Highlights

• Propranolol is a beta-blocking medication that’s well known to reduce the symptoms of anxiety.
• Because of that effect, propranolol is sometimes prescribed “off-label” to help men with ED deal with “stage fright” in the bedroom.
• While propranolol is well understood as a medication, there are important side effects and contraindications, and it should only be taken under a doctor’s advice.
• Mindfulness and mental health treatment are other ways to manage performance anxiety.

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Physicians sometimes prescribe Propranolol, a beta-blocker medication, to help alleviate sexual performance anxiety in men with erectile dysfunction (ED). However, it’s important to note that using propranolol for this purpose is considered an off-label application, meaning it has not been officially approved by the FDA for treating sexual performance anxiety.

Here’s a look at the benefits versus the risks of using propranolol for the treatment of performance anxiety caused by ED.

What Is Propranolol?

Propranolol is a beta blocker used to treat heart conditions. It blocks the channels that adrenaline and noradrenaline (also called epinephrine and norepinephrine) use to increase heartbeat. It’s most commonly used to help prevent a second heart attack in people who have had a first one and to keep the heart’s rhythm on an even keel. It may also be used as a second line in treating blood pressure.

One of the unexpected side effects of this, for reasons doctors are still trying to figure out, is that beta blockers can reduce the physical symptoms of anxiety. It’s so well known for this that some doctors in training will take it before their exams to help manage their own anxiety. While it’s not been studied extensively for this purpose, doctors may prescribe propranolol “off-label,” or outside its FDA-approved uses, for calming nerves before a performance.

Can Propranolol for Performance Anxiety Help in the Bedroom?

Performance anxiety and ED can go hand in hand. Men can worry that their partners are unsatisfied or that they aren’t living up to their “usual standard,” creating a spiral of worry that can leave men too anxious to be intimate. Propranolol has a place in treating this, largely by alleviating the symptoms of anxiety.

While it’s primarily prescribed for cardiovascular conditions such as hypertension and angina, propranolol has been found to be effective in reducing the physical symptoms of anxiety. It works by blocking the effects of adrenaline and noradrenaline to help calm the body’s fight-or-flight response, which is responsible for the physical symptoms of anxiety, such as rapid heartbeat, sweating, and tremors.

This may allow men with ED to feel more relaxed and focused during sexual activity, increasing their confidence and ability to achieve and maintain an erection.

A 2022 study of performance anxiety and PTSD found that propranolol reduces the physical symptoms felt in anxious situations, like stage fright, that interfered with performance. There’s plenty of anecdotal evidence of propranolol limiting these symptoms as well, so much so that it’s considered a performance-enhancing drug by some sports organizations, including the Olympics, which stripped an athlete of medals for using it in 2008.

There are several caveats to propranol’s use for performance anxiety, however:

• It is not an anxiolytic. The research indicates that propranolol isn’t an effective treatment for anxiety disorders. Remember that propranolol is a beta-blocker, not an anti-anxiety medication. If you have symptoms outside of performance anxiety, talk to your doctor about appropriate medications for thos symptoms.
• It does not help with premature ejaculation. Studies have found propranolol to have little to no effect on premature ejaculation, another common cause of performance anxiety in the bedroom.
• It can actually cause ED. Ironically, the biggest problem for some men is the fact that propranolol itself carries an ED risk as a side effect. The theory is that because propranolol can lower blood pressure, it can make it more difficult for the penis to get the blood flow it needs to sustain an erection. The exact incidence of ED as a side effect of propranolol isn’t available, although high blood pressure seems to be a key risk factor in those who develop the side effect.

Is Propranolol Safe?

Propranolol has been on the market since 1964, so its risks and benefits are fairly well understood. However, people with certain conditions should not take propranolol or should use it only under careful medical supervision. 

These precautions apply to individuals with: 

• Diabetes
• Reversible airway diseases like asthma or COPD
• Any form of heart or circulatory disease
• High or low blood pressure

Medication interactions are also a point of concern. Propranolol has a number of potential drug interactions, including antidepressants and common over-the-counter medications like nonsteroidal anti-inflammatory drugs (NSAIDs). For this reason, it’s only recommended to take propranolol when it’s prescribed to you by a doctor who knows your medical and family history.

Are There Alternatives to Propranolol?

Fortunately, there are several alternatives to propranolol for managing the symptoms of anxiety. Here are a few other ways to get similar results: 

• Mindfulness and meditation. Meditation has been extensively studied as a way to manage anxiety symptoms, improving performance in a wide range of activities.
• Exercise. A consistent exercise routine can also help with anxiety symptoms and has other positive effects on ED as well.
• Communication. Part of performance anxiety can be driven by fear of what your partner will think. Talking with them, either one on one or as part of a couples counseling session, can help take the stage fright out of the bedroom.
• Therapy for performance anxiety. ED is a difficult thing for men to live with, and being able to open up to somebody, in a support group or one on one, can help get at the root of your anxiety about being intimate again.
• Prescription anxiety medication. Anxiety disorders can go undiagnosed for years in some patients. If you think you have one, see your doctor.

These propranolol alternatives also have an effectiveness advantage, as they’re generally practiced as part of a broader ED care plan. It may make sense to see if they’ll work for you before turning to propranolol.

Is Propranolol Right For You?

You should never use a prescription medication without a doctor’s approval, and seeking professional help should be your first step for any health concern. But if you’re interested in propranolol as a short-term treatment, take the following steps.

• Talk to your doctor. Get a thorough exam and a careful review of your current lifestyle and medications to determine if you’re a good candidate.
• Be open about your concerns. Talk about how you’re feeling, what you’re worried about, and why.
• Consider your options. Review possible causes of your anxiety, both physical and emotional, and understand all of your treatment options.

Whether or not propranolol is an option for you or not, lifestyle changes and open communication with your doctor will put you on the path to better management of both anxiety and erectile dysfunction.

Prescription Medications Have Been Tested Specifically for ED

FDA-approved oral erectile dysfunction medications are the most effective treatment for ED for many men, including many who struggle with performance anxiety. Because medications like Viagra, Cialis, vardenafil, and Stendra have been on the market for many years, they’re well understood and known to be both safe and effective for the treatment of ED.

eDrugstore Is Your Trusted Source for FDA-Approved Treatments

eDrugstore can help you see if these medications are right for you, pick out the one that best fits your needs, and stay on top of the latest news about ED treatments. If you don’t have a prescription, take advantage of a free medical consultation with a U.S.-licensed physician, who will write your prescription for you. 

To get started with a medication that’s designed specifically to treat ED, visit our erectile dysfunction page.

Disclaimer: This article provides general information about health and related topics but is not intended as a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition.

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