Xanax vs. Propranolol For Anxiety

Xanax, a benzodiazepine, minimizes stress by targeting the central nervous system. Propranolol, a beta-blocker, reduces anxious symptoms through beta-receptors.


Nearly 27 million American adults say public speaking is one of their biggest fears.

To cope, many rely on prescription drugs to eliminate the uncomfortable side effects of their nerves.

Xanax is the single most prescribed psychiatric medication in the U.S.

Though lesser known to the general public, Propranolol for anxiety is the go-to method for many of the world’s top performers, including Katy Perry, Shawn Mendes, Whitney Cummings, and Blair Tindall.

As a law student, Pam Holland really struggled. It wasn’t managing the constant mountain of material she had to read through or passing the tough exams. In fact, she did quite well when it came to the actual school part.

But Pam had a public speaking phobia that left her in a constant state of fear of being called on.

Anytime she was asked to speak, she would go into instant fight-or-flight mode. She would sit through lectures silently praying that the professor wouldn’t call on her.

For months leading up to any sort of presentation, her anxiety would spike, leaving her anxious and sleepless. And on the day of the presentation, her fear would completely take over, causing her to feel paralyzed.

Her mind would go blank.
She would feel nauseous.
Her eyes would lose focus.
A few times she even felt like she might blackout.

Cases like Pam’s certainly aren’t rare; in fact, nearly 27 million American adults list fear of public speaking as a top phobia.

And while some may be able to shake off their pre-presentation jitters, those suffering from true performance anxiety can face real repercussions to both their professional and personal lives.

To cope, many people seek out help from prescription medications to eliminate the effects of their anxiety, including Xanax and Propranolol.

Though both are commonly prescribed to help minimize the symptoms of anxiety, each works very differently and should be used in different circumstances.


What Is Xanax?

Xanax is a type of tranquilizer that’s most often used to treat anxiety and panic attacks. In fact, it’s the single most prescribed psychiatric medication in the U.S. with more than 48.5 million prescriptions written.

While it’s often referred to as an antidepressant, it’s actually a benzodiazepine, a type of medication prescribed for depression and anxiety disorders.

Although extensive research has been done on benzodiazepines and their effects on the human body, there is still a lot unknown about them and the long-term effects of using them.

Benzodiazepines work by enhancing certain chemicals in the brain while preventing others from being released.

In the case of this medication, it increases a chemical known as gamma-aminobutyric acid (or GABA), which is believed to reduce the body’s stress response and help it remain calm.

Other benzodiazepine medications include Ativan, Valium, Halcion, and Klonopin.

Similar to these other medications, Xanax is only meant to be used as a short-term solution and should not be taken for long periods of time.

Though it has been shown to be effective in some cases, it’s also considered to be addictive. It should only be taken under the close supervision of a healthcare expert.


What Are The Side Effects Of Xanax?

To help cope with the symptoms of her built-up anxiety, Pam received a prescription for Xanax from her doctor. Though she found that it was helpful for her, she did experience a few side effects:

Drowsiness as a side effect, like what Pam describes, isn’t out of the ordinary.

Other common side effects can also include lightheadedness, increased saliva production, and a change in sex drive.

Though less common, some people do experience more serious side effects.

These can include:

  • Changes in mood
  • Hallucinations
  • Thoughts of suicide
  • Slurred speech
  • Loss of coordination
  • Trouble walking


How Long Does Xanax Stay In Your System?

For occasional users, Xanax can stay in the body for several days, taking up to 4 or 5 days to be completely removed from their system. For heavy users, it can remain in their bodies for up to a week.

There are several other factors that can affect how long it takes for the medication to leave your system, including:

  • The speed of your metabolism
  • Your weight
  • Your height
  • Your body fat content
  • Your age
  • The health of your liver and kidneys
  • The amount of medication taken
  • How long you’ve taken your prescription for


Who Shouldn’t Use Xanax

Xanax is not considered a safe medication for several groups of people.

These include those with:

  • An allergy to other benzos, including diazepam and lorazepam
  • History of liver disease or kidney disease
  • Personal or family history of substance abuse
  • History of glaucoma
  • Are pregnant or currently nursing

Xanax is also often not considered safe for many older patients, who may be even more susceptible to some of the side effects. And it is not recommended for children.

It’s incredibly important to consult with a healthcare provider to determine if any prescription medication is right for you.

When speaking with your doctor, be sure to provide them with a full list of other medications and supplements you’re taking as negative drug interactions are possible.


How Is Xanax Dosed?

Xanax is available in tablet form in several different doses ranging from 0.25 mg to 2 mg. Often, a doctor will recommend starting with a lower dose and may gradually increase the dosage based on your specific symptoms.

Your medication should be taken following exact dosage and instructions; do not increase how much you take without first consulting your doctor for medical advice.

Additionally, you should speak to your doctor if you decide to stop your prescription as it can cause severe withdrawal symptoms if stopped abruptly. Gradually reducing the dosage with help from your doctor can help to prevent these symptoms.

According to American Addiction Centers, withdrawal symptoms can include:

  • Headaches
  • Blurred vision
  • Muscle pain
  • Tremors
  • Diarrhea
  • Numb fingers
  • Sensitivity to light and sound
  • Loss of appetite
  • Insomnia
  • Heart palpitations
  • Sweating
  • Anxiety
  • Panic
  • Paranoia
  • Seizures


Can Xanax Be Abused?

Xanax is considered a controlled substance and has become an often abused drug due to what’s known as the “Xanax high”. It’s relatively easy to develop a tolerance to and is abused by people both with and without a prescription.

Signs of abuse include:

  • Continued use despite side effects
  • Inability to stop using it
  • Loss of interest in activities
  • Obsession with getting more
  • Risk-taking behaviors, such as combining your prescription and alcohol or driving after taking your medicine

Similar to other addictions, Xanax abuse can lead to poor relationships, forgotten responsibilities, and poor health.

If you or someone you know is suffering from addiction, please contact the Substance Abuse and Mental Health Services Administration (SAMHSA) at 1-800-662-HELP (4357).

Josh Throneburg stood up in front of his congregation to deliver his sermon, something he looked forward to each week. It was mid-morning on a Sunday, no different than the hundreds of times he’d spoken before.

But as he began to recite the first passage, he noticed a fluttering in his chest. He continued to speak, finding that each word was becoming harder to get out than the one before. He began to feel like he was running out of breath. The fluttering turned into racing, the pounding in his chest growing faster and louder until he couldn’t stand it any longer.

Looking up at the pews filled with people in front of him, he stopped and excused himself from the stage. Once out of view, he took a seat gasping for air, and waited for his heart rate to slow until the panic finally subsided.

There was nothing about this particular morning that should have caused him to panic. He had planned out his sermon ahead of time the same way he always had. The congregation was no larger than normal- only full of the same familiar and friendly faces he had become accustomed to seeing week after week. It really was just a regular Sunday.

But from that day on, each Sunday morning Josh stood up to speak, his body would go into instant panic mode.

Anxiety attacks like this one weren’t completely out of the ordinary for Josh.

Despite growing up around planes and helicopters, and even having flown a few himself, Josh had developed a fear of flying. Similar to his fear of public speaking, it suddenly appeared one day and then never left. He tried a few coping mechanisms but he would still freak out.

Then, it got worse:

“I had arranged a trip with three of my friends to visit Israel and Egypt. It was a huge trip for all of us and everyone was really excited about it. We got to the airport and we’re sitting in the lounge- minutes away from our departure time - and the panic hit me. There was no way I could get on the flight and I had to turn to my friends and tell them so. That was the moment when I knew that I had to do something about this.”

About a year after Josh experienced that first panic attack in front of his church, a doctor from his congregation approached him about Propranolol. This doctor had listened to Josh, who had become very open about his anxiety attacks, share his story and had even witnessed Josh struggle to speak firsthand.

Josh had no reservations about giving it a try. He got a prescription from his doctor and took it the next week before standing up to speak.

The difference was immediate.

His racing heart slowed and his breathing remained even. Though Josh still felt his nerves, the beta-blockers kept them from getting in his way, allowing him to speak calmly and confidently:

“Whenever I have an anxiety attack, I can feel it start to come on. I can feel it coming, I know it’s coming, and that freaks me out even more. There have been moments when I’m getting up to deliver a sermon when I can feel the tiny beginnings of one coming on. But even as I’m publicly presenting, in the back of my mind I have an immediate thought of ‘Oh no, I took my Propranolol and I’m going to be fine’. And my breathing will even out and it just passes. And I move on.”

Though Josh found beta-blockers to be the answer to squashing his anxiety while speaking, they weren’t the right fit for him when it came to calming his nerves during flights. Backing out the last minute of his trip to Egypt and Israel was the last straw for Josh. He finally went to see his doctor about his anxiety attacks, who prescribed him Xanax for flying.

Josh still considers himself to be a nervous flyer, but his medication keeps him calm enough to make it through the flight without experiencing panic.

Josh only takes Propranolol before delivering his sermons on Sunday mornings. And he only takes a Xanax if he feels panic beginning to creep up during a flight.

Both situations cause anxiety attacks that leave his heart racing and a breathless feeling.

But each requires something different to help him remain calm.


What Is Propranolol?

Propranolol, a type of non-selective beta-blocker, is a medication that was created for people suffering from heart conditions and high blood pressure.

But taken in smaller doses, it can prevent the stress hormone norepinephrine, or adrenaline, from being released throughout the body. This prevents common physical symptoms of nerves, including shaky hands, rapid heartbeat, and breathlessness.

Unlike other anti-anxiety medications that are used to treat disorders such as generalized anxiety disorder or panic disorder, beta-blockers are used for situational anxiety. Rather than being taken every day, they are prescribed on an as-needed basis with most patients only needing them temporarily.

Propranolol does not affect the chemicals in your brain as a benzodiazepine can. Though you’ll still feel nervous, your body won’t exhibit any physical signs of that stress. Often, this can help people suffering from performance anxiety feel calmer and more confident.

In some cases, it’s even been prescribed by doctors to tackle social anxiety.

Propranolol, sometimes known under the name Inderal, has been used for decades by some of the world’s top performers to help quell the physical signs of nerves during a performance. The Royal College of Music London reported that 72% of classical musicians said they had used beta-blockers, and 92% believed they were the most effective treatment for performance anxiety.

For Pam, beta-blockers made all the difference in the world:

“I was amazed the first time that I could feel the anxiety in my brain but not in my body. I just didn’t have that feeling that I was going to blackout and that I wouldn’t be able to think straight. So I had what I would consider healthy anxiety. Anxiety like you’re pumped; you can use it, you can get through whatever it is you’re trying to get through, and it being there just isn’t a big deal. Beta-blockers really helped me get past my speaking anxiety and really changed the trajectory of my whole career. Now, I give speeches and presentations all of the time and don’t even think twice about it.”


What Are The Side Effects Of Propranolol?

For those who are taking small doses of beta-blockers for performance anxiety, side effects are rare. However, they can sometimes cause people to experience the following:

  • Slowed heart rate
  • Hair loss
  • Dry eyes
  • Nausea
  • Weakness or fatigue
  • Breathing problems
  • Changes in blood pressure
  • Vomiting

Additionally, Propranolol and alcohol shouldn’t be mixed together as this may increase your chances of experiencing negative side effects.


How Long Does Propranolol Stay In Your System?

In general, Propranolol leaves your system totally after about 2 days. However, its effects wear off much sooner.

There are several other factors that can affect how long it takes for the medication to leave your body, including:

  • The speed of your metabolism
  • Your weight
  • Your height
  • Your body fat content
  • Your age
  • The health of your liver and kidneys
  • The amount of medication taken
  • How long you’ve taken your prescription for


Who Shouldn’t Use Propranolol?

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 consult a medical professional to ensure a prescription is a safe treatment option for you.


How Is Propranolol Dosed?

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

When used for heart and blood pressure conditions, Propranolol is given anywhere from 100-240 mg per day.

But when used to minimize the symptoms of anxiety, a much smaller dose is required, usually around 10 mg per use. Microdosing the drug in this way often allows patients to get the benefits of the medication, without experiencing a full-body effect.

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


Can Propranolol Be Abused?

Beta-blockers are not a controlled substance. They are considered to be non-addictive and are non-narcotic.

For Pam, Propranolol has been a safe way to overcome her anxiety:

“As the years went on, I had this routine where I would take beta-blockers even if I had to prepare because the preparation was making me so anxious. And as I did that more and more, I didn’t need them to prepare because I wasn’t as anxious anymore. I would still use beta-blockers during a big presentation, but as time went on, I needed it much less there as well. Now, I can prepare and present without taking a beta-blocker and do just fine.”


Xanax Or Propranolol For Anxiety: Which Is Better?

Though both Xanax and Propranolol are used to treat anxiety, they are each most effective for different types of anxiety. It’s important to consult with your doctor to determine which is right for you.

For Josh, he believes that each works for him but in very different situations. Beta-blockers are a lifesaver for him when he’s delivering a sermon or officiating a wedding but notes that they just don’t work the same when he’s about to get on a plane. Xanax, on the other hand, is the exact thing he needs to get through a flight without panic but makes him too tired to use it before a speech.

It’s all about using the right thing at the right time.

If Pam could change anything about her own experience, it would be asking for help earlier on:

“The reason I’m so passionate about this is that I wish I had known about these options earlier. It’s not just that you have to deal with the fear of whatever it is you’re afraid of, that fear can also limit your career choices. There may be people who want to go into performing or teaching or litigation or whatever it is they want to do who feel they just can’t because their nerves simply get in their way.”

Both of these are prescription medications 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 either is an appropriate treatment option for you.
  2. Go to a psychiatrist to discuss if either drug may be the right treatment for you.
  3. For those who are 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 history to be 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.
Interested in finding out if Propranolol is right for you? Get started now with a quick online consultation with one of our licensed doctors to get your personalized prescription.

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