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Levatol Side Effects

Generic Name: penbutolol

Note: This document contains side effect information about penbutolol. Some of the dosage forms listed on this page may not apply to the brand name Levatol.

For the Consumer

Applies to penbutolol: oral tablet

Along with its needed effects, penbutolol (the active ingredient contained in Levatol) may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor immediately if any of the following side effects occur while taking penbutolol:

Less Common

  • Chest pain
  • difficult or labored breathing
  • increased sweating
  • pain in the limbs
  • shortness of breath
  • tightness in the chest
  • wheezing

Incidence Not Known

  • Abdominal or stomach tenderness
  • abdominal or stomach pain, usually after eating a meal
  • black, tarry stools
  • blood in the urine
  • bloody nose
  • bloody stools
  • constipation
  • cough or hoarseness
  • diarrhea
  • fever with or without chills or sore throat
  • general feeling of tiredness or weakness
  • heavier menstrual periods
  • lower back or side pain
  • nausea
  • painful or difficult urination
  • pinpoint red spots on the skin
  • rectal bleeding
  • skin rash
  • sore throat
  • sores, ulcers, or white spots on the lips or in the mouth
  • unusual bleeding or bruising
  • unusual tiredness or weakness
  • vomiting
  • worsening of heart block

Some side effects of penbutolol may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

Symptoms of Overdose

  • Blurred vision
  • chest pain or discomfort
  • confusion
  • difficulty with breathing
  • dilated neck veins
  • dizziness, faintness, or lightheadedness when getting up suddenly from a lying or sitting position
  • extreme fatigue
  • irregular breathing
  • noisy breathing
  • slow or irregular heartbeat
  • sweating
  • swelling of the face, fingers, feet, or lower legs
  • weight gain

Some side effects of penbutolol may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

More Common

Less Common


  • Decreased interest in sexual intercourse
  • inability to have or keep an erection
  • loss in sexual ability, desire, drive, or performance

Incidence Not Known

  • Crying
  • decreased awareness or responsiveness
  • depersonalization
  • dysphoria
  • euphoria
  • hair loss or thinning of the hair
  • memory loss
  • mental depression
  • mimicry of speech or movements
  • mutism
  • negativism
  • pain of the penis on erection
  • paranoia
  • peculiar postures or movements, mannerisms or grimacing
  • quick to react or overreact emotionally
  • rapidly changing moods
  • reddened skin
  • severe sleepiness
  • skin rash

For Healthcare Professionals

Applies to penbutolol: oral tablet


Penbutolol is generally well tolerated in selected patients. In one study of 111 hypertensive patients who took penbutolol (the active ingredient contained in Levatol) for eight weeks, 12% reported side effects. The incidence of side effects appeared to decrease with continued therapy. Less than 1% of patients discontinue therapy due to side effects.[Ref]

Nervous system

Nervous system are the most common. General tiredness is reported in 7%, headache in 3%, and dizziness in 5% of patients. Dizziness may be related to orthostatic hypotension. Peripheral paresthesias are rarely described, and may be due to the peripheral cardiovascular side effects of the drug. Penbutolol (the active ingredient contained in Levatol) may rarely be associated with sleeping problems.[Ref]


One double-blinded, placebo-controlled study in 10 hypertensive patients who suffered recurrent bouts of Raynaud's phenomenon showed that penbutolol (the active ingredient contained in Levatol) 20 mg twice a day did not produce any additional vasoconstrictor effect on digital circulation as measured by skin thermometry, time to induce symptoms, or superficial skin blood flow.[Ref]

Cardiovascular effects of penbutolol (decreased blood pressure or heart rate) can be problematic. Bradycardia and postural hypotension occur in approximately 2% and 4% of patients, respectively. Dizziness is reported in 5% of patients and may be related to hypotension or bradycardia in some cases. Because penbutolol decreases myocardial contractility, new or worsened heart failure is seen in rare, isolated cases, usually in patients with preexisting left ventricular systolic dysfunction. Dyspnea on exertion or AV block have been associated with penbutolol in rare cases.

Penbutolol can have a deleterious effect on the serum lipid profile, which may be important in some patients with or at risk for coronary artery disease.

Peripheral cardiovascular effects usually present as cold extremities or paresthesias.[Ref]


Respiratory side effects including respiratory insufficiency can develop due to beta-2-adrenergic receptor blockade (inhibition of bronchial dilation). This can result in asthmatic symptoms in 1% of patients and can be more likely or more severe in patients with preexisting reactive airways disease.[Ref]


Gastrointestinal side effects include nausea or vomiting in 5%, abdominal pain in 2%, flatulence in 1%, and dry mouth in 1% of patients.[Ref]


Endocrine side effects have been reported. Some patients with diabetes or thyrotoxicosis are at risk for masking the signs or symptoms of their diseases (sweating, tachycardia, hypoglycemia) during penbutolol (the active ingredient contained in Levatol) therapy. Like some other beta-blockers with intrinsic sympathomimetic activity, penbutolol may cause significant increases in serum triglycerides and decreases in HDL cholesterol.[Ref]


Renal side effects of penbutolol (the active ingredient contained in Levatol) appear to be of no significance. Data show that glomerular filtration rate and renal plasma blood flow are not significantly affected when blood pressure is lowered using therapeutic doses in patients with chronic renal insufficiency.[Ref]


Musculoskeletal side effects including muscular fatigue or cramping is rare. No other musculoskeletal complaints have been reported.[Ref]


Hypersensitivity reactions have not been reported during penbutolol (the active ingredient contained in Levatol) therapy, but have been associated with other beta-blockers. These reactions have presented as erythema, fever with sore throat, laryngospasm, and respiratory distress.[Ref]


Hematologic side effects (including laboratory abnormalities) have not been associated with penbutolol (the active ingredient contained in Levatol) The manufacturer, however, states that agranulocytosis and both thrombocytopenic and nonthrombocytopenic purpura have been associated with other beta-blockers.[Ref]


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2. Lameijer LD, Voermans LA, Houtzagers JJ, Chadha DR "Use of fixed doses of beta blocking drugs in the treatment of hypertension. Randomised study of atenolol and penbutolol." Eur J Clin Pharmacol 21 (1981): 93-6

3. Schlanz KD, Thomas RL "Penbutolol: a new beta-adrenergic blocking agent." DICP 24 (1990): 403-8

4. "Carteolol and penbutolol for hypertension." Med Lett Drugs Ther 31 (1989): 70-1

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6. Vander Elst E, Lawrence J, Rossner M, Mertens H "Penbutolol in hypertension, alone and in combination with furosemide. A long-term multicentre study." S Afr Med J 63 (1983): 143-7

7. Ohman KP, Asplund J, Landahl S, Liander B "Penbutolol (Hoe 893d) in primary hypertension. Blood pressure effects, tolerance and plasma concentrations." Eur J Clin Pharmacol 22 (1982): 95-9

8. Giudicelli JF, Richer C, Chauvin M, Idrissi N, Berdeaux A "Comparative beta-adrenoceptor blocking effects and pharmacokinetics of penbutolol and propranolol in man." Br J Clin Pharmacol 4 (1977): 135-40

9. "Product Information. Levatol (penbutolol)." Reed and Carnrick, Jersey City, NJ.

10. van der Meulen J, Reijn E, Heidendal GA, Oe PL, Donker AJ "Comparison of the effects of penbutolol and propranolol on glomerular filtration rate in hypertensive patients with impaired renal function." Br J Clin Pharmacol 22 (1986): 469-74

11. Frishman WH, Covey S "Penbutolol and carteolol: two new beta-adrenergic blockers with partial agonism." J Clin Pharmacol 30 (1990): 412-21

12. Graml E, Verho M, Rangoonwala B, Englert R, Haringer E, Pahnke K "Efficacy of penbutolol and a combination of a low dose of penbutolol with piretanide in the treatment of mild to moderate hypertension." Pharmatherapeutica 4 (1985): 236-43

13. Heel RC, Brogden RN, Speight TM, Avery GS "Penbutolol: a preliminary review of its pharmacological properties and therapeutic efficacy in hypertension and angina pectoris." Drugs 22 (1981): 1-25

14. Houtzagers JJ, Chadha DR "Once-daily penbutolol or atenolol can replace combination therapy in essential hypertension." J Int Med Res 10 (1982): 1-5

15. Lund-Johansen P "Long-term hemodynamic effects of penbutolol at rest and during exercise in essential hypertension." Eur J Clin Pharmacol 16 (1979): 149-53

16. Holti G "A double-blind study of the peripheral vasoconstrictor effects of the beta-blocking drug penbutolol in patients with Raynaud's phenomenon." Curr Med Res Opin 6 (1979): 267-70

17. Clucas A, Miller N "Effects of acebutolol on the serum lipid profile." Drugs 36 Suppl 2 (1988): 41-50

18. Haeringer E, Graml W, Rangoonwala B, Roessner M "Efficacy of penbutolol and a fixed combination of penbutolol with furosemide in the treatment of hypertension." Pharmatherapeutica 3 (1982): 233-42

19. Valimaki M, Maass L, Harno K, Nikkila EA "Lipoprotein lipids and apoproteins during beta-blocker administration: comparison of penbutolol and atenolol." Eur J Clin Pharmacol 30 (1986): 17-20

20. Bailey RR, Carlson RV, Walker RJ, Swainson CP "Effect of oral penbutolol on renal haemodynamics of hypertensive patients with renal insufficiency." N Z Med J 98 (1985): 683-5

21. De Plaen JF, Vander Elst E, Van Ypersele de Strihou C "Penbutolol or hydrochlorothiazide once a day in hypertension. A controlled study with home measurements." Br J Clin Pharmacol 12 (1981): 215-21

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

Some side effects may not be reported. You may report them to the FDA.