Propranolol: Risks of Prescribing in Anxiety in Patients at Risk of Self-harm

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Project summary

This project turns what we know into what we do: a consistent, system-wide approach to make propranolol prescribing safer. Built on patient safety events, coroners’ concerns and the recognised risk of severe toxicity in overdose, it converts learning into action: to initiate carefully, review regularly and reduce avoidable oversupply. The propranolol project delivers measurable, sustainable improvement at scale.

Following the 2020 HSSIB report on underrecognised harm, NENC Medicines Safety Group strengthened systemwide awareness and agreed a shared approach between primary care and mental health partners, noting propranolol is not recommended in NICE anxiety guidance. Coroner reports, incident themes and Emergency presentations highlighted ongoing overdose risk where propranolol is used (particularly for anxiety); prescribing data also showed NENC remained a high-prescribing area with local variation.

I reviewed key national and local resources (HSSIB, PrescQIPP, RDTC) and with mental health colleagues, produced a safety poster, education slides and clinical prompts. This supported a formulary update to reinforce safer prescribing, including quantity limits and disposal advice. BI data was used to baseline patient numbers prescribed propranolol for anxiety; incomplete indication coding limited certainty, but enabled targeted review. With AnalyseRx, I developed searches to flag missing indications and potential higher-risk patients.

Resources were shared across primary and secondary care, hosted on GPTeamNet, and circulated via NHS Futures and University of Sunderland teaching; the poster was subsequently adopted by NHS Surrey Heartlands ICB. Durham's MO workplan delivered a “repeat but not issued” search with CDRC: in Q3, 90.8% of identified patients had propranolol removed from repeat and the remainder moved to acute, reduced-quantity supplies. The approach has been embedded locally, including within North Tyneside’s Prescribing Engagement Scheme.

A Learning from Patient Safety Events (LfPSE) thematic review was completed using the search term “propranolol”. Across Dec 2024–Nov 2025, 178 NENC reports for propranolol overdose were identified (with a small summer peak). Reporting quality varied and indication was often missing, requiring manual data cleansing; enhanced mental health reporting provided fuller detail. Alongside prescribing data and incident themes, the finding prompted further action. Analysis identified vulnerable cohorts and patterns in reporting: incidents were recorded most often in young people, predominantly in females, and most commonly in White British patients.

Overall, the programme embedded safer prescribing, reduced unnecessary oversupply, and provides a model that can be scaled and sustained through routine review.