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VISKEN TABLETS 5MG
Active substance(s): PINDOLOL
NAME OF THE MEDICINAL PRODUCT
Visken 5 mg Tablets
Pindolol 5mg Tablets
QUALITATIVE AND QUANTITATIVE COMPOSITION
Each tablet contains 5 mg pindolol.
Excipients with known effect:
(83 mg/ tablet)
For the full list of excipients, see section 6.1.
White, round, flat, bevelled tablets, marked ‘Visken 5’ on one side and with a score line on the
The score line is only to facilitate breaking for ease of swallowing and not to divide into equal
This medicine is indicated in adults for the treatment of essential hypertension. It is also used as a
prophylactic treatment of angina pectoris.
Posology and method of administration
Essential Hypertension: Initially one 5 mg tablet two or three times a day. According to the
response of the patient the dose may be increased at weekly intervals to a maximum of 45 mg
given in divided doses twice or three times daily.
Once daily dosage schedule: Further work shows that many patients respond to a once daily
dosage regime. Initially 15 mg (3 tablets) should be taken once a day with breakfast and adjusted
according to individual response up to a maximum of 45 mg (9 tablets). Most patients respond to
a once daily dose of between 15-30 mg (3-6 tablets).
The onset of action of this medicine is usually rapid, with most patients showing a response
within the first one to two weeks of treatment. However, the maximum response may take several
weeks to develop.
Prophylactic treatment of Angina pectoris: Usually 2.5 mg to 5 mg orally three times a day
according to response. It reduces the frequency and severity of anginal attacks and increases work
The safety and efficacy of this medicine in children has not been established. Its use is therefore
Use in the elderly
No evidence exists that elderly patients require different dosages or show different side-effects
from younger patients.
Method of administration
This medicine is contraindicated in patients with:
• Hypersensitivity to the active substance or to any of the excipients listed in section 6.1.
• Untreated cardiac failure
• Cardiogenic shock
• Sick sinus syndrome
• Sino-atrial block
• Second and third degree heart block
• Prinzmetals angina
• History of bronchospasm and bronchial asthma (a warning stating "do not take this
medicine if you have a history of wheezing or asthma" will appear on the label)
• Untreated phaeochromocytoma
• Peripheral circulatory disease
• Pronounced bradycardia
• Chronic obstructive pulmonary disease
• History of cor pulmonale
• Metabolic acidosis
• Prolonged fasting
Severe renal failure
Use of anaesthetics with a negative inotropic effect
Owing to the danger of cardiac arrest, a calcium antagonist of the verapamil type must not be
administered intravenously to the patient already receiving treatment with a beta-blocker.
Special warnings and special precautions for use
Patients with a poor cardiac reserve should be stabilised with digitalis before treatment with
Visken/ Pindolol Tablets to prevent impairment of myocardial contractility.
As for other beta-blockers, and especially in patients with ischaemic heart disease, treatment
should not be discontinued suddenly. The dosage should gradually be reduced, i.e. over 1-2
weeks, if necessary at the same time initiating replacement therapy, to prevent exacerbation of
As beta-blockers increase the AV conduction time, beta-blockers should only be given with
caution to patients with first degree AV block.
If the patient develops increasing bradycardia less than 50-55 beats per minute at rest and the
patient experiences symptoms related to bradycardia, the dosage should be reduced or gradually
As with all antihypertensive agents, a cautious dosage schedule is indicated in patients with
severe coronary or cerebral arteriosclerosis.
As with all beta-blockers, Visken/ Pindolol Tablets should be used with caution in patients with a
history of a recent myocardial infarction.
Caution must be exercised when beta-blocking agents are administered to patients with
spontaneous hypoglycaemia or diabetes under treatment with insulin or oral hypoglycaemic
agents, since hypoglycaemia may occur during prolonged fasting and some of its symptoms
(tachycardia, tremor) may be masked. Beta-blockers may also mask the symptoms of
Beta-blockers may unmask myasthenia gravis.
During treatment with Visken/ Pindolol Tablets, patients should not undergo anaesthesia with
agents causing myocardial depression (e.g. halothane, cyclopropane, trichloroethylene, ether,
chloroform). Visken/ Pindolol Tablets should be gradually withdrawn before elective surgery. In
emergency surgery or cases where withdrawal of Visken/ Pindolol Tablets would cause
deterioration in cardiac condition, atropine sulphate 1 to 2 mg intravenously should be given to
prevent severe bradycardia.
If a beta-blocker is indicated in a patient with phaeochromocytoma it must always be given in
conjunction with an alpha-blocker. Pre-existing peripheral vascular disorders may be aggravated
Since beta-blockers may potentiate the negative-inotropic and dromotropic effects of calcium
antagonists, like verapamil or diltiazem, any oral co-medication (e.g. in angina pectoris) requires
close clinical control (see also section 4.5).
In severe renal failure a further impairment of renal function following beta blockade has been
reported in a few cases. In patients with renal impairment, the elimination half-life for unchanged
pindolol is not expected to be significantly different from the subjects with normal renal
function. Creatinine clearance, urea and electrolytes should be monitored in patients with renal
impairment since they might be more susceptible to the effects of antihypertensive drugs.
There have been reports of skin rashes and/or dry eyes associated with the use of betaadrenoceptor blocking drugs. The reported incidence is small and in most cases the symptoms
have cleared when treatment is withdrawn. Discontinuance of the drug should be considered if
any such reaction is not otherwise explicable.
Patients with known psoriasis should take beta-blockers only after careful consideration.
Anaphylactic reactions precipitated by other agents may be particularly severe in patients taking
beta-blockers, especially non-selective drugs, and may require higher than normal doses of
adrenaline for treatment. Whenever possible, beta-blockers should be discontinued in patients
who are at increased risk for anaphylaxis.
Visken5 mg Tablets/Pindolol 5 mg Tablets contain mannitol
May have a mild laxative effect.
Interaction with other medicinal products and other forms of interaction
The antihypertensive effect of pindolol is enhanced by concomitant treatment
with other antihypertensives.
Calcium-channel blocking agents: Visken/ Pindolol Tablets should not be used with calciumchannel blockers with negative inotropic effects e.g. verapamil and to a lesser extent diltiazem.
The concomitant use of oral beta-blockers and calcium antagonists of the dihydropyridine type
can be useful in hypertension or angina pectoris. However, because of their potential effect on the
cardiac conduction system and contractility, the i.v. route must be avoided. The concomitant use
with dihydropyridines e.g. nifedipine may increase the risk of hypotension. In patients with
cardiac insufficiency, treatment with beta-blocking agents may lead to cardiac failure.
Use of digitalis glycosides, in association with beta-adrenoceptor blocking drugs, may increase
atrio-ventricular conduction time.
Clonidine: when therapy is discontinued in patients receiving a beta-blocker and clonidine
concurrently, the beta-blockers should be gradually discontinued several days before clonidine is
discontinued, in order to reduce the potential risk of a clonidine withdrawal hypertensive crisis.
MAO inhibitors: concurrent use with beta-blockers is not recommended. Possibly significant
hypertension may theoretically occur up to 14 days following discontinuation of the MAO
Caution should be exercised in the concurrent use of beta-blocking agents with class 1
antiarrhythmics (e.g. disopyramide, quinidine) and amiodarone.
Concomitant use of beta-blockers may intensify the blood sugar lowering effect of insulin and
other antidiabetic drugs. Use of beta-blockers may prevent appearance of the signs of
hypoglycaemia (tachycardia). During concurrent therapy with antidiabetics a close watch should
therefore be kept on carbohydrate metabolism, and the dosage of hypoglycaemic medication may
have to be readjusted.
Cimetidine, hydralazine and alcohol may induce increased plasma levels of hepatically
Concomitant administration with beta-blockers may enhance the vasoconstrictive action of ergot
Non-steroidal anti-inflammatory drugs (NSAIDs), such as indomethacin, may decrease the
hypotensive effects of beta-blockers, and there have been isolated reports of a deterioration in
renal function in predisposed patients.
Sympathomimetics with beta-adrenergic stimulant activity and xanthines such as adrenaline,
noradrenaline, isoprenaline, ephedrine and phenylephrine (e.g. local anaesthetics in dentistry,
nasal and ocular drops): concurrent use with beta-blockers may result in mutual inhibition of
therapeutic effects; in addition, beta-blockers may decrease theophylline clearance.
Concomitant use of beta-blockers with tricyclic antidepressants, barbiturates, rifampicin and
phenothiazines as well as other anti-hypertensive agents may increase the blood pressure lowering
Reserpine: concurrent use may result in an additive and possibly excessive beta-adrenergic
Beta-blockers and certain anaesthetics (e.g. halothane) are additive in their cardiodepressant
effect. However, continuation of beta-blockers reduces the risk of arrhythmia and hypertension
during anaesthesia (see section 4.4).
Fluoxetine can increase pindolol levels.
Antimalarials such as mefloquine can cause arrhythmias and caution is necessary if used with
Excessive caffeine and nicotine intake may oppose the beneficial effects of pindolol.
Concomitant administration of sulfinpyrazone with pindolol may reduce or abolish its
Fertility, Pregnancy and lactation
Pindolol should not be given during pregnancy unless there are no safer alternatives.
Beta-blockers may reduce placental perfusion, which may result in intrauterine foetal death,
immature and premature deliveries. Use the lowest possible dose. If possible, discontinue betablocker therapy at least 2 to 3 days prior to delivery to avoid the effects on uterine contractility
and possible adverse effects, especially bradycardia and hypoglycaemia, in the foetus and
Pindolol passes in small quantities into breast milk. Breastfeeding is therefore not recommended
Effects on ability to drive and use machines
Because dizziness or fatigue may occur during initiation of treatment with betaadrenoceptor blocking drugs, patients driving vehicles or operating machinery should
exercise caution until their individual reaction to treatment has been determined.
Blood and lymphatic system disorders
Thrombocytopenia (sometimes with purpura), agranulocytosis
Metabolism and nutrition disorders
Diabetes mellitus, hypoglycaemia, hyperglycaemia
Hallucination, acute psychosis, sleep disorder, depression, nightmare, confusional state, libido
Nervous system disorders
Headache, dizziness, tremor
Visual impairment,vision blurred, vision abnormal, keratoconjunctivitis, dry eyes
Bradycardia, complete atrioventricular block, cardiac failure, cardiac arrhythmia
Hypotension, peripheral coldness, Raynaud’s phenomenon, paraesthesia, intermittent
claudication, necrotising vasculitis
Respiratory, thoracic and mediastinal disorders
Bronchospasm (in patients with bronchial asthma or a history of bronchial complaints), dyspnoea
Diarrhoea, nausea, vomiting, constipation, dry mouth, sclerosing peritonitis, retroperitoneal
fibrosis, abdominal discomfort, dyspepsia, flatulence
Musculoskeletal and connective tissue disorders
Muscle spasms, arthralgia, myalgia, myasthenia gravis
Skin and subcutaneous tissue disorders
Rash, psoriasis, toxic epidermal necrolysis, cutaneous lupus erythematosus, pruritus,
Reproductive system and breast disorders
Renal and urinary disorders
General disorders and administration site conditions
Increased antinuclear antibodies
Chronic treatment with pindolol increases very low density lipoprotein and decreases high
density lipoprotein, which may have an adverse effect on the risk of cardiovascular events
Beta-blockers may mask the symptoms of thyrotoxicosis or hypoglycaemia.
Reporting of suspected adverse reactions
Reporting suspected adverse reactions after authorisation of the medicinal product is important.
It allows continued monitoring of the benefit/risk balance of the medicinal product. Healthcare
professionals are asked to report any suspected adverse reactions via the Yellow Card Scheme,
Poisoning due to an overdosage of beta-blocker may lead to pronounced hypotension,
bradycardia, hypoglycaemia, heart failure, cardiogenic shock, conduction abnormalities (first or
second degree block, complete heart block, asystole), or even cardiac arrest. In addition,
dyspnoea, bronchospasm, vomiting, impairment of consciousness, and also generalised
convulsions may occur. Rhabdomyolysis with myoglobinuria has been reported as a complication
of severe overdosage with oxprenolol.
The manifestations of poisoning with beta-blocker are dependent on the pharmacological
properties of the ingested drug. Although the onset of action is rapid, effects of massive overdose
may persist for several days despite declining plasma levels. Watch carefully for cardiovascular or
respiratory deterioration in an intensive care setting, particularly in the early hours. Observe mild
overdose cases for at least 4 hours for the development of signs of poisoning.
Treat by elimination of any unabsorbed drug and general supportive measures.
Patients who are seen soon after potentially life-threatening overdosage (within 4 hours) should be
treated by gastric lavage and activated charcoal.
Treatment of symptoms is based on modern methods of intensive care, with continuous
monitoring of cardiac function, blood gases, and electrolytes, and if necessary intravenous fluid
and electrolytes replacement, and emergency measures such as artificial respiration, resuscitation
or cardiac pacemaker.
Marked bradycardia as a result of overdosage or idiosyncrasy should be treated with atropine
sulphate 1 or 2 mg intravenously. If necessary, isoprenaline hydrochloride can be administered by
a slow intravenous injection, under constant supervision, beginning with 25 mcg (5 mcg/min)
until the desired effect is achieved. A cardiac pacemaker may be required, IV. glucagon (5-10 mg)
has been reported to overcome some of the features of serious overdosage and may be useful.
For seizures, diazepam has been effective and is the drug of choice.
For bronchospasm, aminophylline, salbutamol or terbutaline (beta2-agonist) are effective
bronchodilator drugs. Monitor the patient for dysrhythmias during and after administration.
Patients who recover should be observed for signs of beta-blocker withdrawal phenomenon (see
Pharmacotherapeutic group: beta blocking agents, non selective.
ATC code: C07AA03
Mechanism of action
Pindolol is a potent beta-adrenoceptor antagonist (beta-blocker). It blocks both B- and B2adrenoceptors for more than 24 hours after administration. It has negligible membrane-stabilising
activity. As a beta-blocker, Pindolol protects the heart from beta-adrenoceptor stimulation by
acetecholamines during physical exercise and mental stress, and also reduces the sympathetic
drive to the heart at rest. Its intrinsic sympathomimetic activity (ISA), however, provides the heart
with basal stimulation similar to that elicited by normal resting sympathetic activity, with the
result that heart rate and contractility at rest and intracardiac conduction are not unduly depressed.
The risk of bradycardia is therefore small and normal cardiac output is not reduced.
Pindolol is a beta-blocker with clinically relevant vasodilator activity. This results from the ISA
exerted on B2-adrenoceptors in blood vessels. The high vascular resistance of established
hypertension is lowered by Pindolol; tissue and organ perfusion is not impaired, and may even be
In contrast to the potentially adverse changes in blood lipoprotein profiles seen during treatment
with other beta-blockers (a decrease in the HDL/LDL ratio), the ratio of high density lipoproteins
(HDL) to low density (for further information see product licence file).
The rapid, nearly complete absorption (>95%) and the negligible hepatic first-pass effect (13%) of
Pindolol result in a high bioavailability (87%).
Maximum plasma concentration is reached within one hour after oral administration. Pindolol has
a plasma protein binding of 40%, a volume of distribution of 2-3 l/Kg and a total clearance of 500
The elimination half-life of Pindolol is 3-4 hours. 30-40% is excreted unchanged in the urine,
while 60-70% is excreted via kidney and liver as inactive metabolites. Pindolol crosses the
placental barrier and pass in small quantities into breast milk.
Patients with impaired kidney or liver function may usually be treated with normal doses. Only in
severe cases may a reduction of the daily dose be necessary.
Preclinical safety data
There are no pre-clinical data of relevance to the prescriber which are additional to that
already included in other sections of the SmPC.
List of excipients
Microcrystalline cellulose, polyvinylpyrrolidone, magnesium stearate, talc, mannitol.
Special precautions for storage
Nature and contents of container
PVC/PVDC clear blister packs in a cardboard carton containing 56, 60 or 100 tablets.
Not all pack sizes may be marketed.
Special precautions for disposal and other handling
MARKETING AUTHORISATION HOLDER
Amdipharm UK Limited
Miles Gray Road
MARKETING AUTHORISATION NUMBER
9. DATE OF FIRST AUTHORISATION/RENEWAL OF THE AUTHORISATION
Date of first authorisation: 1 January 2005
Date of latest renewal: 22 September 2010
DATE OF REVISION OF THE TEXT