Big presentation at work? Propranolol. A first date with someone who seems just a little too attractive? Propranolol.
Giving a wedding speech, attending a job interview or enduring an awkward family gathering where your aunt asks when you are having another child? There is now a small pill promising to take the edge off — and it seems to be everywhere.
Propranolol is a beta-blocker commonly available in 10mg and 40mg tablets. It has become something of an underground phenomenon among people desperate to prevent their bodies from revealing their nerves at exactly the moment they want to appear composed.
You may recognise the sensation. Your heart begins pounding as if it is trying to break free from your ribcage. Your hands tremble, your voice falters and your face turns an unmistakable shade of red just as someone asks an entirely ordinary question.
All the while, your mind helpfully insists that everyone in the room is watching — and will later dissect your performance on Slack.
That is where propranolol enters the picture.
Propranolol works by blocking the effects of adrenaline on beta receptors. It slows the heart rate and may reduce some physical symptoms associated with anxiety.
Unlike antidepressants, which may be prescribed to manage anxiety over a longer period, propranolol works by blocking the effects of adrenaline on beta receptors.
By slowing the heart rate, it can ease some of the physical symptoms linked to anxiety, including palpitations, shaking and sweating.
Put simply, it may help stop the body from reacting to a routine work meeting as though it were a matter of life or death.
Small enough to carry in a handbag or coat pocket, propranolol has taken on the appeal of a discreet superpower.
For people who dread public speaking, job interviews or other high-pressure situations, the possibility of easing those physical symptoms is understandably attractive.
Increasing numbers of people appear to be seeking it out.
US health authorities estimate that prescriptions for propranolol have risen by 28 percent since 2020, reaching roughly 10 million prescriptions a year among 2.8 million patients.
Those figures include every use of the drug, not only anxiety, and do not account for all purchases made through private channels.
Propranolol has become a talking point on social media, where videos and personal testimonials have helped present it as a potential quick fix for nerves.
It is easy to see why. Propranolol has become a regular topic on social media, with videos and personal testimonials helping to frame it as a possible quick fix for nervousness.
The relevant hashtag has reportedly attracted more than 55 million views on TikTok, while celebrities including Khloe Kardashian and Chelsea Handler have publicly mentioned or endorsed the medication.
Two of my friends now take it. One was prescribed propranolol by her primary care physician. The other bought it online because, ironically, she was too anxious to discuss the medication with a doctor.
I was baffled. Surely a medication that can affect heart rate and blood pressure could not really be so easy to obtain with nothing more than an internet connection and a debit card?
Wrong.
A quick Google search showed several websites offering propranolol pills after a short online questionnaire covering general health, date of birth and doctor details.
The website I chose advertised same-day delivery and offered a 10 percent discount code. It asked for the name and address of my doctor, but I have found no evidence that my practice has been contacted.
The tablets cost about $48 for a pack of 28 10mg pills and arrived a few days later. From the initial search to purchasing propranolol, the process took just five minutes.
Where was the safeguarding? Had anyone properly assessed whether the drug was suitable for me? Had my medical history been reviewed by an appropriately qualified prescriber?
I have low blood pressure myself. Yet, during my experience of buying the medication online, I was concerned that this risk had not been adequately addressed.
Common side effects include dizziness, tiredness, cold hands and feet, and sleep disturbances.
Because the drug slows the heart rate and can lower blood pressure, it may be unsuitable for people who already have low blood pressure. It can also be problematic for people with asthma and certain other medical conditions.
To be clear, buying prescription medication online is not inherently unsafe or illegitimate. Reputable online services can provide legitimate treatment.
But a questionnaire, safety guidelines pamphlets and payment do not demonstrate that a proper, individual clinical assessment has taken place.
And propranolol is not a medicine that should be prescribed on autopilot: US pharmacy guidance specifically identifies it as a drug requiring additional safeguards when supplied online.
Nevertheless, patients and clinicians continue to discuss its use, particularly when symptoms such as a racing heart and trembling become overwhelming in specific situations.
‘In my experience, the people who find propranolol helpful are usually those whose anxiety shows up mostly in the body, with palpitations, shaking and a pounding chest,’ says Dr Daniel Gordon, private family doctor and managing director at DGA Health.
‘Settling those sensations can break the cycle where the physical symptoms feed the fear, and some people feel more in control as a result.
‘But feeling calmer in the body is not the same as treating anxiety, and for many people talking therapies, and sometimes other medicines, are the foundation.
Daniel Gordon, who is a private doctor at DGA Health, recommends propranolol for those whose anxiety shows up in the body but warns against taking it without undergoing an assessment
‘The evidence available on propranolol is also thinner than its viral reputation suggests.
‘A systematic review of eight small randomized trials, covering around 200 people, concluded that the evidence was insufficient to support routine use of propranolol in any anxiety disorder, with most studies small, often older and at risk of bias.
‘Some people do report relief of physical symptoms, but [health authorities] do not recommend propranolol for anxiety, and we lack large, modern, well-designed trials.
‘This is exactly why proper assessment matters.
‘Propranolol should generally not be used by people with asthma, certain heart rhythm problems such as heart block, a very slow heart rate or low blood pressure, and it can mask the warning signs of low blood sugar in people with diabetes.
‘It can also interact with other medicines, so a clinician needs to check your history, your current medication and how you have been feeling in yourself before it is prescribed,’ says Gordon.
To be clear, propranolol can be a genuinely helpful medication for some people when prescribed appropriately.
But there is a world of difference between a clinician assessing your medical history and an online transaction that leaves you wondering whether anyone has properly considered the risks.
There are ways to manage anxiety, from psychological therapies such as cognitive behavioral therapy to medical treatment where appropriate.
If your symptoms are affecting your work, relationships or everyday life, speaking to your primary care physician is a far better starting point than taking medication prescribed for somebody else or buying it without a proper assessment.
Because while the promise of silencing your racing heart is undeniably tempting, the longer-term answer may lie in understanding why the moment feels so frightening in the first place.
As for the pills I bought online, they remain unopened in my bedside drawer. I have low blood pressure, and I am not prepared to gamble with my health to find out whether they would take the edge off my nerves.
Our health deserves more than a few clicks and a discount code.
