Pharmacy leaders are calling on the National Institute for Health and Care Excellence (NICE) to review its guideline on anxiety disorders and state that propranolol is not recommended for managing anxiety, after patient safety concerns including fatal overdoses.

In an open letter dated 25 September 2026, the General Pharmaceutical Council, the Royal College of Pharmacy, the College of Mental Health Pharmacy and the Patient Safety Commissioner for England asked NICE to update guideline CG113 on generalised anxiety disorder and panic disorder in adults. Propranolol, a non-selective beta-blocker, is not currently mentioned in the guideline, which was last updated in 2020, and NICE decided not to update it in 2025 after a coroner's request prompted a review.

Overdose risk at the centre of the warning

The letter cites patient safety concerns identified through regulatory work, patient safety intelligence and Prevention of Future Deaths reports, including multiple fatal overdoses. A study in the British Journal of Clinical Pharmacology examined 363 intentional propranolol overdoses reported to the National Poisons Information Service between 2022 and 2023, including 35 deaths. The signatories say there is limited evidence that propranolol works for anxiety disorders, and that overdose can be life-threatening and difficult to treat.

Separately, the Royal College of Pharmacy and the Royal College of Physicians Medicines Safety Joint Working Group have asked the Medicines and Healthcare products Regulatory Agency (MHRA) to review propranolol's official prescribing information, particularly around overdose, self-harm and suicide risk. The MHRA has confirmed it is reviewing the available data on harms from propranolol in overdose. NICE said it is carefully considering the points raised and will respond in due course.

Anyone taking propranolol should not stop it suddenly without medical advice. Patients with concerns should speak to their GP or pharmacist. This article is general news reporting, not personal medical advice.

Sources: Pulse Today, Propranolol safety concerns prompt calls for NICE guideline review, 2 November 2026; LADbible, Experts warn over side effects of commonly prescribed 'magic pill' propranolol, 4 November 2026.