Beta Blockers for Musicians: What They Do, What They Don't, and What Happens Without One

Gökçe Kutsal
Jun 17
11 min read

* Where I describe clients in my blog posts, I've changed names, instruments, and other identifying details to protect their privacy. Sometimes I'm describing one person, sometimes a pattern I've seen across several. The essence of the experience and what we worked on together remain true.

** And one more thing: I'm a performance coach, not a doctor. Nothing here is medical advice, and none of it is a recommendation to start, stop, or change anything you're taking. Beta blockers are prescription medication, and the only person who can tell you whether they're right for you is a doctor or pharmacist who knows your history.

There is a small white pill that lives in a great many musicians' bags.

It doesn't come out often. A lot of the time it just sits there, doing its job simply by being available, and its owner would rather you didn't know it was there at all.

On the morning of a big orchestral audition, somewhere between a quarter and nine in ten of the people in that waiting room have taken, or are about to take, the same small pill... yet not one of them will mention it to the others.

They sit there, silent, each one fairly sure they're the only one who needed it... while the pill in the bag beside theirs is almost certainly the very same one.

Interestingly enough, none of that silence is because the drug doesn't work. For plenty of people it works beautifully, and the relief is real.

The silence is just the culture of the thing.

And the culture has a cost: A drug that gets passed around in confidence, with nothing attached to it but a name and a half-remembered dose, is one a lot of people end up taking blindly.

So here's my unhushed take on this... you might want to grab a cup of tea before we go on.

What Beta Blockers Actually Do (and the One Thing They Can't)

Beta blockers weren't built for nerves. They were built for hearts.

The first one, propranolol, came out of the lab of a Scottish pharmacologist called James Black in the early 1960s (work that later won him a Nobel Prize, which is not something you can say about most things in your bathroom cabinet).

The drug's day job is lowering blood pressure and steadying an irregular heartbeat. On the side, it also prevents migraines.

And somewhere along the way it picked up an entirely different third gig: Calming nervous musicians.

(I guess once someone noticed that a drug that slows a racing heart will also slow the racing heart of a flautist staring down an audition panel, they realised they were on to something.)

Its mechanism is worth a quick look, because everything else depends on it (I promise to keep it short!):

When you're frightened, your body floods with adrenaline, and adrenaline goes around knocking on little doors called receptors, telling your heart to speed up, your blood pressure to climb, your muscles to brace.

A beta blocker plants itself in front of those doors and won't let the message through. So the physical side of fear gets turned down. The pounding heart, the shaking hands, the trembling voice, the sweat... all quieter.

(It's the same steadying effect, by the way, that gets beta blockers banned in Olympic archery and shooting, the two sports where a steady hand is the whole job. Concert halls, luckily, have no such rulebook. Nobody is going to ask a cellist to pee in a cup... at least, not for this.)

Now, they are not sedatives. At the doses musicians use, they won't make you drowsy or slow your thinking.

But notice how they don't touch the mental side at all. The catastrophic thoughts, the I can't mess this up, the running commentary about the panel behind the screen... every bit of that carries on exactly as before.

Most people who take them say the same thing: They still feel nervous. Their hands just stop shaking. When the chef Prue Leith talked about taking propranolol for her own stage fright, she put it almost perfectly: She went from terrified to still nervous, but not terrified.

So if your nerves live mostly in your body, in the tremor that ruins your bow or your vibrato, beta blockers can be genuinely useful.

But if your nerves live mostly in your head, in the overthinking and the spiral and the dread... the pill is aiming at the wrong target.

It can steady the hands of a musician whose real struggle is the voice in their head, and leave that real struggle completely untouched.

In the way I think about performing (a.k.a. The Confident Musician Method), the pill works on the Body. It doesn't touch the Mind, the Vision, and the Craft sides at all.

Why Half the Profession Is Secretly On Them

If you have ever felt alone in this, you really aren't :)

To be honest with you, the numbers are startling:

A 1987 survey of musicians in the biggest American orchestras found that more than a quarter had used beta blockers for their nerves at least once. Of those, around 70% had got the drug without a prescription.

By 2015, a follow-up health survey put it at roughly 70% who had tried them, with about 90% saying they'd consider one for an audition. The documentary Composed surveyed more than 5,000 classical musicians and landed near 72%.

One conservatoire teacher has guessed that 80 to 90% of professionals take something before an orchestral audition, though that one is more hunch than data.

Whatever the precise figure, the shape is clear. This is not a niche habit.

And yet almost nobody says so.

Beta blockers have been called the musicians' underground drug, which is about right, because the whole thing runs like a mild conspiracy that everyone is in and no one will confirm. Everybody knows someone who takes them. Hardly anyone admits to taking them, or will only say so to one or two trusted friends, in a particular lowered voice usually reserved for confessions.

The funny part is that the rest of the world has gone in exactly the opposite direction. Beta blockers turn up on awards-show red carpets now (the actor Rachel Sennott reportedly told a red-carpet interviewer to "take that beta blocker, girl" (which is not a sentence anyone was saying in 1987!), in podcast confessions, in newspaper health columns. Prescriptions have climbed sharply. Classical music is the one room still whispering about a thing the wider culture has more or less started announcing.

I keep poking at the silence because the silence is the actual problem. It is what sends a frightened musician to a friend for a prescription drug, guessing at a dose, carrying a low background hum of shame about needing it at all.

None of that is safe, and none of it is necessary.

My Take: It's A Tool, and It Depends How You Use It

Let's get one thing clear: I'm not anti beta blockers. I'm also not here to talk you into them.

They are a tool, and the useful question about any tool is never whether it's good or bad in the abstract.

It's whether this one is doing its job in a way that is useful for you.

Sometimes it clearly is. Sometimes the physical response is so loud you can't even begin the inner work. You cannot practise noticing a catastrophic thought and gently stepping back from it while your whole body is convinced it is about to be eaten.

In that state, taking the edge off the physical can buy you enough mental space to start. And what I see in my coaching practice is that a lot of musicians find they reach for the pill less often over time, because it simply has less to do.

One exception: If you take beta blockers every day, prescribed for a medical reason, none of this is about you. Please don't change a thing because of a blog post :) Stopping a daily heart (or migraine) medication on a whim can be genuinely dangerous, and that decision belongs to you and your doctor, full stop.

I also want to take a little detour here, because shame does more damage here than the nerves ever do.

Needing help with performance fear is not a character flaw, and it is not a sign you don't belong in this profession. Some of the finest musicians who ever lived were floored by it. Casals, Glenn Gould, Pavarotti... Renée Fleming has written about her throat simply closing on stage, with no warning at all. Andrea Bocelli has said he takes nothing, that the only thing to do is walk out and hope. So many artists with similar problems, and every one of them serious about the work. There is no version of this where struggling makes you less of a musician.

Anyway...

The point I'm trying to make is that a tool you can lean on is fine. But a tool you cannot function without has basically stopped being a tool and started being a leash.

So I never question whether it's a good or bad idea to take them.

I just ask whether you'd still be all right if one day you couldn't.

What Happens When the Pill Isn't There

Let me tell you about two musicians.

The first was an opera singer who had sung in the chorus of a big house, and who had secretly carried a beta blocker in her bag since her first audition, reaching for it before anything that mattered.

One night, partway through a run, the scheduled soloist tested positive for COVID (yes, it was during those dark times)... and she was asked to step in and sing the lead role. Her first solo, on that big stage, with no time to prepare. Naturally, the anxiety arrived instantly.

So she reached into her bag for the pill... and it wasn't there. She had a few seconds of panic. And then she walked on and sang the solo anyway, with the fear fully present and loud the whole way through. It went well... really well.

The second was a first-chair player who, about an hour before a major performance, noticed the tablets in their case had passed their expiry date. They decided, very sensibly, not to gamble on an expired pill, and went on without. They played beautifully.

In both cases the exact thing they had dreaded for years finally happened, accompanied by the thought I can't do this without a beta blocker.

And yet, in both cases, they could do it.

Plenty of the musicians I work with carry a bottle "just in case" and almost never actually take one. The bottle earns its keep simply by sitting in the bag... which tells you something rather important about what is really being managed here.

Because quite often the fear beta blockers manage isn't the 'body' itself. It's the fear of the body. And the pill can't touch that.

So, to be very clear, I am not telling you to throw your pills away...

But I am telling you not to let one small tablet be the only thing standing between you and the stage.

The Safety Conversation Almost Nobody Has

This is the part of the hush-hush culture that genuinely worries me, and I would be failing you if I skipped it.

Beta blockers are prescription heart medication. Getting them from a friend, however kind the friend, skips the one step that exists to keep you safe: A doctor checking whether they are safe for you specifically.

They are not right for everyone. People with asthma, diabetes, low blood pressure, and certain heart and thyroid conditions can be put at real risk by them. The asthma one is worth knowing in particular, because the same action that calms your heart can tighten your airways.

So the sensible move is to try them well ahead of time, with medical guidance, and not meet an unsuspected breathing or heart problem for the first time on a stage.

Then there is the part almost nobody mentions, even people who have taken them for years, because most aren't even aware this is a possibility.

Remember how beta blockers work by blocking the receptors that adrenaline acts on? Well, the emergency treatment for a severe allergic reaction, anaphylaxis, the thing inside an EpiPen, is adrenaline. Which works through those very same receptors.

So if you have beta blockers in your system and you have a serious allergic reaction, to a stray ingredient at a reception, say, or an insect sting, the standard rescue can work less well than it should, and the reaction can run more dangerously.

(There is a second-line treatment that gets around the blockage, a drug called glucagon, but emergency teams don't always reach for it because it isn't widely recognised as an anaphylaxis treatment.)

The risk is clearest in people who take beta blockers regularly, but the drug stays active in your system for hours after a single dose, which is why it is worth understanding even if you only use it now and then.

Now set that next to the culture of secrecy, and you'll see why the two together trouble me so much.

In an emergency, you may not be able to speak.

If nobody around you knows what you've taken...

If it isn't written on a medical-ID note...

If you've never told the people you perform with, if your instinct would be to hide it from a paramedic out of embarrassment...

Then the one piece of information that changes how you should be treated is missing at the worst possible moment.

The stigma that keeps beta blockers a secret is, quite literally, one of the things that can make them dangerous.

That alone is the strongest case I know for bringing this whole subject into the open.

So tell your doctor. Tell someone you trust. Don't carry it alone.

The Bottom Line

So where does all this leave us?

Beta blockers are a tool. Used well, with a doctor in the loop and no shame attached, they help a great many musicians, and there is nothing wrong with being one of them.

The goal I would hold for anyone I work with isn't to get them off the pills. It is to become a musician who can walk on stage with the pill or without it.

Because the steadiness needs to hold when there's nothing in your bag... with preparation that doesn't wobble when you're frightened, and a clear sense of why you're up there at all... none of that is chemical. That part is built, and it doesn't expire, and it can't be left at home by accident.

And if you'd like to stop dreading the day when you're caught without the pill, private coaching is where we can get started together.

FAQ About Beta Blockers

Do beta blockers help musicians with performance anxiety? They reduce the physical symptoms (tremor, racing heart, trembling voice) but not the mental side. Most useful when nerves show up mainly in the body.

Do beta blockers affect your playing or expression? Responses vary. Many feel only relief from tremor; some report feeling flat or losing fine control of vibrato. It's individual.

Are beta blockers safe for musicians? For some, used under medical guidance. They can be risky for people with asthma, diabetes, low blood pressure, or certain heart conditions, which is why a doctor's check matters.

Can you take beta blockers without a prescription? They're prescription-only. Getting them from a friend skips the medical screening that catches the conditions that make them dangerous.

Do beta blockers interact with an EpiPen? They can blunt adrenaline, the rescue drug for anaphylaxis, so a severe allergic reaction can be harder to treat. Tell any clinician or medical personnel treating you that you take them.

About

I'm Gökçe Kutsal, a music performance coach for professional orchestra musicians and opera singers, with an MA in Voice Pedagogy, plus coaching and teaching experience since 2017. I work with orchestral musicians, soloists, and audition candidates across Europe, the UK, North America, and Australia — and I write about performance anxiety, audition preparation, and the craft of practice for musicians who already have the technique and are trying to work out why it doesn't always hold up under pressure.

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