Performance anxiety
Performance anxiety is similar to social anxiety disorder, but the social anxiety is restricted to discrete performance situations (such as a public performance). Psychosocial interventions (eg cognitive behavioural therapy [CBT] including an exposure component) are essential, and should be used as first-line treatment.
Propranolol has a limited role in performance anxiety; toxicity in overdose must be considered. Although propranolol does not relieve anxiety itself, it may reduce distressing physiological symptoms associated with anxiety (tremor, palpitations and sweating). To assess tolerability, advise the patient to take a trial dose at home before taking a dose in a performance situation.
If propranolol is considered appropriate for performance anxiety in adults and young people, use:
propranolol 10 to 20 mg orally, 30 to 60 minutes before the performance. If needed, the dose can be increased up to 60 mg. performance anxiety propranolol propranolol propranolol
For children older than 12 years with extreme performance anxiety that limits their capacity to function, consider using:
propranolol 10 to 20 mg orally, 30 to 60 minutes before the performance. If needed, the dose can be increased up to 40 mg. propranolol
Evidence is insufficient to support the use of propranolol for performance anxiety in children 12 years or younger.