Factors associated with the primary care management of anxiety disorders in adults despite safety concerns related to propranolol toxicity

Aim To understand sociodemographic and clinical factors associated with the prescribing of propranolol outside national guidance in adults with anxiety in primary care. Methods Cross-sectional study using routinely recorded primary care data extracted from primary care prescribing system and electronic patient record. Data included: age, gender, Index of Multiple Deprivation (IMD), first spoken language, concomitant mental health condition other than anxiety, concomitant physical health condition, risk of suicide or previous suicide attempt and referral to talking therapies for in adult patients aged 18 years and over diagnosed with anxiety between 01/12/2022 and 30/11/2025. Results 20,202 patients were included in the final analysis. 13% were prescribed propranolol. 35% male, 34% female patients with concomitant mental health condition. 39% male, 36% female patients with concomitant physical health condition. More female patients were prescribed propranolol (p<0.001). Ages 18-29 were less likely to be prescribed propranolol than ages 50-59 (p<0.001). Patients in more deprived areas were more likely to be prescribed propranolol (p=0.004). There was no statistically significant difference in the risk of suicide between patients prescribed propranolol and those not prescribed propranolol (p=0.92). Conclusions Propranolol continues to be prescribed for anxiety. It is more likely to be prescribed for female patients, those aged between 40-59 and patients in more deprived areas. The absence of statistical significance in the risk of suicide between patients prescribed propranolol and patients not further highlights the safety concerns regarding the toxicity of propranolol in overdose.