PsychRounds: The Psychiatry Podcast The Anxiolytics: Propranolol (Inderal)
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Jul 16, 2025 Discover the intriguing off-label uses of Propranolol, particularly in treating anxiety disorders. The discussion reveals its impact on the central nervous system and how it may assist those with PTSD. Unique dosing guidelines and pharmacokinetics are explored, along with the mixed evidence surrounding its efficacy. The potential of Propranolol to reduce emotional intensity during memory consolidation is examined. The episode also covers clonidine's rapid effectiveness in anxiety treatment, leading to a lively appeal for listener engagement.
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Propranolol's CNS Penetration Is Unique
- Propranolol crosses the blood-brain barrier due to its lipophilicity, unlike some other beta blockers.
- This unique property is key to its psychiatric applications, especially in anxiety disorders.
Propranolol's Mechanism in Anxiety
- Propranolol blocks beta-1 and beta-2 receptors, reducing sympathetic nervous system activity.
- This action lowers heart rate, blood pressure, and physical anxiety symptoms but isn't FDA-approved for psychiatric use.
Limited Evidence but Popular Use
- Evidence for propranolol in anxiety disorders is limited and has methodological issues.
- It’s not recommended in major guidelines but remains popular anecdotally for performance anxiety.