Other drugs used in the management of anxiety (Formulary: CNS)

TAM (Treatments and Medicines) NHS Highland
NHS Highland

Propranolol may be used to reduce the autonomic symptoms of situational anxiety but is potentially harmful and is not recommended for long-term management.  Other drugs for anxiety, in the longer term, are more appropriate first-line in most patients; refer to TAM Generalised anxiety disorder.

PROPRANOLOL

Therapy notes

MHRA advice: Drug-name confusion: reminder to be vigilant for potential errors (January 2018) (www.gov.uk)

Formulation and dosage details

Formulation:

Tablets 10mg, 40mg

Dosage:

Initially 10mg 3 times daily, increased to 40mg 3 times daily if necessary. Monitor blood pressure as appropriate; refer to BNF.

Formulation and dosage details

Formulation:

Modified release capsules 80mg

Dosage:

1 capsule daily. Monitor blood pressure as appropriate; refer to BNF.

PREGABALIN

Therapy notes

MHRA advice: Pregabalin (Lyrica): reports of severe respiratory depression (February 2021) (www.gov.uk).
MHRA advice: Pregabalin (Lyrica), gabapentin (Neurontin) and risk of abuse and dependence: new scheduling requirements (April 2019) (www.gov.uk).

  • Pregabalin has become a drug of misuse and caution is advised when prescribing. Be aware or gain reassurance that the person being prescribed pregabalin is not purchasing/acquiring medicines privately.
  • Pregabalin can be used third-line after specialist initiation only, in treatment-resistant generalised anxiety disorder but other options are recommended in preference; refer to generalised anxiety disorder guideline.
  • Pregabalin is licensed for the treatment of generalised anxiety disorder however the manufacturer has not made a submission to SMC regarding pregabalin in this indication and it has consequently not received a recommendation for this use in NHS Scotland.

Formulation and dosage details

Formulation:

Capsules 25mg, 50mg, 75mg, 100mg, 150mg, 200mg, 225mg, 300mg (specialist initiation)

Dosage:

Initially 75mg twice daily, increased if necessary, at 7-day intervals in steps of 75mg twice daily; maximum dose 300mg twice daily.
Minimise the number of capsules to be taken by use of higher strength capsules as appropriate.

Formulation and dosage details

Formulation:

Oral solution 100mg/5mL (specialist initiation)

Dosage:

Initially 75mg twice daily, increased if necessary, at 7-day intervals in steps of 75mg twice daily; maximum dose 300mg twice daily.

PRAZOSIN

Therapy notes

BNF

Formulation and dosage details

Formulation:

Tablets 500 microgram [off-label] (specialist initiation only)

Dosage:

Post-traumatic stress disorder: see Prazosin for PTSD-related nightmares TAM guideline
See generalised anxiety disorder guideline.

Editorial Information

Document Id: F073