Pindolol

Pronunciation

Pronunciation: PIN-doe-lahl
Class: Beta-adrenergic blocking agent

Trade Names

Visken
- Tablets 5 mg
- Tablets 10 mg

Apo-Pindol (Canada)
Gen-Pindolol (Canada)
Nu-Pindol (Canada)
Sandoz Pindolol (Canada)

Pharmacology

Nonselectively blocks beta receptors, which primarily affect heart (slows rate), vascular musculature (decreases blood pressure), and lungs (reduces function).

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Pharmacokinetics

Absorption

Rapidly and reproducibly absorbed (more than 95%). T max is 1 h. Bioavailability is approximately 100%.

Distribution

Protein binding is 40%. Evenly distributed between plasma red cells. Vd is 2 L/kg.

Metabolism

Metabolized in the liver (60% to 65%) as hydroxy metabolites.

Elimination

Urine (amount of dose excreted 60% to 65%; as unchanged 35% to 40%); feces (6% to 9%). T 1/2 is approximately 8 h (polar metabolites). T 1/2 is 3 to 4 h.

Special Populations

Renal Function Impairment

50% decreased in volume of distribution in uremic patients, generally excreted in less than 15% of dose as unchanged in the urine.

Hepatic Function Impairment

In cirrhosis patients, elimination was more variable in rate and slower, half-life ranged from 2.5 h to more than 30 h. Exercise caution; dosage adjustments may be necessary.

Elderly

In elderly hypertensive patients, the half-life is more variable, averaging 7 h.

Indications and Usage

Management of mild to moderate hypertension.

Contraindications

Greater than first-degree heart block; CHF unless secondary to tachyarrhythmia treatable with beta-blockers; overt cardiac failure; sinus bradycardia; cardiogenic shock; hypersensitivity to beta-blockers; bronchial asthma or bronchospasm, including severe COPD.

Dosage and Administration

Adults

PO 5 mg twice daily. May be increased by 10 mg every 3 to 4 wk until desired response; max dose is 60 mg/day.

General Advice

Administer without regard to meals. Administer with food if GI upset occurs.

Storage/Stability

Store at or below 86°F.

Drug Interactions

Clonidine

May enhance or reverse antihypertensive effect; potentially life-threatening situations may occur, especially on withdrawal.

Epinephrine

Initial hypertensive episode followed by bradycardia may occur.

Ergot derivatives

Peripheral ischemia, manifested by cold extremities and possible gangrene, may occur.

Insulin

Prolonged hypoglycemia with masking of symptoms may occur.

Lidocaine

Lidocaine levels may increase, leading to toxicity.

NSAIDs

Some agents may impair antihypertensive effect.

Prazosin

Orthostatic hypotension may be increased.

Theophyllines

Elimination of theophylline may be reduced. Also, effects of both drugs may be reduced by pharmacologic antagonism.

Verapamil

Effects of both drugs may be increased.

Laboratory Test Interactions

None well documented.

Adverse Reactions

Cardiovascular

Bradycardia; hypotension; CHF; edema; worsening angina.

CNS

Depression; visual disturbances; short-term memory loss; dizziness.

Dermatologic

Skin rash; increased sensitivity to cold.

EENT

Dry eyes; visual disturbances.

GI

Nausea; vomiting; diarrhea.

Genitourinary

Impotence; urinary retention; difficulty with urination.

Hematologic

Agranulocytosis.

Hepatic

May increase AST or ALT; rarely increases LDH or alkaline phosphatase.

Metabolic

May increase or decrease blood glucose, uric acid.

Respiratory

Wheezing; bronchospasm; difficulty breathing (at higher doses).

Precautions

Pregnancy

Category B .

Lactation

Excreted in breast milk.

Children

Safety and efficacy not established.

Renal Function

Dosage may need to be reduced.

Hepatic Function

Dosage may need to be reduced.

Anaphylaxis

Deaths have occurred; aggressive therapy may be required.

CHF

Administer cautiously in CHF patients controlled by digitalis and diuretics. Notify health care provider at first sign or symptom of CHF or unexplained respiratory symptoms in any patient.

Diabetics

May mask signs and symptoms of hypoglycemia (eg, tachycardia, BP changes). May potentiate insulin-induced hypoglycemia.

Peripheral vascular disease

May precipitate or aggravate symptoms of arterial insufficiency.

Thyrotoxicosis

May mask clinical signs of developing or continuing hyperthyroidism (eg, tachycardia). Abrupt withdrawal may exacerbate symptoms of hyperthyroidism, including thyroid storm.

Overdosage

Symptoms

Bradycardia, hypotension, seizures, respiratory depression.

Patient Information

  • Teach patient and family technique for measuring BP and pulse rates and to keep written record.
  • Instruct patient to notify health care provider if pulse rate is less than 50 bpm or systolic BP is less than 90 mm Hg.
  • Warn patient not to engage in activities that require mental alertness until drug effects are apparent because it may cause blurred vision, drowsiness, and dizziness.
  • Explain that decreased blood supply to extremities may cause patient to be more sensitive to cold temperatures.
  • Encourage patients with diabetes to monitor blood glucose carefully.
  • Advise patient to report the following symptoms to health care provider: any asthma-like symptoms, cough or nasal stuffiness, skin rash, fever, sore throat, unusual bleeding or bruising.
  • Instruct patient to sit or lie down immediately if dizziness or faintness occurs.

Copyright © 2009 Wolters Kluwer Health.

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