Propranolol For Anxiety:
How To Ease Performance Nerves

Primarily used to treat blood pressure and heart conditions, beta-blockers are known to lessen the physical effects of anxiety conditions and social phobias.


Performance anxiety occurs during unfamiliar situations or important events like public speaking, interviews, exams, and stage performances.

Propranolol for anxiety hinders the stress hormone epinephrine (adrenaline), blocking the physical symptoms of anxiety that occur when you’re under stress, including rapid heartbeat, shaking hands, and sweaty palms.

Beta-blockers are a trusted method used by some of the world’s top performers including Katy Perry, Shawn Mendes, Whitney Cummings, and Blair Tindall.

Have you ever found yourself in a situation where your nerves just completely took over?

Maybe it was during a presentation that you spent weeks preparing for. But when the moment came to show off all of the hard work you put in, you instantly became a nervous, sweaty wreck.

Or maybe it was when you finally met with a recruiter for your dream job. All of a sudden, your thoughts became so cloudy you could barely get out enough words to answer her questions.

Or perhaps it was your first time going on a date after ending a long relationship. Your usually cool and collected self unexpectedly turned into a spaz- your hands shaking so badly, you nearly spilled a glass of red wine on your date’s pearly white shirt.

If any of this sounds familiar to you, you’re definitely not alone.

All of the above scenarios describe performance anxiety, which can occur during unfamiliar situations or events that make us so nervous that we lose control of our ability to stay calm.

This shows up differently in different people. For some, it results in sweaty palms or tremors while others experience blushing or dry mouth.

And it’s incredibly common.

But unfortunately, many people often spend years, if not their entire lives, suffering through or just avoiding social situations that make them uncomfortable.

But there’s good news:

It turns out you can decrease your nerves by using Propranolol, a non-selective beta-blocker that’s been trusted for decades to minimize some of the most common symptoms of stress by the world’s top performers.

Defining Performance Anxiety

Anytime Y Combinator Founder Richard Nelson had to present in front of a group, his body would automatically go into panic mode. His hands would begin to sweat and he would experience a shortness of breath.

Worst of all, his mind would go completely blank.

Despite all of his hours of practice, he would completely lose his train of thought in the middle of speaking. It was as if his brain would shut down entirely.

Sound familiar?

Richard was experiencing situational anxiety, an overwhelming sense of stress associated with a specific situation or event.

For Richard, that situation was public speaking. It was only when he found himself expected to speak up in a room full of people that his nervous symptoms would arise.

And he had no idea what to do about it. He had tried a few different things but nothing completely took away the problem. It would be years before Richard finally found the answer to his problem.

But public speaking isn’t the only situation that causes elevated panic. Other examples include:

  • Going to a job interview
  • Attending a networking event
  • Meeting someone for a first date
  • Riding an airplane
  • Sharing an opinion during a meeting
  • Making small talk with new acquaintances
  • Being away from home
  • Using a public restroom
  • Leading a meeting or discussion
  • Standing alone in a public place

But let’s be clear here:

We aren’t talking about Generalized Anxiety Disorder (GAD), which is a continuous state of worry regardless of the situation.

Someone with GAD feels a heightened sense of stress and worry regularly. Even when a stressful situation, such as a big presentation, ends their symptoms stick around.

Understanding the type of anxiety you’re experiencing is an important first step in finding a solution that can truly make a difference for you.


Anxiety’s Mind-Body Connection

Though anxiety of any kind is referred to as a mental health condition, there’s actually a strong connection to our physical bodies as well. In fact, it can cause both a mind and body response.

You’ve probably heard this response referred to as your fight-or-flight mode, your reaction to anything dangerous.

When this happens, your brain sends out indicators to your body to react to whatever it’s perceiving as a threat.

These reactions come in the form of symptoms that often include:

  • Nervousness
  • Irritability
  • Fatigue
  • Worry
  • Low self-esteem
  • Shaky hands
  • Headaches

  • Muscle tension
  • Chest pains
  • Sweaty palms
  • Rapid heartbeat
  • Shallow breathing
  • Sweating
  • Blushing

Your fight-or-flight response is a pretty important asset, but it can sometimes switch on in a situation it doesn’t need to be used for, like a presentation for instance.

Making matters worse, these symptoms often cause a negative feedback loop- something Richard experienced firsthand:

“When I’m presenting, I will often psych myself out. I’ll say ‘I’m nervous’. And when I’m nervous, I’ll get on stage and think ‘Oh shit, I’m so nervous and I can’t think’. And when I can’t think, I can’t deliver properly. Even though I know everything there is to know about my business; I could talk about it forever one-on-one with someone. When I would go on stage, I would literally not be able to think. I would have a complete mind blank.”

Because he thought about how he would sometimes forget what he was going to say when he became nervous…

…his mind actually went blank.

In the end, Richard’s nerves caused him to experience a self-fulfilling prophecy.


Where Performance Anxiety Comes From

Just as the situations that cause unease vary from person to person, so do the causes behind it. In fact, there is a lot of debate over the root cause of anxiety disorders. And most doctors believe there isn’t one singular cause.

Most often, anxiety is thought to be the result of:

  • A previous bad experience
  • A prior trauma
  • Certain lifestyle choices
  • Personality type
  • Family history and genetics

Sometimes, it can even be the result of another medical condition or certain medications.

Understanding the cause of your apprehension is often a helpful step in determining the best type of treatment for you.

Perhaps one of the biggest problems with any type of stress is that most people don’t seek help. And because of that, their symptoms worsen over time.

At one point in college, Richard had to give a presentation in front of the class and he ended up suffering a full panic attack.

“There were maybe 30 to 45 people in the class. And I had to leave the front of the room and go splash water on my face, I was just so nervous. And it was weird. That was really the first time. And then it got considerably worse, to the point where I was scared to pipe up in a meeting when I was at work. It was to the point where I would avoid applying for certain positions at work because I was afraid of having to talk or be more of a leader and run a board meeting. It was holding me back in my career. And that’s when I realized ‘Ok, this is a problem that I have to address’.”

Only after his distress reached the point where it was affecting his professional and personal life did Richard decide to get help. He began attending Toastmasters meetings, consulted with a psychiatrist, and, after reading about Richard Branson’s experiences with beta-blockers for public speaking, he reached out to his doctor to discuss a prescription.


How Propranolol Works

Here’s the thing:

Anxious symptoms may be getting in your way. But they don’t have to be.

Propranolol, sometimes referred to as Inderal, is a type of beta-blocker medication that was created for people suffering from heart disease and high blood pressure.

But how does it work in the case of performance anxiety?

It prevents the stress hormone norepinephrine, or adrenaline, from being released throughout the body.


…your hands won’t receive the signal to shake…

…your heart won’t hear the command to beat faster…

…and your lungs won’t pick up on the direction to take in oxygen faster.

Basically, your physical body won’t respond to the fact that it’s under stress.


Who Beta-Blockers Can Help

Unlike other antidepressants or benzodiazepines available, such as Xanax or Valium, Propranolol will not alter the chemicals in your brain.

Instead, it will stop your body’s physical reaction to the nerves you’re feeling.

According to Dr. Attaran:

“[Beta-blockers] will not eliminate the feeling of anxiety and fear, but they will reduce some of its symptoms. This can prevent a negative feedback loop in some performers, who will feel even more nervous if they notice they have a tremor, for example”.

But do they actually work?

The Royal College of Music London study reported that 72% of classical musicians said they had used beta-blockers and 92% believed they were the most effective treatment.

Moreover, some of the world’s top performers have openly talked about how this medication has helped them, including pop star Katy Perry, musician Shawn Mendes, comedian Whitney Cummings, and Mozart in the Jungle author Blair Tindall.

Blair, in particular, has been very open about her past struggles with stage fright.

Even before she began to play, Blair would feel out of breath. Her hands trembled so badly it was a miracle she could hold onto her oboe. In a panic, her mind wandered away from the music, causing her to lose focus.

Each time, Blair felt exasperated: “It feels like you’re going to die. It feels like ‘Oh my god, when is this going to be over?’ And, as a professional musician, you’re supposed to love doing this”.

In the summer of 1985, Blair was taking her third shot at auditioning for the Marlboro Music Festival, an event featuring some of the world’s most talented classical musicians. After learning about Inderal from a fellow musician, Blair had gotten a prescription of her own. And though she was skeptical they would help, she decided to use this audition to give them a try.

Arriving at her audition, Blair immediately noticed something was different. Her adrenaline began to rush through her as she crossed the stage and found her seat.

But despite feeling nervous, her breath was normal. Her hands were steady. She felt focused.

Blair began to play, flying through her audition piece. She played just as she had during her hours of practice, hitting every note perfectly.

As she left the stage, Blair couldn’t help but feel elated. Her audition had gone so well that the poor experiences of bad auditions already seemed like a distant memory. Just a few hours later, she received some good news.

“I was the runner-up for the Marlboro audition! I wasn’t even close to qualifying the previous two years. And that was a very difficult festival to get into. I just couldn’t believe it! I remember going home and telling my roommate ‘Oh my god, I can’t believe it! This stuff really works!‘” said Blair.

As for Richard, Propranolol seemed to be the key to unlocking his fear of public speaking.

“With beta-blockers, I’m still nervous but it blocks the symptoms of being nervous. So I don’t get sweaty palms, I don’t have shortness of breath. Not having those symptoms actually allows me to be more focused. And now when I’m presenting, I like to think I can do it really well.”


What Doctors Have To Say

Beta-blockers have been around for decades. And while they’re considered to be an effective treatment option for heart and blood pressure conditions, some doctors believe they aren’t considered to be the best option for performance anxiety.

“Bringing up Propranolol is resurrecting a dead body,” said Stefan Hofmann, a psychologist from Boston University in an article from STAT news.

But many other healthcare experts, including Dr. Attaran, note that for patients who are physiologically affected by nervousness, this treatment option can be very helpful. And many doctors say they regularly prescribe it to patients who have nervous symptoms in their way.

And many doctors consider them to be a safer option than other anxiety medications available, such as Xanax, which is a controlled substance.

Beta-blockers, on the other hand, are considered to be non-addictive and are non-narcotic.

Jim Safka, the former CEO of notable companies such as and, is grateful his doctor gave him a prescription, noting it made a significant difference in his professional life.

Early on in his career, Jim would panic during meetings, too shy to get out more than just a word or two. Eventually, his doctor wrote him a prescription. The medication not only took away Jim’s nervous symptoms, but he also noticed an increase in his confidence levels.

“It was literally like a magic pill to me from that point on,” Jim said.

Jim noted that he continued to keep his medication in his briefcase, pulling it out whenever he was scheduled for a TV appearance or big speaking event.

“I honestly believe it changed my life,” he said.


Getting A Propranolol Prescription

Propranolol is a prescription medication and cannot be purchased over the counter.

There are three ways to get a prescription:

  1. Talk to your primary care doctor, who will be able to determine if this is an appropriate treatment option for you.
  2. Make an appointment with a psychiatrist, who may be more well-versed in this type of treatment.
  3. For those uncomfortable asking for medication, there’s Kick’s personalized beta-blocker prescription service. You can avoid the hassle of making an appointment and immediately complete a medical visit evaluated by a qualified, licensed doctor in your state. And no need to stand in line at the pharmacy- Kick will deliver your prescription directly to your door as soon as it’s ready.


Propranolol Dosage Information

As with any medication, the dosage will vary based on your personal needs.

When used for heart conditions and hypertension, a dose of Propranolol ranging from 100-240 mg per day is often prescribed.

But when used to minimize anxious symptoms, a much smaller dose is required- usually around 10 mg per use. Microdosing beta-blockers in this way often allows patients to get the benefits of the medication at a much lower dosage than for heart or blood pressure conditions.

Taking such a small dose can help reduce the risk of experiencing side effects. In fact, 10mg is often trusted by doctors to be given to infants as small as 22 lbs who were born with infantile hemangioma birthmarks.


Who Shouldn’t Use Beta-Blockers

Propranolol is an FDA-approved medication, but prescriptions for situational anxiety are off-label. Though this medication is generally regarded as safe, there are some people it isn’t suitable for.

It’s important to let your doctor know if you have a history of any of the following:

  • Asthma, bronchospasm, or other breathing problems
  • Cardiogenic shock
  • Slower than normal heart rate
  • Raynaud’s syndrome or other peripheral artery diseases
  • Diabetes
  • Abnormal blood pressure levels

You should also notify your doctor of any medications you’re currently on to avoid any negative interactions.

Make sure to seek medical advice to ensure this treatment option is safe for you.

It’s also important to point out that, although they may be rare, this medication can cause side effects.

Common side effects can include:

  • Hair loss
  • Dry eyes
  • Nausea
  • Weakness or fatigue
  • Vomiting
  • Cold hands

Though rare, more serious side effects may consist of low blood pressure, breathing problems, allergic reactions, or slow heart rate.


How To Get The Most Out Of Propranolol For Performance Anxiety

Propranolol can be a safe and effective option for those suffering from the symptoms of performance anxiety.

But in order to make the biggest difference in minimizing nerves, Dr. Attaran recommends people work with their doctor to create a full, personalized treatment plan to meet their specific needs.

“Beta-blockers can be used as a tool. Just as training, preparation, visualization, good diet and exercise are tools to create the conditions for a good performance, beta-blockers are also a tool. However, they should not be a substitute for the other tools mentioned here.”

Richard found the same to be true in his own experience, noting that, while he noted improvement in himself, they were part of a set of different tools he used to overcome his fears:

“If you just do beta-blockers, and you don’t practice talking in front of people, it’s not going to work. You’re still going to be nervous. But what the beta-blockers will do is bring you out of that hump with practice.”

Interested in finding out if Propranolol is right for you? Learn more about Kick’s personalized beta-blocker prescription program.

Editor’s Note: This guide was originally published in September 2018 and has been updated for accuracy and comprehensiveness.