Knowledge, attitudes, and patterns of nonmedical beta-blockers use among medical students: a comparative study between Lebanon and Armenia

The use of beta-blockers for off-label indications, such as the treatment of performance and examination anxiety-related issues, has increasingly surfaced in the literature as a phenomenon in medical students. Although the use of these medications may help relieve physical symptoms of anxiety associated with it, public health concerns have arisen considering the unsupervised medication use. This study aims to assess the knowledge, attitudes, and patterns of beta-blockers use among medical students in Lebanon and Armenia. A cross-sectional survey was carried out, using a standardized questionnaire, administered on a self-reporting basis, among medical students in both Lebanon and Armenia during the academic year 2025–2026. A set of sociodemographic variables, the use of beta-blockers in their lifetime and currently, use and pattern of use, sources of prescriptions, use of doses, efficacy, side effects, and knowledge and attitudes about beta-blockers were explored in the survey using descriptive and inferential statistical methods. A total of 600 participants were recruited (Lebanon: n = 292, and Armenia: n = 308). Beta-blockers use was reported by 23 Lebanese students (7.9%) and 26 Armenian students (8.4%). Use was significantly more common among males in both Lebanon (82.6% of users, p = 0.007) and Armenia (69.2% of users, p = 0.002). In Armenia, use was additionally associated with advanced academic year (p < 0.001). Self-prescription predominated in both countries (82.6% in Lebanon; 65.4% in Armenia). Most users reported perceived effectiveness in reducing anxiety (87.0% and 84.6%, respectively). Self-reported adverse effects were noted by 13 Lebanese users (56.5%) and 14 Armenian users (53.8%), most commonly hypotension. No statistically significant differences were observed between countries in patterns of use, dosing behavior, perceived effectiveness, or reported adverse effects. The prevalence of nonmedical use of beta-blockers among Lebanese and Armenian medical students is relatively uncommon but includes self-prescription, unsupervised dose adjustments, and notable adverse effects. Similar misuse patterns across different regulatory systems suggest that academic stress and performance pressure play key roles, highlighting the need for targeted educational and supportive interventions to promote responsible medication use and healthier coping strategies.