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Nebivolol for anxiety: Doses, benefits, and risks

Some doctors prescribe nebivolol off-label for anxiety. Learn about typical dosing and how it compares to other beta blockers.
Rebecca Rovenstine writer headshot
By | Jul. 10, 2025 Medically reviewed by Anne Jacobson, MD, MPH
Rx pill bottle: Nebivolol dosage for anxiety symptoms

Key takeaways

  • Nebivolol is a beta-blocker used to treat hypertension, but it may be prescribed off-label to treat physical symptoms of anxiety.

  • The usual dose of nebivolol for anxiety ranges from 1.25 mg to 5 mg, though there are no exact dosing guidelines since it’s not FDA-approved to treat anxiety.

  • Most people tolerate nebivolol well, but some may experience side effects. Some of the most common side effects include headache, dizziness, and weakness.

In this article:

It’s estimated that around 19.1% of adults in the U.S. have an anxiety disorder in a given year. It’s not just a person’s emotions and thoughts that anxiety affects. These intense feelings of unease can also come with physical symptoms, like a racing heart, sweating, and shaking. 

One option doctors may prescribe for certain forms of anxiety is nebivolol. Nebivolol, sometimes sold under the brand name Bystolic, is a prescription beta blocker originally intended to treat high blood pressure. However, it can also help calm the body’s physical response to anxiety. 

What is nebivolol?

“Nebivolol is a beta-blocker. These are a class of medications typically used to treat high blood pressure and certain heart conditions,” said Dr. Charles Sweet, a board-certified psychiatrist and medical advisor for Linear Health. He continued, “It primarily works by blocking beta-1 adrenergic receptors in the heart, which slows the heart rate and reduces the force of contraction, ultimately lowering blood pressure.”

While the U.S. Food and Drug Administration (FDA) approved nebivolol for the treatment of hypertension (high blood pressure), physicians may prescribe nebivolol off-label for anxiety. Off-label means a healthcare provider prescribes a medication to treat something other than what it is FDA-approved for. 

Nebivolol can help reduce physical symptoms like rapid heartbeat, sweating, and restlessness. But the jury’s still out on the effectiveness of beta blockers to treat anxiety. A systematic review and meta-analysis in 2024 found that there was “no evidence for a beneficial effect of beta blocker compared with either placebo or benzodiazepines.” However, those researchers also determined that more evidence was needed.

A 2024 study of general practitioners in Australia found that beta blockers are seen by some healthcare providers as lower-risk alternatives to anti-anxiety medications like Valium and Xanax. Beta blockers don’t pose a risk of addiction like benzodiazepines do, but they may not act as fast. Another reason beta blockers may be given is that there is less stigma for patients who don’t want to take a “mental health drug.”

One drawback of nebivolol is that it can be quite expensive without insurance. On average, the retail price of the generic version, nebivolol HCl, is $458 per 90, 5 mg tablets. The name-brand, Bystolic, can have an average retail price of about $703 for 90, 5 mg tablets.

Nebivolol dose for anxiety

“There is no standardized or FDA-approved dosage of nebivolol for anxiety, but when used off-label, doctors may prescribe lower doses than for hypertension,” explained Dr. Sweet.

The recommended dosage for blood pressure is 5 mg to 10 mg of nebivolol daily, but for anxiety, it’s more commonly a small dose. The nebivolol dosage for anxiety typically ranges from 1.25 mg to 5 mg per day. A starting dose for anxiety issues usually begins at 1.25 to 2.5 mg and will be titrated (adjusted) up to 5 mg, depending on tolerance.

Condition  Dosage of nebivolol
Hypertension 5 mg to 10 mg daily
Anxiety disorder 1.25 mg to 5 mg daily

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If a person has situational anxiety triggered by certain social events and places, they may take nebivolol as needed beforehand, but it would have to be several hours ahead of the occasion. There are other beta blockers that are more commonly prescribed for situational anxiety, such as propranolol. 

“[Nebivolol] is not recommended for PRN (as needed) use due to its longer half-life and more gradual onset of effect, which typically takes about 1 to 2 hours to become effective,” explained Dr. Ritu Goel, a board-certified psychiatrist in Los Angeles at MindClaire. “Maximum therapeutic benefits usually emerge after consistent daily usage.”

Nebivolol reaches peak plasma concentrations 1.5 to 4 hours after taking it. The half-life, or the amount of time it takes for the drug’s active ingredients to be reduced by half within the body, can take 12 to 19 hours. When nebivolol is used to treat hypertension, it can take up to two weeks to lower blood pressure.

 Nebivolol is typically used as a short-term treatment for anxiety symptoms, as it does not address the underlying cause of anxiety disorders. Psychotherapy, like cognitive behavioral therapy (CBT), and other medicines, like selective serotonin reuptake inhibitors (SSRIs), have shown better effectiveness at treating anxiety.

Nebivolol safety

Nebivolol is generally well tolerated, especially at lower doses. But as with any medication, there are side effects that could occur. Common side effects of nebivolol include:

  • Headaches
  • Dizziness
  • Insomnia
  • Weakness

There are certain people who should not take nebivolol or use it with caution. Those with low blood pressure, slow heart rate, certain heart rhythm problems, or other severe cardiovascular disorders, including heart failure, may not be good candidates for this medicine. Individuals with a medical history of diabetes, liver or kidney disease, myasthenia gravis, asthma, COPD, and thyroid disease could also have a higher risk of adverse effects.

It’s also a good idea to give a complete list of the medications you’re taking to your healthcare provider and pharmacist, as there can be drug interactions with nebivolol. This can include certain blood pressure medications, antidepressants, heart rhythm drugs, and medications that are CYP2D6 inhibitors.

For people who take nebivolol daily, it’s important to stop it only under the guidance of a qualified healthcare professional. Rapid withdrawal of blood pressure drugs may lead to increases in blood pressure (sometimes higher than pretreatment levels), irregular heartbeat, angina (severe chest pain), and tremors.

Is nebivolol right for you?

“Nebivolol is suitable for individuals who experience anxiety with prominent physical/somatic symptoms, such as performance anxiety or social anxiety with noticeable physiological responses, like sweating, increased heart rate, and palpitation,” said Dr. Goel.

It may not be a good fit for those experiencing side effects or with certain health conditions. Again, nebivolol treats some of the physical symptoms of anxiety but not the mental or emotional ones. The high price tag of nebivolol may also make it less accessible. However, if it’s the price of nebivolol that’s holding you back, a SingleCare coupon can significantly reduce the cost. 

To know whether nebivolol would be a good option for your specific needs, consult with your healthcare provider. They can go over your options for anxiety treatment, including medication, therapy, and lifestyle changes, and answer any questions you have about your health conditions to get the best personalized treatment.