The New Little Blue Pill

This year’s award shows came with a new kind of red-carpet accessory. Not a designer bag, or a borrowed necklace — but a prescription pill. At the Golden Globes, Robert Downey Jr. admitted, “I took a beta-blocker, so this will be a breeze.” Actress Rachel Sennott’s Oscars advice was even blunter: “Take that beta blocker, girl. Swallow it down and lock in.”

The drug in question — propranolol, first approved in 1967 for heart disease — is suddenly being passed around Hollywood dressing rooms, sold on telehealth websites, and raved about on TikTok wedding prep threads. It’s marketed like a “cheat code” for nerves.

Stage fright? First date jitters? A shaky wedding toast?

There’s a pill for that.

But propranolol was never meant to treat anxiety. Let me explain…

Beta-blockers were invented in the 1960s to manage high blood pressure, irregular heart rhythms, and angina. They work by blocking the effects of adrenaline on “beta receptors” throughout the body. The result: slower heart rate, weaker heart contractions, lower blood pressure.

When applied to anxiety, that means beta-blockers don’t touch the worry itself — but they quiet the physical symptoms: trembling hands, sweaty palms, pounding heart. In other words, they calm the body’s alarm bells, even if the fire is still raging upstairs.

The calming effect was first noticed in 1965, when propranolol reduced anxiety symptoms in patients with thyroid-related rapid heartbeats. In the UK, propranolol is licensed for anxiety. In the US, it’s strictly off-label — meaning doctors can prescribe it, but the FDA has never officially signed off.

Pop culture has a way of turning old drugs into new crazes. In the 1960s, Valium was “mother’s little helper.” In the 2020s, Ozempic became the shot heard ‘round the world. Today, propranolol is quietly having its own celebrity-fueled moment.

Prescriptions are up 28% since 2020. Telehealth platforms like Hers and Nurx advertise propranolol as a fast, discreet fix for “performance anxiety.” A questionnaire, a self-reported blood pressure reading, and a week later the bottle shows up in the mail.

Here’s what makes it fascinating to me: I have no issue with beta-blockers being used for anxiety. Compared to many alternatives, they’re safe, low-risk, and genuinely helpful for people in the right situations. But there are two angles worth noticing:

To understand the hype, you have to compare beta-blockers to the other anxiety pill that defined the last century: benzodiazepines.

Valium, Xanax, Ativan — they work by enhancing GABA, the brain’s main inhibitory neurotransmitter. The effect is unmistakable: sedation, relaxation, sometimes euphoria. The problem is equally unmistakable: dependence, withdrawal, and abuse.

Beta-blockers are different. They don’t sedate. They don’t create euphoria. They don’t rewire your brain chemistry. And crucially, they’re not addictive. For doctors wary of handing out benzos like candy, propranolol feels like a safer, lower-stakes option.

But “safer” doesn’t mean “risk-free.” Too much propranolol can cause fainting, slow the heart dangerously, and worsen asthma or diabetes. In the UK, regulators have warned pharmacies about overdose cases — including a teenager who died after taking propranolol alongside other medications. There is a reason they still require a doctor to sign off.

Here’s the inconvenient truth: the evidence for beta-blockers in anxiety is weak.

A few small trials show propranolol reduces anxiety compared to placebo. But systematic reviews find the data low-quality, with small sample sizes and inconsistent results. The consensus: propranolol helps physical symptoms, but isn’t comparable to antidepressants or therapy for long-term anxiety disorders.

That’s why I keep coming back to the irony. In my newsletter about ketamine, I wrote about how a drug can be both transformative and exploited at the same time. Beta-blockers aren’t nearly as dramatic — but the same duality is at play. They are safe, useful, even elegant in what they do. But the cultural hype around them — and the business models now forming to monetize them — tell a story that’s bigger than the pill itself.

The rise of propranolol says as much about culture as about medicine.

We live in a time where every uncomfortable feeling is framed as something to optimize. GLP-1s for weight, ketamine for depression, melatonin for jet lag. It was only a matter of time before “nerves” joined the list.

Podcasters joke about popping beta-blockers before live shows. Influencers recommend them before walking down the aisle. Telehealth companies pitch them with slogans like “ice in your veins.”

Is that empowerment — or medicalization of normal life stress? Maybe both.

It’s worth remembering: beta-blockers don’t make you brave. They just make you look brave.

They can stop your hands from shaking during a speech, but they won’t write the speech. They can keep your voice steady on a date, but they won’t make the conversation interesting. They can mute the adrenaline, but they can’t quiet the thoughts that triggered it.

For chronic anxiety, the gold standards remain the unsexy options: therapy, mindfulness, and SSRIs. Propranolol is a tool — a helpful one, sometimes — but not a cure.

Beta-blockers are, on the whole, good medicine. They’re safe, effective in the right situations, and far less risky than many alternatives. If you’ve ever needed to steady your hands before a big moment, propranolol can be a useful tool.

But they’re also the perfect drug for capitalism to sink its teeth into. Dirt cheap to make, non-addictive, widely useful, and already blessed with celebrity buzz. It’s no surprise that telehealth companies are packaging them as confidence in a capsule — charging subscription prices for something that costs a pharmacy pennies.

That doesn’t mean it’s irresponsible to prescribe them, or wrong to use them. It just means we should keep our eyes open. The next time you see a glossy article or ad pushing a pill as the solution to everyday stress, remember: 

The medicine is real. But the business model is too.

Alec Wade Ginsberg, PharmD, RPh
4th-Gen Pharmacist | Owner & COO, C.O. Bigelow
Founder, Drugstore Cowboy