Non-selective beta-blocker (used for anxiety, performance anxiety, tremor, migraine, and cardiac conditions)

Inderal (propranolol) Withdrawal

Propranolol (Inderal) is used in psychiatry for performance and physical anxiety symptoms, and in medicine for blood pressure, tremor, and migraine. It is not habit-forming, but abrupt discontinuation carries a real cardiovascular risk: rebound tachycardia and hypertension, and in patients with heart disease, rebound angina or even heart attack. For that reason it should be tapered, not stopped suddenly, particularly in anyone with a cardiac history.

By Dr. Ben Soffer, DO — board-certified physician, at-home ketamine therapy in Florida and New Jersey.

Half-life

~4 hours for the immediate-release form; the long-acting form lasts longer.

Withdrawal timeline

Onset— 1-3 days after abrupt stop

Heart rate and blood pressure can rebound upward within days of stopping suddenly.

Peak— Days 2-6

Palpitations, fast heartbeat, elevated blood pressure, and rebound anxiety are most prominent here.

Resolution— 1-2 weeks

With a proper taper these effects are largely avoided; the anxiety or condition it was treating may return.

Common symptoms

  • Rapid or pounding heartbeat (palpitations)
  • Elevated blood pressure
  • Rebound anxiety
  • Tremor return
  • Sweating

Less common

  • Headache
  • Chest discomfort
  • Insomnia

Notable / pattern-defining symptoms

Rebound cardiovascular effects - in patients with coronary disease, abrupt beta-blocker cessation can precipitate angina or, rarely, a heart attack. This is the central safety reason to taper.

Tapering guidance

  • Taper gradually over 1-2 weeks (longer in cardiac patients) rather than stopping abruptly.
  • Patients with known heart disease should taper only under physician guidance.
  • Coordinate with the prescribing physician.

Where ketamine therapy fits

This pairing has a useful logic worth discussing with your physician: ketamine can transiently raise heart rate and blood pressure during a session, and propranolol blunts exactly those responses. Some patients take propranolol for the physical symptoms of anxiety. The interaction is real in both directions, so any plan - including how propranolol is timed around sessions - should be coordinated with the prescribing physician, with blood-pressure monitoring.

Check ketamine therapy eligibilityMedication safety with ketamine

Frequently asked questions

Is it dangerous to stop propranolol suddenly?

It can be, especially with a cardiac history. Abrupt cessation can cause rebound tachycardia and hypertension, and in coronary disease, angina or rarely a heart attack. Taper under physician guidance.

Is propranolol addictive?

No. It is not habit-forming. The reason to taper is cardiovascular rebound, not dependence.

Can propranolol be used with ketamine therapy?

It requires coordination and monitoring. Propranolol blunts the heart-rate and blood-pressure rise ketamine can cause, so the timing and plan should be managed by the prescriber.

Important: This page is informational and does not constitute medical advice or a recommendation to start, stop, or change any medication. Tapering psychiatric medications should always be coordinated with the prescribing physician. Compounded ketamine for anxiety, depression, PTSD, and chronic pain is not FDA approved.

Browse all medication withdrawal guides.