Propranolol vs Bisoprolol Beta Blockers for Anxiety

Propranolol (commonly sold under the brand name Inderal) and Metoprolol (commonly sold as Lopressor) are both beta blockers designed to block the effects of adrenergic hormones, and are prescribed to treat various heart conditions. However, beta blockers like propranolol and metoprolol are also used off-script to prevent anxiety symptoms. We look at which beta blocker is most effective against performance anxiety symptoms.

Propranolol, predominantly marketed under the name Inderal, and Bisoprolol, marketed under the brand name Zebeta, are two popular beta-blocker medications that serve the core purpose as heart and cardiac medications ^[1]. However, many people are using beta-blockers like these two to help with their anxiety and stage fright issues. This type of usage (for that other than the original purpose it was prescribed for) is called ‘off-script’, and there are a lot of performers of all types (musicians, speakers, actors, sales professionals, even politicians) using beta blockers like Bisoprolol and Propranolol ‘off-script’ to help them keep their nerve while performing.

We’ve received several emails following our other articles comparing different beta-blockers (this Metoprolol vs Propranolol for Anxiety article being the main one) where people want us to compare Propranolol to Bisoprolol for anxiety purposes; as those are the two beta-blocker variants they are considering trying. Rather than respond in private messages and email, we thought we would share our thoughts about how these two medications stack up against each other here on this site, as we’re sure many others might be making the same comparisons.

We will explain what the medications are and how they work, look into why performers use them to help with their anxiety, recommend dosages for each, and finally summarize which of the beta-blocker variants might be best for you. If you have any additional questions that aren’t covered here, please leave a comment and we’ll make sure to update the article with answers.

What is Propranolol?

Propranolol is one of the most commonly prescribed beta-blocker medications in the US.

Beta-blockers, which we’ve covered in many places on this site like here and here, are also known as beta-adrenergic blocking agents, because they work by blocking the effects of adrenergic hormones, such as adrenaline.

Doctors and medical professionals typically prescribe beta-blockers to treat various heart conditions, if lifestyle adjustments alone are failing to do the job.

Here are some of the typical conditions for which your doctor or medical professional might recommend a beta-blocker ^[11]:

• High blood pressure
• Irregular heartbeat
• Angina (chest pain)

Beta-blockers can help those suffering from cardiovascular issues by influencing the force with which your heart pumps blood. Beta-blockers are sometimes also prescribed for conditions like migraines, and harmless tremors of the arms, hands, etc.

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Propranolol Brand Names

Propranolol was originally marketed under the brand name Inderal when it was manufactured by ICI Pharmaceuticals (now AstraZeneca), in 1965.

Propranolol is also marketed under the following brand names:

• Avlocardyl
• Deralin
• Dociton
• Inderalici
• InnoPran XL
• Indoblok
• Sumial
• Anaprilin
• Bedranol SR (Sandoz)
• Ciplar and Ciplar LA by Cipla (in India)
• Hemangeol

What is Bisoprolol

Bisoprolol is another popular beta-blocker drug that works in a similar way to Propranolol. Bisoprolol blocks the effects of adrenaline and therefore is prescribed by doctors and medical practitioners to treat heart and cardiovascular issues like high blood pressure, irregular heartbeat and similar conditions.

Bisoprolol is most commonly sold under the brand name Zebeta, and is pretty much exclusively available in oral tablet form. In India, Bisoprolol is sold under the name Bisotab and in Italy, Bisoprolol is sold under trade name Congescor ^[2].

Bisoprolol predominantly affects the bodies response to certain nerve impulses in parts of the body like the heart. As a result, the heart beats slower and decreases blood pressure. When blood pressure is lowered, the amount of blood and oxygen is increased to the heart ^[3].

Why do people use Propranolol and Bisoprolol for anxiety?

I like to cite a particular study performed in 1987, which showed just how popular beta-blockers like Bisoprolol & Propranolol are amongst musicians. The survey, carried out by the International Conference of Symphony Orchestra Musicians who represent some of the largest orchestras in America, found that 27 percent of participating musicians were using beta-blockers to help with their performance anxiety symptoms ^[4]. Many experts estimate that this number is much higher today (likely 30-40% higher, but that is purely an assumption based on musicians and clients I speak to).

So why are so many people who regularly face high-pressure scenarios using beta blockers like Bisoprolol & Propranolol to help with their performance anxiety?

Well, as we previously described, beta-blockers relax the load on your cardiovascular system by blocking the effects of the adrenaline hormone. This has major benefits for anyone facing down a high-anxiety situation.

Adrenaline is a stress-related hormone. It binds itself to adrenergic receptors in the heart, also known as beta receptors ^[5]. 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 block the effects of adrenaline and prevent it from binding to the beta receptors in the heart. This then means that the heart can return to its regular workload, and your blood pressure can remain steady ^[6].

So when you are preparing for a high-pressure scenario like giving a talk in front of a large audience, or auditioning or playing music on stage, it is to be expected that you will feel a certain level of stress. In these scenarios, you will naturally feel an adrenaline rush as a part of that stress response.

When you are experiencing performance anxiety or stage fright, you are experiencing your stress response going too far. The adrenaline hormone is having a much greater effect on you, which causes your heart rate to skyrocket, along with other symptoms of performance anxiety.

As beta-blockers like Bisoprolol and Propranolol block the effects of adrenaline, they also prevent you from experiencing the physical symptoms of performance anxiety.

Remaining physically calm has an overall calming effect, which then allows you to get through your high-pressure scenario. And that is why so many performers use beta blockers like Propranolol and Bisoprolol to help them before getting on stage or facing a nerve-wracking event.

Recommended dosages for Propranolol and Bisoprolol

Before using Bisoprolol or Propranolol — or any prescription drug for that matter — you should consult with a licensed medical practitioner first in order to make sure you’re not at risk. You can also discuss dosage with them. For reference purposes however, here are recommended dosages when using these beta-blockers for anxiety purposes:

• Recommended Propranolol Dosage for Anxiety: effective dose is between 40-80 mg per day, taken in a single dose or that can be split throughout the day.
• Recommended Bisoprolol Dosage for Anxiety: 5mg-10mg orally one to two hours before an anxiety-inducing event. Same maximum recommended Bisoprolol dose = 20mg in a single day.

Propranolol and Bisoprolol Side-Effects

Beta-blockers, generally speaking, are pretty safe as far as prescription medications go. But here are some of the potential, albeit rare, side effects of Propranolol and Bisoprolol ^[8][9]:

Propranolol Side-Effects

• Dry eyes
• Abnormally low heart rate
• Fatigue or weakness
• Nausea

Severe side effects of Propranolol are quite rare, but if you experience any of the following symptoms after taking the drug, be sure to contact your doctor immediately:

• Allergic reactions like skin hives or rashes
• Swelling in the face – lips, tongue, etc.
• Shortness of breath

Bisoprolol Side-Effects

• If you have diabetes, bisoprolol may mask some of the symptoms of hypoglycemia (low blood sugar) ^[7].
• Body aches or pain
• Chest pain
• Difficult or labored breathing
• Ear congestion
• Loss of voice
• Pain or tenderness around eyes and cheekbones
• Shortness of breath or troubled breathing
• Tightness in chest
• Unusual tiredness or weakness
• Wheezing ^[3]

Severe side effects are quite rare, but if you experience any of the following symptoms after taking Bisoprolol, be sure to contact your doctor immediately ^[3]:

• Chest discomfort
• Lightheadedness, dizziness, or fainting
• Slow or irregular heartbeat

Propranolol vs Bisoprolol: Which is right for me?

Both of these medications work in a similar way and realistically, for most people, either one would work fine to assist in preventing anxiety symptoms.

It’s always a good idea to speak to your licensed doctor or medical practitioner who should know best 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 Propranolol and Bisoprolol to help you decide between the two:

• Propranolol is the more popular of the two beta-blockers among performers because it works best for short-term relief. Propranolol quickly brings you back to a calm state, at least physically, which then has an effect on you mentally, and you feel calmer overall.
• Performers like Propranolol because the side effects are quite minimal. For some, Propranolol is a bit too strong of a relaxant and can make them feel too drowsy to perform at their best. While it is not ideal to be a jittery mess, you also do not want to feel sleepy and lethargic during a speaking event or performance.
• Bisoprolol works mainly on the heart, while other beta-blockers like Propranolol work on the heart as well as other parts of the body as well. This may mean that there are less adverse side effects with Bisoprolol for some people, but it may also mean that Bisoprolol is not as effective as Propranolol at actually reducing anxiety ^[10].

Figuring out whether Propranolol or Bisoprolol work better for your specific anxiety symptoms may come down to simple experimentation with the two and self-examination to analyze if the effects (and side-effects) of one are better or worse for you, specifically.

Natural beta-blocker alternatives to Bisoprolol & Propranolol

Although both Propranolol and Bisoprolol beta-blockers are reported to have minimal side-effects while being effective for fighting anxiety, you may be reluctant to become dependent on them long-term.

If used consistently for a long period of time, there definitely is a risk of becoming dependent on them. Not just for performing, but to maintain regular cardiovascular function. Although that’s quite uncommon among people who use Propranolol or Bisoprolol for stage fright ^[11].

Regardless, here are some natural beta-blocker alternatives to help you maintain your calm and composure before a performance.

L-theanine

L-theanine is an amino acid found in green tea, black tea, and oolong tea. It is also easily available in supplement form.

L-theanine has been shown to increase GABA levels in the brain, which is a neurotransmitter linked with a greater sense of calmness and balanced mood ^[12].

Valerian Root

A herb found in the root of the valerian plant, valerian root is another supplement that is often recommended to ease symptoms of tension and anxiety ^[13].

Valerian Root has been used in traditional medicine in ancient Greece and Rome to deal with symptoms of nervousness, stress, trembling, etc.

But Valerian can also make some people drowsy. So, keep that in mind if you’re considering using it before a performance.

Magnesium and vitamin B6

Combining magnesium and vitamin B6 can improve mental performance before a performance. Research currently indicates that combining these two ingredients improves focus and behavior in kids who are diagnosed with ADHD ^[14].

You could even combine vitamin B6, magnesium, and L-theanine, for example, to get the best of both worlds.

L-theanine supports a relaxed state, and the B6/magnesium combination provides that extra mental focus so you can deliver an amazing performance.

Cognitive performance supplements

Probably the most effective natural beta-blocker alternatives are supplements that boost mental performance.

The best supplements are a combination of various ingredients in the right proportions that work together to suppress anxiousness, while at the same time providing a boost in natural energy and mental focus.

One such supplement is PerformZen. It combines various ingredients, including L-theanine, magnesium, and vitamin B6, as I mentioned above, to help calm the nerves before a speech.

At the same time, PerformZen helps increase mental sharpness and focus so we could connect with our audience with greater enthusiasm. Check PerformZen out!