Propranolol and Difficulty Breathing

It is well known that beta-blockers can affect the beta-2 receptors and potentially cause issues with breathing.  Non-selective beta-blockers like propranolol may be even higher risk for causing these symptoms. I discuss more in-depth about the pharmacology of beta-blockers on my new podcast if you want to check that out! Here’s the case:

A 78 year old female has had difficulty with essential tremor.  She has had the tremor most of her life and has managed with primidone.  The primidone has been well tolerated.  She is now recently reporting that the primidone doesn’t seem to be working as well as it used to and is wondering what can be done.

The primary care provider initiates propranolol 20 mg three times per day.  This is not effective so the provider gradually increases the dose to 60 mg three times daily.  The 78 year old reports tolerating the dose without dropping the blood pressure and pulse too low, but is reporting a new symptom of difficulty breathing.  She had apparently had some asthma as a child which had not been an issue as an adult.

Important things to remember with this effect on the lungs is that selectivity of agents is important.  Beta-1 selectives are typically less likely to cause this effect on the lungs.  Unfortunately in this situation, the beta-1 selectives typically aren’t as effective as propranolol.  The other thing to remember is that as we escalate the dose, we are more likely to lose selectivity as well as cause adverse effects.

The patient and provider elected to taper back and off of the propranolol and stick with the primidone alone.

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  1. Viktor

    It reduces my ability or strength of my breathing and I also had been diagnosed with mild asthma early in my life. As I reduce my propranolol, I’m realising and reminding myself to treat my asthma and I often do it only intermittently with an albuterol inhaler.,

  2. Susan Jones

    Hi I have been taking propranolol for about 4 weeks for Anxiety. Unfortunately it seems to have affected my breathing I am having difficulty taking deep breaths.
    Can you say if this would be the tablet doing this. I have had breathing bouts with anxiety previously but nothing like this.

  3. Yvonne Smith

    Beware of propranolol! Although it can appear to be helpful for anxiety, the side effects themselves can emulate anxiety symptoms. Difficulties with deep breathing, or other breathing issues are side effects of this drug as well as a symptom of anxiety. This confuses an already anxious person!
    It can also cause abdominal distress which can feel like excess adrenaline! Once again, very confusing for an already anxious individual.
    Propranolol causes sleep disturbances. It can deplete melatonin by as much as 80%! The anxious recipient of this toxic drug now loses valuable sleep and blames it on their mental state, whereas the propranolol is the likely villain of the piece.
    And then, when you realise what this over prescribed drug has done to your body, you have to taper off it because you’re told that going cold turkey is dangerous!
    If you weren’t anxious before, you will be now!
    I would advise anyone to think twice before embarking on a devastating journey accompanied by propranolol!

  4. Laura Harwood

    I completely agree. Propanolol helped with my restless legs and anxiety but I have a respiratory virus and realized my albuterol didn’t work. It was very alarming. Also, I found out it narrows my bronchioles and I was having bronchiospasms that made it difficult to breathe. This medication should not be used for anyone with a history of asthma or bronchitis. People need to understand if you are prescribed albuterol it won’t work if you are taking propanolol. I never told my psychiatrist about my history of asthma because it didn’t have any issues since I sopped smoking. Propanolol caused a full on asthma attack that I couldn’t treat

  5. Jason Harris

    Hi there, I have been talking Propranolol since February 2023, I was talking 40mg twice a day at first but I was experiencing thumping heart beats so my propranolol was increased to 40mg three times per day. After 4 days of taking my increase medication I had been feeling uneasy and not very steady on my feet and quickly realised that I was experiencing low blood pressure. Now my medication has been reduced to 20mg three times per day. So far my blood pressure has been in good range but my breathing has been difficult in the last 8 weeks, my breathing has been shallow and difficult to take deep breaths in and when I do I hear a rumbling noise I also have a dry cough. After reading your article I will be making a doctor appointment on Monday to discuss my experience. Is there any other medicines you can take for rapid heart rate and heart palpitations. Since being diagnosed with an Arota root dilation of 4cm in May 2023, daily routine has become more difficult.


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Written By Eric Christianson

April 1, 2018

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