UK health authorities are initiating a safety review of propranolol, a common beta blocker prescribed off-label for anxiety, following a concerning rise in overdoses and fatalities associated with the drug. The review comes amid a significant increase in prescriptions, particularly among young women and adolescents.
Experts from the Royal College of Physicians and the Royal College of Pharmacy have called for an end to prescribing propranolol for anxiety, citing a lack of proven efficacy and the serious risks involved. In the 2022-2023 period alone, over 300 intentional overdoses of the drug were reported in the UK, resulting in 12 deaths.
The drug, typically used for high blood pressure and heart conditions, works by slowing the heart rate. While it can alleviate physical symptoms of anxiety such as sweating and shaking, medical professionals argue that its benefits for generalized anxiety do not outweigh the significant dangers. The National Institute for Health and Care Excellence (NICE) does not recommend beta blockers for anxiety, though doctors can prescribe them "off-label."
Co-chairs of the Royal Colleges, Dr. Zuzanna Sawicka and pharmacy specialist Kate Ryan, stated in a letter that propranolol is "of no proven efficacy for treatment of generalised anxiety." They expressed concern that GPs may perceive beta blockers as less risky than alternatives like benzodiazepines, which are known for their addictive properties. However, they warned that exceeding recommended doses of propranolol can lead to life-threatening poisoning that is difficult to treat.
Adding to the concern, the number of prescriptions for propranolol has surged. Prescriptions for girls aged 12 to 17 increased by over 92% in the last decade, reaching 1.1 million in 2025. Similarly, prescribing rates for women aged 18 to 23 rose by over 81% in the same period. The majority of these prescriptions were for anxiety.
The drug's popularity has also been amplified by public endorsements from celebrities. Figures such as Emma Watson, Khloe Kardashian, Dame Prue Leith, Robert Downey Jr., and Rachel Sennott have spoken about using beta blockers for performance anxiety or stage fright. Watson has reportedly expressed regret over taking the medication, while Sennott and Downey Jr. have mentioned using it before public events.
The Medicines and Healthcare Products Regulatory Agency (MHRA) will now review the available data on propranolol's harms and overdose risks. The experts emphasize that patients at increased risk of overdose, including those taking antidepressants or who have previously overdosed, continue to be prescribed propranolol. They believe the MHRA has the authority to mitigate harm by updating warnings associated with the drug.
While not suitable for everyone, common side effects of beta blockers include tiredness, dizziness, and fainting. Inappropriate or high doses can cause a dangerously slow heart rate. The risks are amplified when the medication is obtained from unregulated sources. Medical professionals also advise that long-term use of beta blockers for anxiety is debated, and sudden discontinuation can lead to exacerbated heart problems and withdrawal symptoms such as irregular heart rate and increased sweating.
Patients are advised to consult with their doctors before taking propranolol, as individuals with conditions like asthma or COPD may face higher risks of side effects and complications.