Beta blockers for performance anxiety: what they do and do not do

Your hands shake. Your heart is going before you have said a word. Your mouth is dry and the room has gone slightly too bright. If that happens before a presentation, an exam or a performance, you may have wondered whether a tablet could simply switch it off.

A beta blocker is the usual answer people have heard of. It can help with some of this, but not all of it, and it is not right for everyone.

The short version

• A beta blocker such as propranolol works on the body's physical response (a racing heart, shaking, sweating). It does not treat the worry itself.
• Trials in performers show it reliably slows the heart, but the evidence that it lowers anxiety or improves the performance is much weaker.
• It is a prescription medicine with real exclusions, including asthma, so it needs a conversation with your GP, not a borrowed tablet.
• If the fear keeps coming back, a talking therapy such as cognitive behavioural therapy (CBT) is the longer-term route.

What a beta blocker actually does

Take propranolol as the example. The NHS describes it as a beta blocker that slows your heart rate, and says it can help with the physical symptoms of anxiety, like sweating and shaking.

Notice what that sentence leaves out. It does not say the tablet calms the thoughts. The dread, the replaying of what might go wrong and the urge to avoid the event are still yours to deal with.

A steadier hand and a quieter pulse may still feel useful to some people, even when the worry is unchanged.

What the research shows

A 2019 systematic review of performance anxiety in professional musicians (Fernholz and colleagues, in Psychological Medicine) found that beta blockers consistently reduced heart rate. The results for performance quality were mixed, and people's own anxiety ratings often did not differ from placebo. The trials were small, mostly short and mostly single dose, and the review rated their quality as low. Its authors concluded beta blockers are an option only for the physical symptoms, and found stronger support for CBT.

A wider 2025 review (Archer and colleagues, in the Journal of Affective Disorders) looked at beta blockers for diagnosed anxiety disorders. It included ten studies, five of them pooled in the analyses (179 people in total), and found no evidence of benefit over placebo or over benzodiazepines in social phobia or panic disorder. The studies were small and many were at high or unclear risk of bias. The authors are clear this means benefit has not been shown, not that it has been shown not to work. They also note that prescribing for anxiety rose between 2003 and 2018 with no clinical guidance on it.

Not shown to work is not the same as shown not to work.

So a cautious GP is not being obstructive, and a GP who offers a short trial is not being careless. Both are reading the same thin evidence.

Who it is not suitable for

This is the part I would underline. The NHS lists people who should tell their doctor before starting propranolol, including anyone with lung disease or asthma, low blood pressure, a slow heart rate, worsening heart failure, diabetes, liver or kidney problems, poor circulation in the limbs, or a past history of depression or thoughts of harming themselves. The list also covers pregnancy and breastfeeding.

With a list that long, this should not be a tablet passed along by a friend or bought from an unregulated website.

Side effects and how it is taken

The NHS lists common side effects as headache, tiredness, dizziness, cold fingers or toes, feeling sick, and difficulty sleeping or nightmares. They are usually mild and short-lived. The first dose can cause dizziness, so you should not drive, cycle or use machinery if you feel dizzy.

That is why it is worth asking your GP about taking a first dose on an ordinary day, well before the event, rather than for the first time on the morning of it. You find out how you react while nothing is riding on it.

The NHS gives a usual adult dose for anxiety of 40mg once a day, and says it is normally used for a short time for the physical symptoms. If you have been taking it regularly, do not stop it suddenly. The NHS warns that this can cause an irregular heart rate, sweating and shaking. Your doctor will reduce the dose gradually.

What to ask your GP

Questions that make a short appointment go further:

• Is a beta blocker suitable given my other conditions and medicines, especially asthma, diabetes or blood pressure?
• Is this for one event, or a pattern that keeps coming back?
• Should I try a dose on a normal day first?
• What else would you suggest alongside it?

How to get the most from a short GP appointment about anxiety has more on using the time. If the physical symptoms come in waves unrelated to events, when to see your GP about anxiety covers when to get checked.

When the fear is the real problem

If the dread of the next event is bigger than the event, the tablet is working on the wrong end. The musician review found stronger support for CBT than for beta blockers, and a GP's honest take on medication vs therapy sets out that choice more broadly. For the evening before, the night before something you are dreading is the practical companion to this post. Separately, brightloaf's therapy is built around 20 minute sessions, rather than the usual 50 minutes.

Whatever you decide, check with your GP or pharmacist before combining a beta blocker with other medicines, and do not change a dose on your own.

This post is general information and not a substitute for personal medical advice. If you ever feel your life is in danger or you might harm yourself, call 999 or go to A&E, or call Samaritans free on 116 123, any time. brightloaf is not a crisis service.