Beta Blocker Dosages For Anxiety – Recommended Dosage For Propranolol, Metoprolol, Carvedilol, Acebutolol, Atenolol & Bisoprolol

Beta-blockers are prescription medications typically prescribed for cardiovascular health conditions such as blood pressure, angina (chest pains) and irregular heart rhythm (arrhythmia), among others. Available over-the-counter under names like Propranolol, Metoprolol, Carvedilol, Acebutolol, Atenolol & Bisoprolol; beta-blockers have become extremely popular for professional and amateur performers who need to control their performance anxiety & stage fright symptoms, as beta blockers can block adrenaline effects. We look at the right dosages that are recommended for several popular beta-blocker medications when used for anxiety.

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If you’ve been experiencing stage fright every time you’re about to get on stage to perform in front of an audience, or facing-down any high-stakes scenario, you might be considering beta-blockers to fight your performance anxiety (the official name for ‘stage fright’).

Maybe you’re a musician, a public speaker, or a stand-up comedian, and your hands start sweating, your heart starts racing, and your voice gets shaky as the time approaches for you to take the stage.

If you experience these kinds of performance anxiety symptoms, beta-blockers can seem like a logical solution (we have a fantastic article all about using beta blockers for anxiety that you can read here). If this is the case, make sure you understand that you need to get the dosage right. We will always recommend speaking to a medical professional about dosages to make sure you don’t suffer from any side-effects or adverse reactions. But below, we cover the recommended dosages for several over-the-counter beta blockers that are commonly used for anxiety.

Summary: Recommended Beta Blocker Dosages For Anxiety

Typically prescribed for cardiovascular health conditions, Beta-Blockers are very commonly used “off-script” for anxiety. The most common beta blockers used for anxiety are available over-the-counter as Propranolol, Metoprolol, Carvedilol, Acebutolol, Atenolol, Bisoprolol & Nebivolol.

The core mechanism of Beta-blockers is relaxing the load on your cardiovascular system by blocking the effects of the adrenaline hormone. Too much adrenaline is also what causes typical anxiety symptoms, so by blocking the effects of adrenaline, beta-blockers are also reducing anxiety symptoms (there’s more to it then that, but that’s the simplified explanation).

Typically, your doctor will recommend your beta-blocker dosage based on your specific needs, but here are the common dosage recommendations for several popular beta-blockers for the purpose of treating anxiety symptoms:

  • Propranolol Dose For Anxiety: Between 10mg per day to 40mg per day.
  • Metoprolol Dosage For Anxiety: Between 50mg per day to 100mg per day.
  • Coreg Dosage For Anxiety: Start with 3.125mg twice daily for 2 weeks, if tolerated well then increase to 6.25mg twice daily.
  • Acebutolol Dose For Anxiety: Between 200mg per day to 400mg per day.
  • Atenolol Dosage For Anxiety: Between 10mg per day to 40mg per day.
  • Bisoprolol Dosage For Anxiety: Between 5mg-10mg orally one to two hours before an anxiety-inducing event.
  • Nebivolol Dosage For Anxiety: Between 2.5mg per day to 10mg per day, as a single dose.

What Are Beta-Blockers?

Beta-blockers are a type of pharmaceutical drug that doctors typically prescribe for cardiovascular conditions such as high blood pressure, chest pains, irregular heartbeat, and in some cases, even migraines.

So, it begs the question of why do so many performers use beta-blockers to fight performance anxiety and to help them get through a gig or other high-anxiety scenario [1]? In fact, beta-blockers are especially popular among musicians. A 1987 survey by the International Conference of Symphony Orchestra Musicians, representing some of the largest orchestras in the U.S., found that 27 percent of their musicians were using beta-blockers for performance anxiety [2]. Experts estimate that number is much higher today.

To understand why beta-blockers may help someone get through a performance, a client meeting, or a date, we need to take a look at how beta-blockers work within the body.

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How do Beta-blockers Work?

Beta-blockers relax the load on your cardiovascular system by blocking the effects of the adrenaline hormone [1]. That’s the core mechanism of beta-blockers.

Adrenaline is a stress-related hormone. It binds itself to adrenergic receptors in the heart, also known as beta receptors [3]. As a result, the heart has to pump blood with greater force, which causes your blood pressure and heart rate to go up.

Beta-blockers are also known as beta-adrenergic blocking agents. They block the effects of adrenaline and prevent it from binding to the beta receptors in the heart. Consequently, the heart can return to its regular workload, and your blood pressure can remain steady.

This is why beta-blockers are prescribed for people with high blood pressure and hypertension.

Why Do Performers Use Beta-Blockers for Anxiety?

Performers take beta-blockers because it is too much adrenaline that is responsible for their anxiety symptoms in the first place. And as we stated above, beta-blockers block the effects of the adrenaline hormone.

When you’re about to go on stage, or you’re about to walk in for an interview or an audition, it is to be expected that you’ll feel some level of stress. Naturally, you’ll feel somewhat of an adrenaline rush as a part of that stress response.

For most people, it’s not a big deal and some might even use that stress response to their advantage, upping the intensity of their performance.

But if you experience performance anxiety, the stress response goes too far. You experience a much greater effect of the adrenaline hormone, which causes your heart rate to skyrocket, along with other symptoms of stage fright.

Since beta-blockers block the effects of adrenaline, the medication also prevents you from experiencing the physical symptoms of performance anxiety. Remaining physically calm has an overall calming effect (mentally and otherwise), which then allows you to get through your engagement.

And this is why a lot of performers use beta-blockers!

What beta blocker medications can be used for anxiety?

What Beta Blocker Medications Can be Used For Anxiety?

There are various beta-blockers available with a prescription, but here are some of the most common ones (and their common brand names):

Propranolol/Inderal is the most common beta blocker when it comes to people using them for anxiety symptoms. Propranolol is also the most commonly prescribed beta blocker in the US, overall.

There are other medications that people commonly use off-script for anxiety, like Clonodine, Gabapentin and Depakote, but these are not technically beta-blockers so will not be covered here.

Recommended Metoprolol Dosage for Anxiety

Typically, your doctor will recommend your Metoprolol dosage based on your specific needs.

That said, the usual Metoprolol dosage for anxiety is between 50mg per day and 100mg per day. It may be taken at once or divided up in different doses [4]. Depending on how you respond to the initial dosage, your physician may recommend that you increase your daily intake. The maximum recommended dosage is 450mg per day.

You should be careful not to go over your recommended dosage of Metoprolol/Lopressor. Taking too much can slow down your heart rate to dangerous levels and cause breathing difficulties, dizziness, and possibly tremors [5].

You may also be prescribed other medications, like diuretics, together with Metoprolol/Lopressor to treat high blood pressure.

Recommended Carvedilol Dosage for Anxiety

The recommended Coreg dosage for adult hypertension is:

  • Starting dose of Coreg is 3.125mg twice daily for 2 weeks
  • Following Coreg being well-tolerated, the dosage can be increased to 6.25mg twice daily
  • Patients should be maintained on lower doses if higher doses are not tolerated
  • A maximum dose of 50mg twice daily has been administered to patients with mild-to-moderate heart failure weighing over 85kg (187 lbs) [6]

When considering Coreg dosage for anxiety, you should talk with your doctor to make sure there are no potential negative interactions and to find the exact dosage that matches your physical/health attributes.

Recommended Propranolol Dosage for Anxiety

Much of the dosage information you’ll find for Propranolol are for treating heart conditions and high blood pressure. It’s therefore vital that you understand the recommended Propranolol dosage for anxiety, if this is the reason you’re taking it (a common use of propranolol is for public speaking, as an example).

Propranolol in tablet form ranges in strength from 10mg tablets to 160mg. It also may be prescribed in liquid form, however this is most often used for infants, so we’ll only talk about Propranolol in tablet form here.

Adult Propranolol doses for things like hypertension, angina and arrhythmia generally range from 40mg to 320mg per day, depending on the condition [7]. That may be split into several doses per day.

The recommended Propranolol dose for anxiety is not as high, at between 10mg to 40mg per day. 10mg may be enough to see relief from your symptoms. If not, it is generally safe to increase the dosage up to 40mg. However, keeping to the smallest dose that proves effective will help minimize any side effects.

Be aware, this is just a guideline, and not medical advice. Pay attention to the dosage prescribed by your doctor, as you may have other medical conditions or prescriptions that have to be taken into account.

Recommended Atenolol Dosage for Anxiety

Atenolol is most commonly taken in tablet form, recommended with or without food. Tablets come in 25mg, 50mg and 100mg [8]. Atenolol can also be administered via IV infusion, however this would only be in a hospital setting.

Recommended Atenolol dosage varies from 25mg to 100mg per day, depending on what condition it’s being used to treat. 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].

Before deciding to take Atenolol for anxiety, it’s important to check with your doctor to ensure the intended dosage is safe, and will not cause issues with any other medication or health issues you may have.

Recommended Acebutolol Dosage for Anxiety

Acebutolol only comes as an oral capsule and is typically used to treat high blood pressure (hypertension) and a type of irregular heart rhythm (premature ventricular contractions, or PVCs) [11].

Acebutolol in capsule form ranges in strength from 200mg tablets to 400mg.

Recommended Acebutolol dosage is 400mg to start, taken once per day, or 200mg taken twice per day. This can vary, depending on what condition it’s being used to treat. An initial dose of 400mg is recommended for high blood pressure (hypertension), and may be increased to 600mg taken twice per day as needed, with the maintenance dose ranging from 400-800mg total per day.

When taking Acebutolol for anxiety, the recommended dosage is 200mg-400mg per day. Generally, your total daily dose shouldn’t be more than 800 mg.

Before deciding to take Acebutolol for anxiety, it’s important to check with your doctor to ensure the intended dosage is safe, and will not cause interactions or issues with any other medication or health issues you may have.

Recommended Bisoprolol Dosage for Anxiety

If your doctor recommends Bisoprolol for your anxiety symptoms, he or she will recommend the right dosage for you based on your health, medical history, etc.

But here are the typical doses for Bisoprolol for different conditions [12]:

  • Bisoprolol Adult Dose for Hypertension: 5mg orally once a day. If desired response is not achieved, may increase the dose to 10mg, then 20mg if necessary. Maximum recommended Bisoprolol dose is 20mg per day [13].
  • Bisoprolol Adult Dose for Anxiety: 5mg-10mg orally one to two hours before an anxiety-inducing event. Same maximum recommended Bisoprolol dose: 20mg in a single day.

Bisoprolol may be taken with or without food, and is pretty much always recommended that it is taken once per day.

If taking Bisoprolol consistently, note that sudden discontinuation has been associated with an exacerbation of angina, and sometimes myocardial infarction (heart attack) or ventricular arrhythmias [12]. If you need to discontinue bisoprolol, your doctor should advise how to do this slowly over at least a week [14].

Recommended Nebivolol Dosage for Anxiety

Nebivolol is a novel beta1-blocker that’s most commonly prescribed for heart-related & cardiac conditions such as hypertension, angina, and signs of congestive heart failure. Nebivolol/Bystolic is most commonly taken orally in tablet form, recommended with or without food.

Compared to some of the other beta blockers listed here, the tolerability of nebivolol has been shown in studies to be superior to that of both Atenolol and Metoprolol [15]. Nebivolol is also the only beta-blocker known to induce the production of nitric oxide, particularly relevant in hypertension, where nitric oxide dysfunction occurs [16].

Recommended nebivolol dosage for high blood pressure in adults is 5 milligrams (mg) once per day. For adolescents, usage and dosage must be determined by your doctor or healthcare professional [17].

When using Nebivolol for anxiety, the recommended dosage ranges from 2.5 milligrams (mg) to 10 milligrams (mg) per day, as a single dose.

Before taking nebivolol/Bystolic for anxiety, it is crucial to consult with a qualified healthcare professional, such as a doctor or psychiatrist, who can assess your condition and provide personalized recommendations. They will consider your specific needs and monitor your response to the medication to ensure its effectiveness and safety.

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Key Takeaways About Beta-blocker Dosages for Anxiety

The effective dose for almost all of the mentioned beta-blockers will typically vary from person to person, as each person’s body is likely to react to the beta-blocker a little differently. However, these dosages can stand as a baseline to help in your search to provide sufficient anxiety relief.

Please be sure to follow your doctor’s advice when taking beta-blockers for anxiety (or any prescription medication), and if you’re concerned about the side effects or risk of withdrawal, consider trying a natural alternative to beta blockers like PerformZen or Silexan.

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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