Acebutolol Dosage

Usual Adult Dose for Hypertension

Initial dose: 400 mg orally once a day or 200 mg orally twice a day.
Maintenance dose: 400 to 800 mg per day.

Usual Adult Dose for Premature Ventricular Depolarizations

Initial dose: 200 mg orally twice a day.
Maintenance dose: 600 to 1200 mg per day in divided doses.

Renal Dose Adjustments

CrCl less than 25 mL/min: The daily dose should be reduced by 75%.

CrCl less than 50 mL/min: The daily dose should be reduced by 50%.

Liver Dose Adjustments

Since acebutolol is primarily metabolized, it is recommended that dosage increments be made cautiously in patients with liver disease.

Dose Adjustments

Dosage adjustments can be made every 2-3 days. In patients with liver disease, dosage adjustments should be made cautiously.

Precautions

Acebutolol is contraindicated in patients with persistently severe bradycardia, with second- and third-degree heart block, with overt congestive heart failure, and with cardiogenic shock.

Sympathetic stimulation may be essential for support of the circulation in patients with diminished myocardial contractility, and its inhibition by beta-adrenergic receptor blockade may precipitate more severe failure. Although beta blockers should be avoided in overt cardiac failure, acebutolol therapy can be used with caution in patients with a history of heart failure who are controlled with digitalis and/or diuretics. Both digitalis and acebutolol may impair AV conduction. If cardiac failure persists, treatment with acebutolol should be withdrawn.

In individuals with aortic or mitral valve disease or compromised left ventricular function, continued depression of the myocardium with beta-blocking agents over a period of time may lead to cardiac failure. At the first signs of failure, patients should be digitalized and/or be given a diuretic and the response closely observed. If cardiac failure continues despite adequate digitalization and/or diuretic, acebutolol treatment should be withdrawn.

While taking beta-blockers, individuals with a history of severe anaphylactic reaction to a variety of allergens may be more reactive to repeated challenge, either accidental, diagnostic, or therapeutic. Such individuals may be unresponsive to the usual doses of epinephrine used to treat allergic reaction.

Acebutolol therapy should be used cautiously in patients with impaired hepatic function.

Although acebutolol is a beta-1 adrenergic selective beta-blocker, beta-2 blocking properties may be exhibited at doses exceeding 800 mg per day. This may be important in patients with reactive airways disease.

Beta-blockers, in general, may decrease peripheral vascular tone and mask the sympathomimetic response to hypoglycemia and thyrotoxicosis and should, therefore, be used cautiously in patients with peripheral vascular disease, hyperthyroidism, and diabetes.

Patients with coronary artery disease receiving acebutolol should be advised to avoid abrupt discontinuation of the drug, as severe exacerbation of angina and occurrence of myocardial infarction and ventricular arrhythmias have occurred.

If treatment for ventricular arrhythmias is to be discontinued, it should be done gradually over a 2 week period.

Withdrawal of beta-blocker therapy prior to major surgery is controversial, as the impaired ability of the heart to respond to reflex adrenergic stimuli may augment the risks of general anesthesia and surgical procedures.

Safety and effectiveness in pediatric patients have not been determined.

Dialysis

Since acebutolol is slightly to moderately dialyzed, the dose should be administered at some time following dialysis when the patient is hemodynamically stable.

Other Comments

The maximum dose is 600 mg orally twice a day.

Compared with Caucasian patients, Black patients have a reduced blood pressure response to monotherapy with beta-blockers; however, the reduced response is largely eliminated if combination therapy that includes an adequate dose of a diuretic is instituted.

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