How much propranolol to take for stage fright?

A viewer of AnxietyBoss messaged me about this question:

When I give a talk to my co-workers, my chest gets tight, my heart races and pounds, my voice shakes, my knees tremble, my face turns beet red, and I get butterflies in my stomach. Just wondering what is the optimal dose of propranolol for stage fright?

Here is my answer:

Propranolol can be effective at reducing the physical symptoms of anxiety when you have stage fright, or performance anxiety (Tyrer, 1988). Performance anxiety occurs when you have to perform in front of an audience, and you have the extreme fear that you will embarrass yourself and that the audience will scrutinize you and make fun of you. Performance anxiety can literally cripple you when you are giving a speech and presentation. It can also hamper you when you are having to play music, or act in a play, or compete in sports. Many people will have performance anxiety when taking tests, examinations.

Beta blockers such as propranolol are effective at reducing the physical symptoms of anxiety, as they block the effects of adrenaline. Adrenaline is released when the fight or flight response is triggered by anxiety, and adrenaline causes increased heart rate, palpitations, sweating, trembling, flushing (face turns red), voice trembling, muscle shaking, and butterflies in the stomach. These physical symptoms of anxiety are major barriers when you have to give a performance in front of an audience. Propranolol helps by blocking adrenaline receptors, and therefore it reduces the physical anxiety symptoms and it allows you to perform better.

The recommended dosage of propranolol for stage fright or performance anxiety is to take 20mg to 40mg about one hour prior to your performance. This should help you to get through your presentation. You should only take propranolol as needed- in other words, you don’t take propranolol everyday- you just take it whenever you have to perform. Propranolol has a short half-life, so it should wear off shortly after your performance. Make sure to take a test dose before you actually have to use it for your actual performance.

Follow-up with your doctor to discuss more on propranolol and anxiety.

Reference:

Current status of beta-blocking drugs in the treatment of anxiety disorders. Tyrer P. Drugs. 1988 Dec;36(6):773-83.

photo credit: byronv2 Edinburgh International Film Festival 2018 – McLaren Animation 02 via photopin (license)