A recent article in the Pharmaceutical Journal highlights the dangers of propranolol used for anxiety, in particular the overdose risk in young people aged under 25 years. Although propranolol is licensed for the treatment of anxiety symptoms, such as palpitations, sweating and tremor, it is not recommended by NICE for generalised anxiety disorder or panic disorder in adults, and the British Association for Psychopharmacology warns that propranolol is neither safe nor effective for anxiety disorders due to its significant side effects and danger in overdose.
The medicines optimisation team recommend that prescribers should avoid initiating new prescriptions and consider the following measures for repeat prescriptions:
· Check patient’s history for evidence of suicidal ideation and self-harm (particularly overdosing)
· Review regularly
· Prescribe the lowest effective dose
· Limit the quantity of tablets prescribed
The team also advised prescribers to review people who have been prescribed propranolol and who have increased risk factors (for example, anyone co-prescribed antidepressants).
Prescribers should be aware of the high prevalence of psychiatric comorbidities associated with a diagnosis of migraine, which is another common indication for prescription of propranolol. It is thought that people with depression and migraine could be at an increased risk of using propranolol for self-harm, and co-prescribing of an antidepressant may increase the risk of toxicity in cases of overdose and cardiac side effects.