Pindolol Side Effects

Some side effects of pindolol may not be reported. Always consult your doctor or healthcare specialist for medical advice. You may also report side effects to the FDA.

For the Consumer

Applies to pindolol: oral tablet

Get emergency medical help if you have any of these signs of an allergic reaction while taking pindolol: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.

Call your doctor at once if you have any of these serious side effects:

• slow or uneven heartbeats;

• feeling light-headed, fainting;

• feeling short of breath, even with mild exertion;

• swelling of your ankles or feet;

• nausea, stomach pain, low fever, loss of appetite, dark urine, clay-colored stools, jaundice (yellowing of the skin or eyes);

• depression; or

• cold feeling in your hands and feet.

Less serious side effects of pindolol may include:

• decreased sex drive, impotence, or difficulty having an orgasm;

• sleep problems (insomnia);

• tired feeling; or

• anxiety, nervousness.

This is not a complete list of side effects and others may occur. Tell your doctor about any unusual or bothersome side effect.

For Healthcare Professionals

Applies to pindolol: compounding powder, oral tablet

Cardiovascular

Like some other nonselective beta-blockers, pindolol may inhibit myocardial contractility. This may be important in some patients with left ventricular systolic dysfunction or congestive heart failure. Other cardiovascular side effects include bradycardia, edema with weight gain (reported in up to 15% of patients in some studies), Raynaud's phenomenon, cold extremities, and AV heart block. Palpitations are reported in less than 1% of patients.

Due to the intrinsic sympathomimetic activity of pindolol, induction or exacerbation of arrhythmias is possible, particularly when higher doses are used. At least one case of enhanced ventricular ectopic activity has been associated with pindolol.

Abrupt withdrawal of pindolol can result in significant hypertension, angina pectoris, and acute coronary insufficiency with myocardial infarction. This may be particularly important in some patients with a history of coronary artery disease.

A 47-year-old man with idiopathic dilated cardiomyopathy and premature ventricular depolarizations (PVDs) was stable on propranolol and digoxin (4 to 5 PVDs/min). Due to fear of negative inotropic activity, the patient was switched to pindolol during ECG monitoring. Fifteen minutes after the first dose of pindolol 10 mg orally, the PVD rate increased to 22 to 25/min, and six beats of nonsustained ventricular tachycardia (VT) were observed. Salvos of VT and ventricular couplets were observed. An idioventricular rhythm with a rate of 63 beats/min was also observed during episodes of sinus bradycardia. The serum digoxin level was 0.5 ng/mL; serum electrolytes were within normal limits. Pindolol therapy was not continued, and 10 hours later, the patient's ventricular ectopy returned to baseline.

Pindolol increases AV nodal conduction time, and may cause or exacerbate AV heart block due to digitalis or other reasons. The effect of pindolol on the AV node is less than propranolol.

Pindolol appears to cause orthostatic hypotension in a significant number of patients with autonomic dysfunction. In one study of seven patients with Shy Drager syndrome, two developed orthostatic changes and frank congestive heart failure at dosages of 15 mg three times a day.

Respiratory

Respiratory compromise has been observed in approximately 1% of patients. This may be very important in patients with reactive airways disease. While pindolol does have intrinsic sympathomimetic activity, its use in patients with bronchial asthma is limited.

Endocrine

A 35-year-old man with hypertension and type II diabetes mellitus developed lightheadedness and fell unconscious while skiing. Pertinent findings included hypothermia, hypotension, sinus bradycardia, "tented" T-waves on the ECG, and an undetectable blood glucose per fingerstick. The patient regained consciousness after intravenous glucose was given. He was accustomed to regular exercise, had not changed his pindolol dose (15 mg/day), but had not eaten a complete breakfast. The authors of this case report believe that, while the patient's glucose stores may have been low, the combined effects of exercise and beta-blockade on glucose metabolism caused the profound hypoglycemia.

Most data indicate (beneficial) significant decreases in total serum cholesterol and triglycerides and a significant increase of HDL cholesterol during pindolol therapy. Other data indicate significant increases in serum triglycerides and decreases of HDL cholesterol during pindolol therapy.

Endocrinologic abnormalities include hypoglycemia. Nonselective beta-blockers, such as pindolol, may inhibit catecholamine-mediated gluconeogenesis and mask the signs and symptoms of hypoglycemia, such as sweating and tachycardia. Data on the effect of pindolol on the lipid profile is controversial. Periodic monitoring of the lipid profile is suggested for patients with preexisting lipid disorders and in whom the consequences of hypercholesterolemia or hypertriglyceridemia are unacceptable.

Nervous system

Nervous system side effects include fatigue or unusual dreams in 5%, insomnia or dizziness in 3%, depression or headache in 2%, and nervousness or tremor in 1% of patients.

Rare cases of pindolol-induced tremor have been reported. While beta-blockers are known to suppress different types of tremors, the paradoxical appearance of tremors during pindolol therapy is attributed to its partial beta-agonist activity.

Gastrointestinal

Gastrointestinal disturbances are unusual. Nausea or abdominal discomfort are reported in 2% of patients. Dry mouth or diarrhea are each reported in approximately 1% of patients.

Genitourinary

In one placebo-controlled, double-blinded study of four beta-blockers in 30 healthy male volunteers, the nonselective beta-blockers, pindolol and propranolol, were associated with the greatest reduction in serum testosterone after one week of treatment. Pindolol was associated with the longest time to nocturnal penile tumescence. There were no statistically significant subjective complaints associated with these laboratory findings, however.

Genitourinary complaints are limited to decrease libido or impotence in approximately 1% of male patients.

Musculoskeletal

Pindolol and carteolol, beta-adrenergic receptor antagonists with intrinsic sympathomimetic activity (ISA), have more commonly been associated with muscle cramps and elevated serum creatine phosphokinase (CK) levels than beta-blockers without ISA.

Musculoskeletal pain, usually presenting as muscle cramps, is reported in up to 3% of patients.

Renal

Renal side effects are not reported during pindolol therapy. Data show that the glomerular filtration rate and effective renal plasma flow are unaffected by pindolol.

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