7 Differences Between Propranolol and Xanax for Anxiety

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Anxiety disorders are the most common mental health condition. There are several types. All involve experiencing worrisome thoughts that interfere with your daily life.

Many medications can treat anxiety disorders. But the best one for you depends on several factors. These include your personal preferences, health conditions, and other medications you take. Here, we'll compare differences between two anxiety medications:propranolol versus Xanax (alprazolam).

1. Xanax is FDA approved to treat anxiety, but propranolol isn't

Xanax is FDA approved for generalized anxiety disorder (GAD) and panic disorder.

Propranolol isn't FDA approved for any type of anxiety. But it's sometimes used "off-label" to help with the physical symptoms of anxiety. Propranolol is FDA approved to treat high blood pressure, migraines, and tremors. It's also approved for heart conditions, such as atrial fibrillation and chest pain.

2. Xanax and propranolol treat different types of anxiety

Xanax is part of a group of medications called benzodiazepines. They treat a range of anxieties, including GAD, panic disorder, and social anxiety. Depending on which benzodiazepine you're taking, anxiety may be an off-label use. Regardless, benzodiazepines aren't first-choice options for anxiety. And they're meant to be used for only a short period of time. This is because they have significant risks, including misuse and overdose.

Propranolol is typically reserved for performance anxiety, a specific symptom of social anxiety. Performance anxiety is a strong and persistent fear about speaking in public. Propranolol may lessen physical symptoms of performance anxiety. But it doesn't treat the anxiety itself.

Some evidence suggests propranolol can be used to treat chronic anxiety and post-traumatic stress disorder.

3. Xanax and propranolol work in different ways

Xanax and propranolol are similar in that neither medication works to eliminate anxiety. This isdifferent from selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs), which can decrease your anxiety over time. This is why SSRIs and SNRIs are first-choice medications for anxiety. Xanax and propranolol are not.

But when comparing propranolol versus Xanax, they work differently. Xanax works by affecting a brain chemical called gamma-aminobutyric acid (GABA). It increases the effects of GABA, which calms your body. This can help treat panic, trouble sleeping, and tension, which can be symptoms of anxiety.

Propranolol works by blocking stress hormones (epinephrine and norepinephrine) from acting on certain receptors (binding sites) in the body. This helps ease performance anxiety. When you experience anxiety, your body produces more of these hormones. But by blocking the receptors they bind to, propranolol can treat shakiness, sweating, and a fast pulse.

4. It's hard to say whether Xanax or propranolol is a better option for anxiety

It's not possible to say whether Xanax or propranolol is a better option for your anxiety. The anxiety treatment that's best for you depends on several factors. These include personal preferences, other conditions, and the type of anxiety you have. Plus, the only studies we havecomparing benzodiazepines with propranolol are from the 1980s and 1990s. They looked at treating panic disorder only. These studies didn't find a difference between benzodiazepines and propranolol.

Xanax and propranolol are not first-choice medications for anxiety. Benzodiazepines, like Xanax, are effective at treating anxiety. But their risks often outweigh the benefits. That's why it's typically used only as needed or on a short-term basis. It may be taken with first-choice medications, like SSRIs. This combination may improve anxiety symptoms, such as panic attacks.

For propranolol, wedon't have a lot of research to compare it with other medications. But in the real world, people report that it helps relieve physical symptoms of anxiety.

5. Xanax and propranolol are dosed differently

When used for anxiety, Xanax is taken a few times a day. Propranolol is taken about an hour before an anxiety-inducing event.

Your Xanax or propranolol dosage may vary. Ask your prescriber about how they expect you to take your anxiety medication. Taking it correctly can help prevent side effects and keep you safe.

Also, ask your prescriber how long they expect you to take your anxiety medication. Medications like Xanax and propranolol aren't typically used long term.

6. Xanax can be habit forming, but propranolol isn't known to be

Xanax, along with other benzodiazepines, are known to be habit forming. They're controlled substances because of their potential for misuse. And there are restrictions on how they're prescribed and refilled. Also, taking Xanax long term, or taking high doses, increases your risk for dependence and misuse. This can increase your risk of a benzodiazepine overdose, which is life-threatening.

Propranolol isn't a controlled substance, and it's not known to be habit forming.

If you or someone you know struggles with substance use, help is available. Call the Substance Abuse and Mental Health Services Administration's National Helpline at 1-800-662-4357 for resources in your area.

7. Propranolol and Xanax have different side effects

Propranolol and Xanax have some common side effects, such as drowsiness and dizziness. Butpropranolol may also cause slow heart rate, low blood pressure, and nausea. Sleep issues may also occur. Propranolol can also mask symptoms of low blood glucose (hypoglycemia).

OtherXanax side effects may include trouble with coordination, memory problems, andlow libido. Misuse and overdose can also happen.

Propranolol and Xanax side effects may be more likely if you take certain other medications. For example,propranolol may interact with ibuprofen (Advil, Motrin), Adderall (mixed amphetamine salts), and rizatriptan (Maxalt).Xanax can interact with opioids like oxycodone (Roxicodone, Oxycontin), sleep medications like Ambien (zolpidem), and seizure medications like carbamazepine (Tegretol). And propranolol and Xanax can interact withsome of the same medications and substances,including alcohol.

How your prescriber decides: Propranolol vs. Xanax

Xanax and propranolol are not first-choice treatment options for anxiety. So you'll likely try other medications first. But if your prescriber thinks Xanax or propranolol is a good option for you, they'll know which to recommend. This is because they're used in different situations.

For example, if you're struggling with performance anxiety, propranolol may be a better (and safer) option. But if you have GAD with frequent panic attacks, and you need something to help while your SSRI or SNRI kicks in, Xanax might be a short-term option.

Your medical history can also help determine if Xanax or propranolol is a good option for you. If you have a history ofsubstance use disorder, Xanax probably isn't the best anxiety treatment for you.

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