A little blue pill designed for the heart is now a fixture in Hollywood dressing rooms, award ceremonies, and even on first dates. It's not Viagra, but propranolol – a beta blocker medication that A-list celebrities are increasingly using off-label to manage anxiety and nerves.
The Celebrities Embracing Beta Blockers
This year, actors including Kristen Bell, Rachel Sennott, and Natasha Rothwell have openly discussed taking beta blockers to cope with the pressures of red carpet events. They follow in the footsteps of other high-profile figures.
In 2022, Khloe Kardashian admitted to borrowing her mother's pills to calm her nerves. The trend gained further attention at last year's Golden Globe awards, where Robert Downey Jr. joked to the audience, "I took a beta blocker, so this will be a breeze."
From Heart Medicine to Anxiety Aid: How It Works
Originally developed in the 1960s to treat heart conditions like high blood pressure and angina, beta blockers such as propranolol and atenolol work by blocking the effects of adrenaline. Adrenaline triggers the body's fight-or-flight response, causing physical symptoms like a racing heart, sweating, and trembling.
By attaching to beta receptors in the heart, these drugs prevent adrenaline from exerting its usual effects, leading to a slower heart rate and weaker contractions. This process lowers blood pressure and, crucially for performers, reduces the visible physical symptoms of anxiety.
The use for anxiety was first noted in 1965 during trials for hyperthyroidism. While licensed for anxiety in the UK, propranolol is often prescribed off-label in the US, as it remains unapproved by the FDA for this specific purpose.
Effectiveness, Risks, and the Prescription Reality
Research on propranolol's efficacy for anxiety presents a mixed picture. One study found patients had significantly lower anxiety and depression compared to a placebo group. Another showed both 20mg and 40mg doses led to noticeable improvements.
However, a recent evidence review concluded that while it may help physical symptoms, proof it outperforms other anxiety medications is limited, with many trials being small or low quality.
A key advantage over drugs like Valium is that propranolol is not addictive and doesn't cause sedation or euphoria. But it is not risk-free.
Common side-effects include:
- Dizziness and fatigue
- Cold hands and feet
- Vivid dreams
More serious, though rare, risks include heart failure, breathing difficulties, and allergic reactions. It is often unsuitable for people with asthma, diabetes, or certain heart conditions. There have also been increasing cases of propranolol overdose, which can dangerously slow the heart and cause seizures.
Despite not featuring in some national guidelines, doctors are increasingly prescribing it as a pragmatic, short-term option, particularly for those on long waiting lists for therapy or reluctant to take antidepressants.
Experts like Dipa Kamdar, a Senior Lecturer in Pharmacy Practice at Kingston University, emphasise that beta blockers address the body's response, not the psychological root of anxiety. They might steady hands for a speech but won't cure persistent worry. For ongoing anxiety, treatments like cognitive behavioural therapy remain the recommended first-line approach in the UK.
Ultimately, propranolol is a beta blocker, not a bravery pill. It may stop your hands from shaking, but it won't magically fix a fear of public speaking or guarantee a smooth first date.
