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Penbutolol Side Effects

Medically reviewed by Last updated on Aug 11, 2022.

Applies to penbutolol: oral tablet.


Penbutolol is generally well tolerated in selected patients. In one study of 111 hypertensive patients who took penbutolol 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 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 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 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 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 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 manufacturer, however, states that agranulocytosis and both thrombocytopenic and nonthrombocytopenic purpura have been associated with other beta-blockers.[Ref]


1. Hayes G "Single-blind comparison of penbutolol and long-acting propranolol in general practice." Pharmatherapeutica 3 (1983): 456-63

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

3. 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

4. Vierhapper H, Dudczak R, Waldhausl W "Penbutolol: comparison of its antihypertensive effect with that of alpha-methyldopa in patients with primary hypertension." Arzneimittelforschung 30 (1980): 1008-11

5. 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

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

7. 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

8. 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

9. 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

10. 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

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

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

14. 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

15. "Product Information. Levatol (penbutolol)." Reed and Carnrick (2001):

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

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