Atenolol vs. propranolol: Which is better for anxiety?

In this article:

• What is atenolol?
• What is propranolol?
• Comparison
• Side effects
• Interactions
• Warnings
• Which one is right for you?

In this article

• What is atenolol?
• What is propranolol?
• Comparison
• Side effects
• Interactions
• Warnings
• Which one is right for you?

Atenolol and propranolol aren’t traditional anxiety meds like SSRIs—rather, they’re blood pressure medications called beta blockers—but they prevent the action of epinephrine (adrenaline), reducing anxiety’s physical symptoms. 

Which one is better? It all depends on the patient’s condition, medical history, and other medications. Read on for a thorough examination of atenolol and propranolol’s key similarities and differences. 

What is atenolol?

Atenolol (brand name: Tenormin) is a cardioselective beta blocker, which means it blocks the body’s beta-1 receptors, primarily around the heart. This prevents chemicals like epinephrine from binding to the receptors and taking effect. Atenolol’s main benefits are cardiovascular, like relaxing the blood vessels and slowing the heart rate, so it’s only FDA approved to treat high blood pressure (hypertension), heart attacks (acute myocardial infarction), and chest pain related to cardiovascular conditions (angina pectoris). 

However, atenolol’s adrenaline-blocking action can also curb the body’s fight-or-flight symptoms, like a racing heart or tremors. That’s why doctors may prescribe it off-label for anxiety. In one 2020 study, 86% of patients with anxiety disorders, trauma-related disorders, and post-traumatic stress disorder reported positive effects while taking atenolol. The typical dose of atenolol for anxiety is 10–40 mg, three times per day. 

What is propranolol?

Propranolol (brand names: Inderal, InnoPran XL, Hemangeol) is also a beta blocker, so it functions much like atenolol in the body. However, it’s a non-cardioselective beta blocker. While cardioselective beta blockers like atenolol target the beta-1 receptors, which are mainly around the heart, non-cardioselective ones like propranolol target beta-2 receptors as well. Beta-2 receptors are found in tissues throughout the body, rather than just the heart and blood vessels. 

Like atenolol, propranolol is FDA-approved to treat hypertension, heart attack, and chest pain. It’s also approved for essential tremors, migraine prevention, hypertrophic subaortic stenosis, and an adrenal gland tumor called pheochromocytoma. Doctors may prescribe it off-label for performance anxiety or stage fright, and although there is some evidence to support this use, researchers have concluded that it’s insufficient to make an official determination on its effectiveness. 

For anxiety, propranolol’s starting dosage is typically 10–40 mg, but this depends on the patient’s health, conditions, other medications, and more. 

How do they compare?

Both of these drugs can treat the physical anxiety symptoms of anxiety, but it’s important to note that they don’t treat the psychological or emotional symptoms, like racing thoughts, dread, or agitation. So they might not be the best option for someone whose anxiety manifests primarily in the mind. 

When it comes to adverse effects, “both medications carry potential, often dose-associated, side effects, such as dizziness and bradycardia,” says Dr. Jake Johnson, MD, founder of Integral Psychiatry. However, “propranolol crosses the blood-brain barrier more readily, potentially offering more central nervous system effects,” such as fatigue, dizziness, or sleep disturbances. 

Because of its effects on both the brain and the body, “for someone who wants something that eases both mental and physical symptoms, propranolol may be a better option,” says Dr. Randall Turner, DO, board-certified psychiatrist and medical director at Able To Change Recovery. “Atenolol might be preferred for people who want to avoid central side effects like fatigue or fogginess. Propranolol also has a shorter acting, which can be helpful if you only need relief for a few hours.”

Neither drug is exceptionally pricey, though. The average retail price for atenolol is $35 for 30, 25 mg tablets, while propranolol typically costs $40 for 60, 10 mg tablets. Health insurance may cover some of these costs if the doctor deems the medication medically necessary. But because anxiety is an off-label use, some plans might not cover it, or require prior authorization first. 

Atenolol vs. propranolol warnings

In most cases, atenolol and propranolol are safe and effective when used correctly. But that doesn’t mean they’re ideal for everyone. Individuals with certain medical conditions will typically want to avoid them. These conditions include:

• Bronchospastic conditions: “Propranolol, in particular, should be used carefully in people with asthma or other breathing issues because it can make those conditions worse,” Dr. Turner says. That also includes chronic obstructive pulmonary disease (COPD), emphysema, and lung infections.

• Certain heart-related conditions: Since they can slow the heart rate, these drugs are contraindicated for people with existing heart problems, such as bradycardia (slow heart rate), heart block, heart failure, and cardiogenic shock.

• Diabetes: Per Dr. Turner, “If you have diabetes, you will also want to be aware that beta blockers can hide symptoms of low blood sugar.”

• Thyrotoxicosis (overactive thyroid): While beta blockers are often prescribed to treat hyperthyroidism, they may also hide the symptoms of hyperthyroidism, and if you abruptly discontinue the drug, it may trigger a severe increase in thyroid hormones (called a thyroid storm). 

• Pregnancy: Some beta blockers are considered safe for pregnant women, but atenolol isn’t one of them, since it may harm the fetus. Propranolol has been linked to reduced fetal growth, but it’s unclear whether the medication or the underlying condition is the cause. 

• Hypersensitivity: Patients who have a known allergy or hypersensitivity to either drug should avoid them. 

Which one is right for you?

Both drugs have shown effectiveness in treating the physical symptoms of anxiety, and both can be pretty affordable. However, neither one is the best option for treating anxiety’s mental or emotional symptoms. In the end, the best choice depends on the specific person and what type of anxiety they have. 

“If you need quick relief before a one-time event, propranolol is often the go-to because it acts fast and calms both the mind and body,” Dr. Turner says. “If you are looking for something that lasts longer or want to avoid potential brain-related side effects, atenolol might be a better option.”

Additionally, if your healthcare provider says either one can work, you can start with one, see how it works, and switch down the road if you’re not satisfied. It’s key to talk it through with your healthcare provider. They know you and your anxiety, so they can help choose the one that will work best.