Efficacy, Safety and Tolerability of Clonazepam 0.25 mg and Propranolol 10/20 mg Fixed-dose Combination among Anxiety Disorder Patients: A Randomized, Double-blind, Multicentric, Active-controlled, Phase IV Study
Anu Kant Mital, Manushree Gupta, Nilesh Shah, Sathianathan R, SVB Gupta, Manjula S, Krishna Kumar M
Citation Information :
Mital AK, Gupta M, Shah N, R S, Gupta S, S M, M KK. Efficacy, Safety and Tolerability of Clonazepam 0.25 mg and Propranolol 10/20 mg Fixed-dose Combination among Anxiety Disorder Patients: A Randomized, Double-blind, Multicentric, Active-controlled, Phase IV Study. Ind J Priv Psychiatry 2025; 19 (1):11-16.
Background and aim: Although monotherapy of anti-anxiety drugs is effective in controlling anxiety, due to the progressive nature of the disease, it is often associated with a lack of effectiveness over time. So, this study was carried out to assess the efficacy, safety, and tolerability of clonazepam 0.25 mg and propranolol 10/20 mg fixed-dose combination among anxiety disorder patients.
Materials and methods: This was a randomized, double-blind, multicenter, actively-controlled, phase IV study conducted among individuals having established diagnosis of anxiety, total Hamilton Rating Scale for Anxiety (HAM-A) score ≥17, Clinical Global Impressions Severity (CGI-S) score >4 in the week prior to inclusion. The study participants were randomized to receive either the test or the reference drug once daily for 8 weeks. At the last study visit, the degree of a patient's anxiety was assessed by using the HAM-A and CGI-S scores.
Results: At week 8, it was observed that there was a decrease in HAM-A score in all the groups. Between the group analysis, at visit 3, there was a reduction in the HAM-A score compared with the randomization visit. The investigator-rated scale and patient-rated global improvement were highest in group B followed by group C compared with group A. Also, there was a notable reduction in group A at week 8 in the CGI-S score as compared with baseline in group B.
Conclusion: The combination of clonazepam and propranolol was effective, safe, and well-tolerated. Hence, it can be a significant armamentarium in anxiety disorder management.
Clinical significance: The clonazepam 0.25 mg and propranolol 10/20 mg fixed-dose combination showed a significant decrease in the HAM-A score across patients with anxiety disorders and was found to be clinically effective, safe, and well-tolerated.
Bystritsky A, Khalsa SS, Cameron ME, et al. Current diagnosis and treatment of anxiety disorders. P T 2013;38(1):30–57. PMID: 23599668.
Craske MG, Rauch SL, Ursano R, et al. What is an anxiety disorder? Focus 2011;9(3):369–388. DOI: 10.1176/foc.9.3.foc369
Chand SP, Marwaha R. Anxiety. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2024.
Garakani A, Murrough JW, Freire RC, et al. Pharmacotherapy of anxiety disorders: current and emerging treatment options. Front Psychiatry 2020;11:595584. DOI: 10.3389/fpsyt.2020.595584.
India State-Level Disease Burden Initiative Mental Disorders Collaborators. The burden of mental disorders across the states of India: The Global Burden of Disease Study 1990–2017. Lancet Psychiatry 2020;7(2):148–161. DOI: 10.1016/S2215-0366(19)30475-4.
Shahrokhi M, Gupta V. Propranolol. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2024.
Basit H, Kahwaji CI. Clonazepam. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2024.
Nardi AE, Perna G. Clonazepam in the treatment of psychiatric disorders: An update. Int Clin Psychopharmacol 2006;21(3):131–142. DOI: 10.1097/01.yic.0000194379.65460.a6.
Worthington JJ 3rd, Pollack MH, Otto MW, et al. Long-term experience with clonazepam in patients with a primary diagnosis of panic disorder. Psychopharmacol Bull 1998;34(2):199–205. PMID: 9641001.
Wang SM, Kim JB, Sakong JK, et al. The efficacy and safety of clonazepam in patients with anxiety disorder taking newer antidepressants: A multicenter naturalistic study. Clin Psychopharmacol Neurosci 2016;14(2):177–183. DOI: 10.9758/cpn.2016.14.2.177.
Grover S, Avasthi A, Sinha V, et al. Indian Psychiatric Society multicentric study: Prescription patterns of psychotropics in India. Indian J Psychiatry 2014;56(3):253–264. DOI: 10.4103/0019-5545.140632.
Laverdure B, Boulenger JP. Médications bêta-bloquantes et anxiété. Un intérêt thérapeutique certain [Beta-blocking drugs and anxiety. A proven therapeutic value]. Encephale 1991;17(5):481–492.
Leister NS, Kattula D, Shyamasunder AH, et al. Treating anxiety and depression in neuroendocrine tumour. Indian J Psychiatry 2022;64(3):S675.
Hallstrom C, Treasaden I, Edwards JG, et al. Diazepam, propranolol and their combination in the management of chronic anxiety. Br J Psychiatry 1981;139:417–421. DOI: 10.1192/bjp.139.5.417.
Shehi M, Patterson WM. Treatment of panic attacks with alprazolam and propranolol. Am J Psychiatry 1984;141(7):900–901. DOI: 10.1176/ajp.141.7.900.