26-05-2025
Experts warn against anxiety drug prescribed to millions due to little-known risk of 'toxic overdose'
Experts have issued a safety warning over a popular anxiety medication that can cause 'toxic' effects including seizures, depression and even cardiac arrest in high doses.
Beta blockers, such as propranolol, have traditionally been prescribed for heart problems, but are increasingly offered by doctors to treat episodes of anxiety—as they slow the heart rate, supposedly reducing the physical symptoms of panic.
Recent British research showed the number of prescriptions for propananol to treat anxiety doubled between 2003 and 2018.
Roughly 7million prescriptions for the drug—which is also given for high blood pressure—are dispensed in the UK every year, according to official data.
But now, experts say not only is there 'no evidence' to prove the drugs work for anxiety, too few patients, who are typically given large numbers of pills, are warned of the risk of overdose.
In a recent letter to The Guardian, pharmacist Christopher Sullivan warned that the drug 'is associated with significant adverse outcomes' and urged GPs to exercise 'extreme caution when prescribing these medicines for anxiety'.
'Prescribing these medicines for anxiety is not recommended in national evidence-based guidelines,' he added.
It followed comments from GP Dr Amir Khan, who told the newspaper that propananol had been linked to 'higher rates of depression' and warned GPs not to prescribe it to anxious patients who also suffer low mood.
'If you are taking them long term, you can't suddenly stop them,' he added. 'You need to be weaned off them.'
The risks are not thought to pertain to those taking the medicine for heart problems and other physical issues like migraine—but experts say patients with mental health troubles are vulnerable to either accidentally or purposefully taking an overdose.
The pharmacist's warning comes amid two high profile deaths related to the drug including accidental overdoses.
In 2019, an inquest heard a mother-of-two, who was an NHS manager, accidentally overdosed on propranolol which she was initially prescribed for anxiety in 2018.
Philippa Hulme, 46, died less than two hours after taking the lethal dose, with tests showing toxic levels in her system.
A statement from Mrs Hulme's GP surgery said: 'Pippa had a history anxiety and depression and was well known to the practice.
'In July 2018 she was prescribed anxiety medication— propranolol and was given 60 tablets to take—one a day a maximum of two in 24 hours.'
The coroner concluded that her death was most likely explained by an 'exacerbation' of anxiety that led her to 'consider it would be beneficial if she took more tablets to help her with the anxiety.
'I do not consider that she knew how toxic propranolol can be.'
Another heartbreaking case is that of a mother-of-five who is thought to have accidentally killed herself with propranolol.
A 2015 inquest heard how Janine Southwell, 37, a former beauty therapist was prescribed the drug, which she was 'reckless' about taking.
She was found dead in bed, in August in 2015, with almost five times the potentially fatal level of the medication in her blood after a meal and glass of wine with her cousin.
Her mother Janet Southwell said: 'She didn't take tablets when she was supposed to so she could have had a stockpile.'
The coroner, Alan Walsh, concluded Ms Southwell did not intend to end her life.
The fresh warnings follow guidance published by the General Pharmaceutical Council in October last year that warned about the 'wide variation' in individuals' response to toxic levels of propanolol.
'Peak plasma concentrations of propranolol occur 1-2 hours after ingestion, so symptoms of overdose will not be seen immediately,' the warning read.
'Rapid deterioration can occur following a propranolol overdose, this can include confusion and loss of consciousness as well as cardiovascular complications including cardiac arrest.
'As propranolol can cross the blood brain barrier, the risk of convulsions is higher than with other beta blockers.
'Delay in treatment increases the risk of fatality, therefore it is important to seek emergency help as soon as possible following overdose.'
The danger of toxic propranolol overdose was a subject of the healthcare safety investigation report in 2020.
This report revealed that vulnerable patients with existing migraines, anxiety and depression were at risk of using propranolol for self-harm.
In 2022 to 2023, the National Poisons Information Service (NPIS) received 358 enquiries involving intentional propranolol overdose.
