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Visken

Generic Name: Pindolol
Class: beta-Adrenergic Blocking Agents
VA Class: CV100
Chemical Name: 1-(Indol-4-yloxy)-3-(isopropylamino)-2-propanol
Molecular Formula: C14H20N2O2
CAS Number: 13523-86-9

Introduction

A nonselective β-adrenergic blocking agent.1 2 3 4

Uses for Visken

Hypertension

Management of hypertension (alone or in combination with other classes of antihypertensive agents).1 32 37 38 52

Slideshow: 2014 Update: First Time Brand-to-Generic Switches

One of several preferred initial therapies in hypertensive patients with heart failure, postmyocardial infarction, ischemic heart disease, and/or diabetes mellitus.84

Can be used as monotherapy for initial management of uncomplicated hypertension; however, thiazide diuretics are preferrred by JNC 7.84

Angina

Management of chronic stable angina pectoris.2 5 15 22

Visken Dosage and Administration

General

  • Individualize dosage according to patient response and tolerance.1

  • If long-term therapy is discontinued, reduce dosage gradually over a period of about 1–2 weeks.1 (See Abrupt Withdrawal of Therapy under Cautions.)

Administration

Oral Administration

Administer orally, usually twice daily;1 bioavailability does not appear to be affected by food.1 (See Absorption under Pharmacokinetics.)

For management of hypertension, once-daily dosing may be possible in some patients.2

Dosage

Adults

Hypertension
Oral

Initially, 5 mg twice daily.1 38 52 84 Increase dosage gradually by 10 mg daily at 3- to 4-week intervals as necessary up to 60 mg daily.1 38 52 84 The usual maintenance dosage range is 10–40 mg daily, given in 2 divided doses.2 11 15

Angina
Oral

15–40 mg daily, given in 3 or 4 divided doses.2 5 22

Prescribing Limits

Adults

Hypertension
Oral

Maximum 60 mg daily.1 38 52 84

Special Populations

Hepatic Impairment

Dosage must be modified in response to the degree of hepatic impairment.1

Cautions for Visken

Contraindications

  • Bronchial asthma, heart block greater than first degree, cardiogenic shock, overt cardiac failure, or severe bradycardia.1

Warnings/Precautions

Warnings

Cardiac Failure

Possible precipitation of CHF.1 2

Avoid use in patients with decompensated CHF, may use cautiously in patients with well-compensated heart failure (e.g., those controlled with ACE inhibitors, cardiac glycosides, and/or diuretics).1

Adequate treatment (e.g., with a cardiac glycoside and/or diuretic) and close observation recommended if signs or symptoms of impending cardiac failure occur; if cardiac failure continues, discontinue therapy, gradually if possible.1

Abrupt Withdrawal of Therapy

Abrupt discontinuance of therapy is not recommended as it may exacerbate angina symptoms or precipitate MI in patients with CAD.1 Abrupt discontinuance of therapy is not recommended.1 Gradually decrease dosage over a period of about 1–2 weeks.1 Monitor patients carefully and advise to temporarily limit their physical activity.1 If exacerbation of angina occurs, reinstitute therapy promptly, and initiate appropriate measures for the management of unstable angina pectoris.1

Bronchospastic Disease

Possible inhibition of bronchodilation produced by endogenous catecholamines.1

Generally should not be used in patients with bronchospastic disease, but may be used with caution in patients with nonallergic bronchospasm (e.g., chronic bronchitis, emphysema).1 (See Contraindications under Cautions.)

Major Surgery

Possible risks associated with general anesthesia (e.g., severe hypotension, difficulty maintenaning heart beat) due to decreased ability of the heart to respond to reflex β-adrenergic stimuli.1 Use with caution in patients undergoing major surgery involving general anesthesia.1

Diabetes and Hypoglycemia

Possible decreased signs and symptoms of hypoglycemia (e.g., tachycardia, palpitation, BP changes, tremor, feelings of anxiety, but not sweating or dizziness).1 68

Use with caution in patients with diabetes mellitus receiving hypoglycemic drugs.1

Thyrotoxicosis

Signs of hyperthyroidism (e.g., tachycardia) may be masked.1 Possible thyroid storm if therapy is abruptly withdrawn;1 carefully monitor patients having or suspected of developing thyrotoxicosis.1

Sensitivity Reactions

Anaphylactic Reactions

Possible increased reactivity to repeated, accidental, diagnostic, or therapeutic challenges with a variety of allergens while taking β-blocking agents in patients with a history of anaphylactic reactions to a variety of allergens.1 Such patients may be unresponsive to usual doses of epinephrine.1

Specific Populations

Pregnancy

Category B.1

Lactation

Distributed into milk.1 Use not recommended.1

Pediatric Use

Safety and efficacy not established.1

Hepatic Impairment

Hepatic elimination; use with caution.1

Common Adverse Effects

Insomnia, dizziness, fatigue, nervousness, bizzare dreams or increased dreaming, weakness, paresthesia, edema, dyspnea, muscle pain, joint pain, chest pain, muscle cramps, nausea, abdominal discomfort, pruritus.1

Interactions for Visken

Specific Drugs

Drug

Interaction

Comments

Aspirin

Pharmacokinetic interaction unlikely1

Digoxin

Possible decreases in serum digoxin concentrations 1

Not considered clinically important1 18

Reserpine

Additive effects1

Monitor for signs of hypotension and bradycardia (e.g., vertigo, syncope, postural hypotension)1

Hypotensive agents (hydralazine, hydrochlorothiazide)

Possible increased hypotensive effects1

Adjust dosage carefully1

Thioridazine

Increased serum concentrations of thioridazine1 and metabolites; higher than expected serum concentrations of pindolol1 73 1

Increased thioridazine concentrations may cause prolongation of the QTc interval and a possible increase in the risk of serious, potentially fatal cardiac arrhythmia (e.g., torsades de pointes)73 1

Concomitant use is contraindicated73

Warfarin

Pharmacokinetic interaction unlikely1

Visken Pharmacokinetics

Absorption

Bioavailability

Rapidly absorbed from the GI tract with peak plasma concentrations reached within 1–2 hours.1 2

Bioavailability 502 –95%.1 2

Onset

Effect on heart rate is seen within 3 hours.2

Hypotensive effect is usually seen within 1 week, but maximum therapeutic response may not be observed until 2 weeks or longer.1

Duration

Acute hemodynamic effects persist for 24 hours after administration.2

Food

Food may increase the rate,2 but not the extent of absorption.1

Special Populations

Bioavailability may be at the lower end of the range in uremic patients;2 extent of absorption may be decreased in patients with impaired renal function.19

Distribution

Extent

Distributed into milk.1

Plasma Protein Binding

Approximately 40–60%.1 2

Elimination

Metabolism

Extensively metabolized in the liver (approximately 60–65%) to metabolites.1 2

Elimination Route

Excreted in urine (35–50%) unchanged.1 2 18

Half-life

3–4 hours.1 2

Special Populations

In patients with creatinine clearances <20 mL/minute, <15% is excreted in urine unchanged.1 18 20

In patients with renal failure, plasma half-life is 3–11.5 hours.2 20

In geriatric patients, plasma half-life is 7–15 hours.1

In patients with hepatic cirrhosis, half-life is 2.5–30 hours.1

Stability

Storage

Oral

Tablets

Tight, light-resistant containers at 15–30°C.1 31

Actions

  • Inhibits response to adrenergic stimuli by competitively blocking β-adrenergic receptors within the myocardium (β1-receptors) and within bronchial and vascular smooth muscle (β2-receptors).2 4 5

  • In addition, causes slight activation of the β-receptors, making the drug a partial β-agonist.2 4 5

  • At higher than therapeutically obtained plasma concentrations, the drug has membrane-stabilizing activity or a quinidine-like effect.4

  • Decreases stress- and exercise-stimulated heart rate.1 2 4 5 Has a lesser effect on resting heart rate (usually decreasing resting heart rate only by about 4–8 bpm or not at all),1 2 4 5 15 22 slowing of conduction in the AV node,4 and cardiac output,2 4 13 22 than do β-adrenergic blocking agents that do not possess intrinsic sympathomimetic activity (ISA).1 2 4 5 15 22

  • The precise mechanism of hypotensive effect has not been determined;1 the drug does not consistently affect cardiac output or renin release, and other mechanisms (e.g., decreased peripheral resistance) probably contribute to its hypotensive effect.1 15 16

  • May increase airway resistance,1 2 4 depending on the patient’s pretreatment sympathetic tone; patients with high pretreatment tone show a decrease in forced expiratory volume in 1 second (FEV1), whereas those with low pretreatment tone may show little, if any, change in FEV1.17

Advice to Patients

  • Importance of taking pindolol exactly as prescribed.1

  • Importance of not interrupting or discontinuing therapy without consulting clinician.1

  • Importance of immediately informing clinician at the first sign or symptom of impending cardiac failure (e.g., weight gain, increased shortness of breath) or if any difficulty in breathing occurs.1

  • In patients with heart failure, importance of informing clinician of signs or symptoms of exacerbation (e.g., weight gain, difficulty in breathing).1

  • Importance of patients informing anesthesiologist or dentist that they are receiving pindolol therapy prior to undergoing major surgery.1

  • Importance of informing clinicians of existing or contemplated concomitant therapy, including prescription and OTC drugs.1

  • Importance of women informing clinicians if they are or plan to become pregnant or plan to breast-feed.1

  • Importance of informing patients of other important precautionary information.1 (See Cautions.)

Preparations

Excipients in commercially available drug preparations may have clinically important effects in some individuals; consult specific product labeling for details.

* available from one or more manufacturer, distributor, and/or repackager by generic (nonproprietary) name

Pindolol

Routes

Dosage Forms

Strengths

Brand Names

Manufacturer

Oral

Tablets

5 mg*

Pindolol Tablets

Genpharm, Mutual, Mylan, Sandoz, Teva, Watson

10 mg*

Pindolol Tablets

Genpharm, Mutual, Mylan, Sandoz, Teva, Watson

Comparative Pricing

This pricing information is subject to change at the sole discretion of DS Pharmacy. This pricing information was updated 02/2014. Actual costs to patients will vary depending on the use of specific retail or mail-order locations and health insurance copays.

Pindolol 10MG Tablets (MYLAN): 60/$70.99 or 180/$194.97

Pindolol 5MG Tablets (MYLAN): 60/$55.99 or 120/$105.98

AHFS DI Essentials. © Copyright, 2004-2014, Selected Revisions March 1, 2007. American Society of Health-System Pharmacists, Inc., 7272 Wisconsin Avenue, Bethesda, Maryland 20814.

† Use is not currently included in the labeling approved by the US Food and Drug Administration.

References

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