The first alternative is usually propranolol itself
This shortage only affects the modified-release capsules. The same drug in immediate-release tablet form is available across the UK. According to NHS Specialist Pharmacy Service guidance, prescribers should review patients on the MR capsules and consider switching to immediate-release tablets in divided doses rather than stopping or substituting the drug entirely (NHS SPS).
Propranolol immediate-release tablets (40mg, 80mg)
The most likely route during this shortage. Same medicine, taken two or three times a day instead of once. The DHSC notification confirms this form remains available and can support an increase in demand. Dose timing matters — only your prescriber should make this change.
Propranolol oral solution
Available but, per DHSC, cannot support a large increase in demand. Sometimes used for people who struggle to swallow tablets. Your pharmacist will know whether it is a realistic option for you locally.
Other beta-blockers — same drug class
According to the BNF, propranolol is a non-selective beta-blocker — it blocks both beta-1 (heart) and beta-2 (lungs, blood vessels, brain) receptors. That non-selectivity is precisely why it works for non-cardiac uses like anxiety symptoms, essential tremor and migraine prevention. The other beta-blockers listed below are cardio-selective (mainly act on the heart), so they are useful substitutes for cardiac indications but are not direct replacements for the non-cardiac uses.
Bisoprolol
Once-daily beta-blocker mainly used for high blood pressure, angina, irregular heart rhythms and chronic heart failure. NICE NG106 places bisoprolol as a first-line beta-blocker in heart failure. Generally less suitable than propranolol for anxiety symptoms or migraine prevention.
Atenolol
Long-established beta-blocker used for hypertension, angina and some arrhythmias. Usually taken once daily. Like bisoprolol, it is cardio-selective so generally not chosen for the non-cardiac uses of propranolol.
Metoprolol
Available as immediate-release and modified-release forms. Used for hypertension, angina and arrhythmias; modified-release metoprolol has an evidence base in heart failure.
Nadolol
Like propranolol, non-selective. Long half-life makes it suitable for once-daily dosing. Less commonly prescribed in the UK than propranolol but still listed in the BNF.
Carvedilol
Non-selective beta-blocker with additional alpha-blocking action. Used in chronic heart failure and hypertension. Specialist-initiated for heart failure.
It depends on why propranolol was prescribed
Propranolol is used for very different conditions. The shortlist of related medicines is different for each.
High blood pressure or angina
NICE NG136 places ACE inhibitors, ARBs and calcium-channel blockers (not beta-blockers) as first-line for most adults with hypertension. If a beta-blocker is needed, bisoprolol, atenolol or metoprolol are the more common UK choices today; propranolol is rarely first-line for blood pressure alone.
Irregular heart rhythm (atrial fibrillation, SVT)
A clinician may consider bisoprolol, atenolol or another rate-controlling medicine such as diltiazem or verapamil — the choice depends on the specific arrhythmia and other heart conditions.
Physical symptoms of anxiety
Propranolol is often used short-term for the physical symptoms of anxiety (rapid heart rate, tremor, shaking). If propranolol cannot be used, a non-medicine option such as cognitive behavioural therapy (CBT) is the long-term NHS recommendation. For acute physical symptoms a clinician sometimes considers another beta-blocker, but the cardio-selective ones (bisoprolol, atenolol) cross into the brain less and may be less effective for this use.
Migraine prevention
NICE CG150 recommends propranolol or topiramate as first-line migraine preventers in adults. If propranolol cannot be used, related options a clinician may discuss include:
- Topiramate — anti-epileptic medicine licensed for migraine prevention.
- Amitriptyline — used off-label for migraine prevention, especially when there is co-existing sleep disturbance.
- Candesartan — an ARB sometimes used off-label by headache specialists for migraine prevention.
Essential tremor
Beyond propranolol, a clinician may consider primidone or gabapentin — these are specialist-initiated and decided case by case.
Overactive thyroid (symptom control)
Propranolol is used to control the heart-racing and tremor of an overactive thyroid while the thyroid itself is treated. If propranolol cannot be used, a clinician may use another beta-blocker (atenolol, bisoprolol) for the symptoms; the thyroid treatment itself (carbimazole, propylthiouracil, radioiodine) does not change.
Critical safety points before any change
- Speak to your GP, pharmacist or specialist team before changing anything.
- Beta-blockers can be unsuitable for some people with asthma, severe peripheral arterial disease or certain heart-rhythm problems — your prescriber will check this.
- If you take other heart medicines, anti-arrhythmics, anti-depressants, or NSAIDs, mention them — beta-blockers interact with several drug classes.
- Tell your prescriber if you are pregnant, breastfeeding, or planning a pregnancy — choice of beta-blocker matters.
- If you feel unwell, dizzy or develop chest pain while waiting for a supply, contact your GP or call NHS 111. Use 999 for emergencies.
How to actually get a supply during the shortage
- Ask your usual pharmacy first — under MSN/2025/059, immediate-release propranolol tablets are an explicit option.
- If immediate-release tablets are not right for you, your GP or specialist can issue a new prescription for another beta-blocker.
- Try other local pharmacies — stock varies day to day.
- Order your repeat prescription before you run out, not on the day.
- Sign up for free MediWatch alerts to be told when propranolol 80mg / 160mg MR capsules come back to supply.
Frequently asked questions
What can I take instead of propranolol in the UK?
For most people the direct option is immediate-release propranolol tablets (40mg, 80mg), which are not affected by the shortage. If propranolol cannot be used at all, a clinician may consider another beta-blocker such as atenolol, bisoprolol or metoprolol — but the choice depends on why propranolol was prescribed. Only a prescriber can decide.
Is bisoprolol the same as propranolol?
They are both beta-blockers but they are not the same medicine. Propranolol is non-selective (acts on receptors throughout the body, including the brain). Bisoprolol is cardio-selective (acts mainly on the heart), so it is generally preferred for heart conditions and hypertension, and is not the usual choice for anxiety symptoms or migraine prevention.
What is the best alternative to propranolol for anxiety?
There is no single "best" alternative — propranolol is used for the physical symptoms of anxiety (rapid heart rate, tremor) rather than as a long-term anxiety treatment. If propranolol cannot be used, a clinician may consider another beta-blocker short-term, or NHS-recommended longer-term options such as CBT or an SSRI. A GP or mental-health team will make this decision.
What is the best alternative to propranolol for migraine prevention?
NICE CG150 lists propranolol as a first-line preventer alongside topiramate. If propranolol is not suitable, a prescriber may consider topiramate or amitriptyline. Newer CGRP-targeted treatments are specialist-initiated. The decision belongs to your GP or headache specialist.
Can I switch from MR capsules to immediate-release tablets myself?
No — this change must be made by a prescriber. MR capsules are taken once a day; immediate-release tablets are taken two or three times a day, so the dose and the timing change. Under the DHSC supply notification, your GP or pharmacist has a clear pathway to make this switch.
Are atenolol, bisoprolol and metoprolol all in shortage too?
As of 28 May 2026, no DHSC Medicine Supply Notification or Serious Shortage Protocol is in force in the UK for atenolol, bisoprolol or metoprolol. That can change. MediWatch monitors the live DHSC and CPE lists daily.
Should I stop taking propranolol if I can't get my MR capsule?
No, do not stop suddenly. Stopping a beta-blocker abruptly can cause your heart rate and blood pressure to rebound, and can be dangerous if you take it for angina or heart-rhythm problems. Contact your GP or pharmacy as soon as possible so they can arrange a switch to immediate-release tablets or another suitable option.
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Join free alerts →Page last updated: 28 May 2026. This page is information, not medical advice — always speak to your GP, pharmacist or specialist team about your own medicines.