Searching for a Solution for Stage Fright…Metoprolol, Propranolol?

Musicians, actors, teachers and politicians may sometimes have one thing in common. They may feel anxious about appearing in public (well, maybe not the politicians). As a result, they’d like a solution for stage fright. We have welcomed a number of nondrug suggestions, including participation in Toastmasters for those who freeze up when they have to give a speech. Some readers rely on herbal approaches. If you consult a doctor about how to handle your stage fright, you might end up with a prescription for a beta blocker like metoprolol to slow your heart rate and keep your hands from shaking.

The Media is Promoting Metoprolol for Stage Fright:

Beta blockers are drugs such as atenolol, bisoprolol, labetalol, metoprolol, nadolol and propranolol. They have been prescribed for decades to treat heart conditions such as hypertension, irregular heart rhythms, angina chest pain, hypertrophic cardiomyopathy and migraine headaches. No beta blocker has received approval for stage fright.

But articles in the mainstream media suggest that beta blockers have become the latest medications to calm nerves, slow heart rate and make speeches less challenging. The most recent article appeared in The Wall Street Journal Magazine (September 2, 2025):

“The Pill That Women Are Taking for Everything From Speeches to First Dates”
“Influencers have described propranolol as a magic pill that eases nervous jitters in all kinds of settings. Prescriptions are on the rise, especially for young women.”

The author, Sara Ashley O’Brien goes on to write:

“Approved by the Food and Drug Administration in 1967 to treat symptoms of cardiovascular disease, propranolol has become the go-to pill for dealing with all sorts of stressful situations, from public speaking to first dates. Prescriptions are on the rise, up 28 percent from 2020, according to the most recent data from IQVIA, making propranolol—a generic drug that is relatively inexpensive—the fastest-growing pill in the category. By slowing down heart rate and lowering blood pressure, the drug can reduce the physical symptoms of anxiety, though it has not been approved by the FDA to treat the condition.”

Fox News Followed up on September 12, 2025:

“Common heart drug doubles as off-label anxiety aid, driving surge in prescriptions”
“Propranolol, originally developed for heart conditions, is now gaining popularity for treating performance anxiety”

The first sentence follows on the heels of the Wall Street Journal:

“Beta blockers are quickly becoming the hot new drug to combat anxiety.”

Back on April 3, 2025 Christina Carol wrote this article for the New York Times:

The title was:

“What Doctors Want You to Know About Beta Blockers for Anxiety”
“Start-ups are making it easier to get the pills online, but experts warn they should be used with caution.”

The first two paragraphs state:

“Anxious ahead of a big job interview? Worried about giving a speech? First date nerves?

“The solution, some digital start-ups suggest, is a beta blocker, a type of medication that can slow heart rate and lower blood pressure — masking some of the physical symptoms of anxiety.”

Please understand, beta blockers are being prescribed “off label” for performance anxiety. We have been writing about this issue for decades. Here are just a few of the questions we have received along with our answers:

Is Metoprolol a Solution for Stage Fright?

Q. I’ve read that beta blockers are being used for anxiety. I was given metoprolol for stage fright. It lasts only 12 hours and is better than atenolol, which lasts for 24 hours. I am an author and have terrible nerves making my voice shake, when I do public speaking. The medicine is wonderful for me.

A. For decades doctors prescribed anti-anxiety agents such as diazepam (Valium) or alprazolam (Xanax) to help people overcome stage fright. But these benzodiazepines can affect behavior and long-term use is often discouraged.

The first beta blocker, propranolol (Inderal), was approved in 1967. It is often prescribed for high blood pressure, angina, atrial fibrillation and other heart problems. The FDA approved the beta blocker metoprolol (Lopressor, Toprol XL) in 1978 for treating high blood pressure, angina pectoris and heart failure.

Many doctors are also prescribing such drugs off label to allay performance anxiety. They work, in part, by blocking the receptors for adrenaline. That’s the compound responsible for fight-or-flight symptoms like a rapid heartbeat. Beta blockers slow down the heart rate, which can help calm an overactive cardiovascular reaction along with cold clammy hands and a shaky voice.

You are right that beta blockers have become popular among performers to ease stage fright. But people with breathing problems such as asthma or COPD should avoid these drugs. Dizziness and sleep problems are also potential downsides. Patients with complicated heart problems should not take beta blockers unless approved by a cardiologist.

Trouble with Propranolol:

Metoprolol is not the only beta blocker. Some physicians have prescribed propranolol as a solution for stage fright. It can be helpful, but again, not everyone benefits.

Q. I love acting, but I suffer from stage fright. My doctor prescribed propranolol to ease my anxiety during a play.

Fortunately, I experimented during the final days of rehearsal. The first night, I couldn’t remember where I put my clothes during a scene change.

The second night, I couldn’t recall my lines. It was a very strange and frightening experience.

Instead, I took Benadryl an hour before going on stage and it took the edge off my anxiety.

A. Many people who love acting as you do also suffer from nerves or even debilitating stage fright. Others are gripped with fear when faced with a public speaking obligation.

Benadryl (diphenhydramine) is not an ideal solution for stage fright. This antihistamine can be very sedating and might interfere with your best performance.

Propranolol (Inderal) and other beta blocker heart medicines like atenolol (Tenormin) and metoprolol have been used for years by professional golfers and musicians to steady their nerves and hands. The PGA banned beta blockers in 2008 as part of its antidoping policy. While some people may find that a beta blocker is helpful for stage fright, it makes sense to test it before show time. You have plenty of company finding that this is not the ideal way to handle performance anxiety.

Another option is cognitive behavioral therapy. Although this may require several sessions with a trained therapist, the results are long-lasting.
Readers of this column also report the herb valerian can be quite helpful.

Here is one testimonial:

“I am a professional singer and my daughter does public speaking for her job. We both swear by valerian. It does the trick for nerves if you take it 15 minutes prior to performing or taking the podium.”

Please share your own experience with beta blockers in the comment section below. Because beta blockers like metoprolol and propranolol have been in the news a lot lately, please share this article with friends and family. Here is another perspective on beta blockers for hypertension. You will read about brain fog, fatigue, insomnia and nightmares, some side effects not mentioned in the articles promoting beta blockers for performance anxiety.