Propranolol and Other Beta-Blockers
Laura Pole, RN, MSN, OCNS, BCCT Senior Researcher
Nancy Hepp, MS, BCCT Project Manager
Last updated December 22, 2020.
Also known by these names
Propranolol is a beta blocker (non-selective beta-adrenergic receptor antagonist) being used off-label for cancer treatment by some integrative oncologists. Off-label use is a drug’s application for a disease or condition that has not yet received FDA approval. Every US state allows for drugs to be used off-label as long as there is enough evidence to support its use.
Most of the human evidence in cancer to date is from case reports, but a number of clinical trials for several cancers are in progress.
Treating the Cancer
Working against cancer growth or spread, improving survival, or working with other treatments or therapies to improve their anticancer action
An extensive review in 2016 found proprnolol exhibits anti-metastatic effects in breast and ovarian cancers. Evidence particularly indicates that propranolol works at multiple points in the metastatic cascade, especially in the setting of the post-surgical wound response (see more in How It Works at right).2
Impacts on Survival
Enhancer of Conventional Treatments
Lab and Animal Evidence
How It Works
Propranolol seems to exert its anticancer activity in several ways:
Propranolol and Surgery
A very interesting and promising use of propranolol is in the surgery setting. The wound-healing response after surgical incision starts a cascade of inflammatory events that can promote cancer growth: suppressing cell-mediated immunity and increasing signals for formation of blood vessels (angiogenesis).
Managing Side Effects and Promoting Wellness
Managing or relieving side effects or symptoms, reducing treatment toxicity, supporting quality of life or promoting general well-being
Reducing the risk of developing cancer or the risk of recurrence
Optimizing Your Terrain
- Reduced effects of psychological stress on primary tumor growth with propranolol44
- Reduced tumor-promoting effects of catecholamines (hormones produced by the adrenal glands) in retrospective clinical studies with ovarian cancer45
- Enhanced immune system cancer-fighting mechanisms, such as increasing the ability of certain immune cells (macrophages) to consume cancer cells by a process called phagocytosis46
Stress and Beta Blockers
Chronic stress triggers a chain of internal events that protects cancer cells from automatic destruction when they break away from the primary tumor. Increased levels of epinephrine and norepinephrine (stress hormones) allow malignant cells to safely leave the primary tumor, avoid cell death, and proceed to the next step of metastasis and progression.
When norepinephrine contacts the beta-adrenergic (ADRB) receptor on tumor cells, it activates Src, a gene which regulates cancer cell survival proteins. This activation causes a chain reaction inside cells that promotes cell survival, mobility, invasion of neighboring tissue and creation of new blood vessels to supply the tumor. Beta blockers plug the ADRB receptor and prevent activation by norepinephrine and other hormones.
Propranolol is available by prescription as both standard and extended-release tablets, an oral solution, and an IV injection. It is available globally in generic form. Estimated cash price for sixty 40-mg tablets ranges from about $40 to $75. Significant discounts are available using prescription drug discount apps such as GoodRX.
Propranolol generally has low toxicity and can be used for many years in long-term treatment.52 However, some cautions should be heeded:
Integrative Programs, Protocols and Medical Systems
|For more information about programs and protocols, see our Integrative Programs and Protocols page.|
BCCT advisor Dwight McKee, MD, an integrative oncologist and co-author of After Cancer Care, February 20, 2017:
“I've advocated for propranolol (which seems to work the best compared with more 'modern' beta blockers), implemented as soon as possible after diagnosis, since a new diagnosis of cancer is a highly stressful event, and we have both experimental and clinical evidence that stress acts as a tumor promoter, although it doesn't appear to be involved in the initiation of malignancy.
I have recommended propranolol for anyone diagnosed with cancer who is experiencing high levels of stress.
I have recommended propranolol for anyone diagnosed with cancer who is experiencing high levels of stress from their diagnosis, and all of the logistics involved in seeing different doctors, and making treatment decisions often with a sense of time pressure (the psychological emergency of a cancer diagnosis). It takes time for people to learn and become proficient with stress management techniques, so I see propranolol as “ training wheels” until they are in calmer waters and well on their way to practicing an “ anticancer lifestyle”, which includes learning and practicing stress management techniques.
Non-cancer Uses of Propranolol
Propranolol is approved by the FDA and commonly used to treat the following:58
Propranolol is also used off-label for a number of conditions including these:59
BCCT has not reviewed the effectiveness of this therapy for non-cancer uses.
- For a more thorough discussion of benefits in cancer and a reference list, see a comprehensive review article: Pantziarka P, Bouche G et al. Repurposing Drugs in Oncology (ReDO)—Propranolol as an anti-cancer agent. Ecancermedicalscience. 2016 Oct 12;10:680.
- Cote J. Could a common and inexpensive heart medicine (beta-blockers) help cancer patients live longer? Cancer Prevention and Treatment Fund.
- Merville S. Betting on Beta Blockers. The University of Texas MD Anderson Cancer Center. Summer 2014.
- ClinicalTrials.gov: Propranolol
- Gurdev Parmar and Tina Kaczor: Textbook of Naturopathic Oncology
- Dwight McKee, MD, editor: Clinical Pearls