adrenaline, the stress hormone associated with the body’s “fight or flight” response.

The conditions that beta-blockers are prescribed to treat include angina, arrhythmia, heart failure, migraines and hypertension (high blood pressure). By blocking the release of adrenaline, beta-blockers help to regulate heart rate and blood pressure, thus providing relief for the aforementioned conditions [3][4].

What is Atenolol?

Atenolol is one of several commonly prescribed pharmaceutical beta-blockers. It is commonly known by its brand name, Tenormin.

Like other beta-blockers (such as Propranolol, Coreg and Clonidine), Atenolol is used primarily for heart conditions, such as hypertension, angina and recovery from heart attacks.

What is Metoprolol?

Metoprolol is the generic name of the brand-name drug known as Lopressor. The FDA approved the use of Metoprolol under the name Lopressor back in 1978 and it is now a widely used drug with around 27 million prescriptions each year in the United States.

Doctors typically prescribe Metoprolol to treat irregular heartbeats and to increase a patients chances of survival after a heart attack or heart failure [5].

Lopressor has also been shown to be useful when it comes to migraines, and for certain types of tremors caused by drugs used to treat mental disorders.

Why do people take Atenolol and Metoprolol for anxiety symptoms?

Now that we have covered the basics about Atenolol and Metoprolol, let’s discuss why people take these beta-blockers to cope with anxiety in the first place.

As mentioned, beta-blockers work by blocking the effects of adrenaline [3]. To understand why that plays a role with anxiety symptoms, we need to understand what happens in your body when you experience performance anxiety symptoms.

Why you experience performance anxiety symptoms

You experience performance anxiety symptoms due to an exaggerated stress response.

Performing in front of an audience is (for most people) a fairly stressful experience. Almost everyone in these circumstances experiences elevated heart rate, and maybe even some slight sweating.

For many, a slight stress response is no big deal, and they carry on with their performance, speech, zoom call, job interview, or exam.

Some people even use the adrenaline rush to their advantage, and it helps them raise the intensity of their performance.

But for those who experience strong performance anxiety symptoms, the stress response goes too far.

Your body thinks that you’re in actual danger and your fight-or-flight response kicks in, resulting in exaggerated symptoms of stage fright like excessive sweating, high blood pressure, dizziness, nausea, and more [6].

How do Atenolol and Metoprolol work for performance anxiety?

Beta-blockers like Metoprolol and Atenolol work by blocking the effects of adrenaline. They reduce the force with which your heart pumps blood and help stabilize blood pressure and heartbeat [7].

Beta-blockers keep anxiety and stage fright at bay in a similar way; by blocking the effects of adrenaline.

The reason you experience extreme nervousness before a performance is because your body goes into survival mode. Even though you are not in actual physical danger; the fear of rejection, humiliation, failure, etc. is strong enough that your brain perceives the situation to be a real threat.

Your body reacts with what is known as a stress response [8]. It shuts down any functions that aren’t necessary for survival (which is why you get that gut-wrenching feeling), and gets ready to either fight or run away fast in order to survive.

This stress response is why your heart starts racing, your palms get sweaty, and your blood pressure skyrockets.

When your body goes into survival mode, it releases stress hormones, including adrenaline. It is the adrenaline that is responsible for ramping up your cardiovascular system to the point where it results in the jittery symptoms of stage fright.

And by blocking the effects of adrenaline, beta-blockers help your heart maintain its natural rhythm and prevent performance anxiety symptoms.

What are the recommended dosages for Atenolol and Metoprolol for Anxiety?

If your doctor recommends Atenolol or Metoprolol for your anxiety symptoms, they will recommend the right dosage for you based on your personal health, medical history, etc.

That said, here are the typical dosages for Metoprolol and Atenolol:

  • Atenolol – Typically varies from 25mg to 100mg a day. An initial dose of 50mg is recommended for angina and hypertension, and may be increased to 100mg per day for hypertension, or 200mg for angina [9]. When taking Atenolol for anxiety, the recommended dose is 50mg to 100mg per day as a single dose [10].
  • Metoprolol – Typically between 50mg and 100mg a day. When taking Lopressor/Metoprolol for anxiety, recommended dosage may start around 100mg per day, taken at once or divided up in different doses [11]. The maximum safe dosage is 450mg per day.

Are there known side effects of Atenolol and Metoprolol?

Beta-blockers, in general, are pretty safe. But here are some of the potential, albeit rare, side effects of Metoprolol and Atenolol:

Possible side effects of Atenolol

Some common side effects of Atenolol include [10]:

  • Dizziness, feeling sleepy or tired
  • Nausea
  • Cold fingers and/or toes
  • Diarrhea
  • Constipation
  • Depressed feelings

More serious side effects of Atenolol may include the following:

  • Shortness of breath
  • Difficulty breathing
  • Chest pain
  • Slow or uneven heartbeat
  • Allergic reaction (anaphylaxis)

If you notice side effects after taking Atenolol, particularly serious side effects or side effects that last a few days or more, call your doctor and/or seek medical advice immediately!

If you take Atenolol regularly, it should not be stopped all at once, as withdrawal symptoms such as an increase in blood pressure or an elevated heart rate may occur [12].

Possible side effects of Metoprolol

Some common side effects of Metoprolol include:

  • Irritability or mood swings
  • Gut issues like gas, bloating, constipation
  • Nausea
  • Heartburn
  • Dry mouth

Just like with Atenolol, these more severe Metoprolol side effects are quite rare:

  • Shortness of breath
  • Unexplained swelling of hands, feet, or ankles
  • Fainting

As we mentioned above, if you notice side effects after taking Metoprolol, particularly serious side effects or side effects that last a few days or more, call your doctor or seek medical advice immediately.

Atenolol vs Metoprolol: Which one should I take?

Overall, both of these drugs work similarly, and for most people, either one would work fine to prevent performance anxiety symptoms.

But your doctor would know better which one would be ideal for you based on your health, medical history, or any other medications you’re currently taking.

Assuming your doctor approves the use of beta-blockers for your anxiety, here are some minor differences between Atenolol and Metoprolol to help you decide between the two.

Differences between Atenolol & Metoprolol

Starting with Atenolol, while not originally intended for it, there is some evidence to indicate that the drug may be effective at treating the symptoms of social anxiety disorders.

A 2020 study showed encouraging results for Atenolol as a treatment for anxiety in patients at a military mental health clinic in Japan [14].

81% of patients with diagnosed anxiety disorders reported that Atenolol had a positive effect on their condition. 90% of patients also reported that there were no adverse effects from taking Atenolol, or that the adverse effects were tolerable.

Interestingly, every patient who had previously taken Propranolol, another commonly used beta-blocker for anxiety, said that they preferred Atenolol.

Another study in 2019 looked at 22 patients, suffering from Generalized Anxiety Disorder, Social Anxiety Disorder and several other related conditions. The patients, who were treated with 25mg of Atenolol, experienced a calming effect within 60 minutes, which lasted up to 8 hours [15].

Most other evidence showing Atenolol as effective for anxiety is anecdotal. The research that currently exists on Atenolol as a treatment for anxiety disorders is encouraging, but more research is necessary to be sure of its efficacy.

Atenolol (Tenormin) is a selective Beta-1 blocker, meaning that it blocks epinephrine from binding to beta receptors (Beta-1) that affect the heart almost exclusively.

Metoprolol (Lopressor) is a less popular beta-blocker for anxiety and is used more commonly for high blood pressure. Metoprolol is also a selective Beta-1 blocker, or in other words it “selects” the beta receptors located in the heart tissue, known as your beta1 receptors.

Metoprolol decreases activity around the heart and can help reduce your heart rate and your systolic pressure, the pressure your blood vessels experience when your heart beats.

It’s often used to help people experiencing conditions like chest pain, irregular heart rate, and high blood pressure.

While Metoprolol has been around far longer then other beta blockers (since the 1960s), it is less popular than the other drugs due to a higher risk of side effects, dizziness, tiredness, or nausea. Versus Atenolol, however, Metoprolol is actually the lower risk option of the two as some more recent studies have shown us.

Similarities between Atenolol & Metoprolol

Here are some of the commonalities that both of these beta-blockers share:

Beta-Blockers will always be a temporary solution for stage fright

When you take beta-blockers, you’re not doing anything to address the root causes of your performance anxiety. You’re applying a quick-fix to stop the physical symptoms.

That is not to say beta-blockers don’t work, because they can. But if you’re only relying on beta-blockers, you’ll most likely have to keep taking them every time you need to perform under pressure [13].

You will need a prescription for both Atenolol & Metoprolol

In the United States, you will need a prescription for both Metoprolol and Atenolol. So, you may need to visit your doctor every time you run out, which can become an inconvenience if you use beta blockers frequently.

In rare cases, these beta-blockers may cause dependency

This is most likely not a concern for most people who only take beta-blockers occasionally for performance anxiety. But if you make it a habit of taking Metoprolol or Atenolol frequently, then you shouldn’t stop it all of a sudden.

When you take beta-blockers frequently, your body becomes dependent on them to some extent. So, stopping abruptly might cause your blood pressure to spike. If you have been taking Atenolol or Metoprolol regularly, talk to your doctor if you want to stop either of the medications.

Are there any natural beta-blocker alternatives for performance anxiety?

If you’re not too excited about becoming dependent on a prescription beta-blocker every time you want to perform, or having to get a prescription whenever you run out, you may want to consider a natural alternative to both Atenolol and Metoprolol.

A natural supplement would achieve the same end-result as a beta-blocker, which is to provide relief from symptoms of performance anxiety. But it would do so by supporting your mind and body in a way that, over time, makes you more resilient. You’d become better equipped to handle the stress response and learn to think about your performance in a way that makes it less stressful, to begin with.

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Besides promoting calmness to reduce anxiety symptoms, PerfomZen also helps with mental focus so you can have the best of both worlds. You remain relaxed, but at the same time, you’re also mentally sharp so you can perform at the highest level.

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Which is better? Atenolol vs Metoprolol

A study published in 2017 looked at the comparative effectiveness of both Atenolol and Metoprolol beta blockers, along with propranolol and oxprenolol by looking at the results of multiple clinical trials [16].

Metoprolol showed a more significant reduction in risk of cardiovascular mortality as compared to Atenolol. Metoprolol also showed a decreased trend for all-cause mortality and coronary heart disease [1].

When evaluated for a decrease in risk of stroke, metoprolol proved to be superior to Atenolol as well. When it comes to less severe side-effects; Metoprolol is undoubtedly the better option of the two beta blockers.

However, there is not a significant difference between the two beta blockers when it comes to performance anxiety symptoms. Both Metoprolol and Atenolol have been shown in studies to help with short-term stage fright and anxiety symptoms.

Keep in mind that a beta-blocker, or any other drug, will never be the solution you’re really looking for, which is to not be fearful about performing in front of an audience in the first place.

To overcome performance anxiety in the long term, consider natural alternatives like PerformZen.

In the meantime, If you’re considering Atenolol or Metoprolol for a quick-fix, be sure to consult with your doctor to make sure it is right for you.


Eric is a performance expert and a member of the PerformZen team since it was founded. Eric has battled anxiety his entire life and he is passionate about helping people gain control over the things that they fear most, with anxiety being at the top of that list for many!

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