Four health organisations have written an open letter to the National Institute for Health and Care Excellence (NICE) urging it to explicitly state that propranolol is not recommended for managing anxiety disorders. The letter, sent on 25 September 2026, highlights ongoing patient safety concerns and fatal overdoses associated with the drug.
The intervention comes as regulators and professional bodies push to address the widespread prescribing of propranolol in primary care despite limited evidence of effectiveness for anxiety and significant toxicity risks in overdose scenarios. The Pharmaceutical Journal reported that the letter was coordinated by the General Pharmaceutical Council and co-signed by the patient safety commissioner for England, Henrietta Hughes; Emily Kennedy, head of professional standards at the Royal College of Pharmacy; and Nicola Greenhalgh, president of the College of Mental Health Pharmacy.
Regulatory Appeal to Update Generalised Anxiety Guideline CG113
The coalition is asking NICE to formally review and update its clinical guideline CG113 for generalised anxiety disorder and panic disorder in adults. Currently, the guideline does not mention propranolol. The signatories want this updated to explicitly state that the drug is not recommended for anxiety disorders and to highlight the associated dangers in overdose.
Guideline CG113 was last reviewed by NICE in 2025 following a coroner’s request. At that time, NICE decided against an update, partly because the Medicines and Healthcare products Regulatory Agency (MHRA) had not issued a drug safety update due to concerns about potentially increasing awareness of the drug as a method of overdose. However, a prevention of future deaths report published in March 2026 stated that propranolol is highly toxic, lacks a specific antidote, and requires hospital-based supportive care.
UK Overdose Data Prompts Calls for Updated Guidelines
The pressure on NICE stems from documented patient harm statistics in the UK healthcare system. Data cited by the organisations show that during 2022–2023, 318 patients took intentional overdoses of propranolol in the UK, resulting in 12 deaths.
Despite these known lethal risks, the letter points out that clinicians in primary care continue to prescribe propranolol commonly for anxiety conditions. The regulatory bodies argue that updating the national guideline would provide healthcare professionals with consistent, evidence-based care standards to help reduce avoidable harm.
Propranolol Overdose Is Toxic and Lacks a Specific Antidote
- What is propranolol? It is a drug that, in overdose, is highly toxic and has no specific antidote.
- Why is it prescribed for anxiety? It is commonly prescribed for anxiety in primary care despite limited evidence for its effectiveness.
- What are the safety concerns? In an overdose, propranolol is highly toxic, has no specific antidote, and requires emergency hospital treatment.
| Metric / Factor | Reported Data (2022–2023 UK Figures) |
|---|---|
| Intentional Overdoses | 318 patients |
| Fatalities from Overdose | 12 deaths |
| Primary Care Status | Commonly prescribed despite limited evidence for anxiety |
| Specific Antidote | None available (treatment is supportive and hospital-based) |
Safeguards and Regulatory Response from NICE and the MHRA
Alongside the call to advise against its use for anxiety, the letter requests that if a clinician still chooses to prescribe propranolol, the guideline must include safeguards. These measures include assessments of suicide and self-harm risk, consideration of prescription quantities, and measures to minimise serious harm.
The MHRA is currently reviewing whether stronger safety warnings are necessary for the drug. Meanwhile, a spokesperson for NICE confirmed on 7 October 2026 that the institute had received the open letter. The spokesperson stated that NICE was carefully considering the points raised and would respond in due course, adding that propranolol is not recommended in the institute’s guideline, which includes detailed care and treatment recommendations for people with generalised anxiety disorder and panic disorder.
NICE May Revise Guidelines Pending MHRA Safety Review
The question of whether NICE will formally revise guideline CG113 to explicitly warn against anxiety use remains open, pending the outcome of the MHRA’s safety review and NICE’s official response to the regulatory coalition.
References
- The Pharmaceutical Journal: Pharmacy regulator and royal college call on NICE to state propranolol is not recommended for anxiety
- NICE Clinical Guideline CG113: Generalised anxiety disorder and panic disorder in adults
- Medicines and Healthcare products Regulatory Agency (MHRA) drug safety monitoring reports
Disclaimer: This article is for informational purposes only and does not substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions regarding a medical condition.
