Other drugs used in the management of anxiety (Formulary)

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