Generic Name: Pindolol
Class: beta-Adrenergic Blocking Agents
VA Class: CV100
Chemical Name: 1-(Indol-4-yloxy)-3-(isopropylamino)-2-propanol
Molecular Formula: C14H20N2O2
CAS Number: 13523-86-9
For ProfessionalsSide EffectsDosageInteractionsMore…
A nonselective β-adrenergic blocking agent.1 2 3 4
Uses for Visken
Management of hypertension (alone or in combination with other classes of antihypertensive agents).1 32 37 38 52
One of several preferred initial therapies in hypertensive patients with heart failure, postmyocardial infarction, ischemic heart disease, and/or diabetes mellitus.84
Can be used as monotherapy for initial management of uncomplicated hypertension; however, thiazide diuretics are preferrred by JNC 7.84
Management of chronic stable angina pectoris†.2 5 15 22
Visken Dosage and Administration
- Individualize dosage according to patient response and tolerance.1
- If long-term therapy is discontinued, reduce dosage gradually over a period of about 1–2 weeks.1 (See Abrupt Withdrawal of Therapy under Cautions.)
Administer orally, usually twice daily;1 bioavailability does not appear to be affected by food.1 (See Absorption under Pharmacokinetics.)
For management of hypertension, once-daily dosing may be possible in some patients.2
Initially, 5 mg twice daily.1 38 52 84 Increase dosage gradually by 10 mg daily at 3- to 4-week intervals as necessary up to 60 mg daily.1 38 52 84 The usual maintenance dosage range is 10–40 mg daily, given in 2 divided doses.2 11 15
15–40 mg daily, given in 3 or 4 divided doses.2 5 22
Maximum 60 mg daily.1 38 52 84
Dosage must be modified in response to the degree of hepatic impairment.1
Cautions for Visken
- Bronchial asthma, heart block greater than first degree, cardiogenic shock, overt cardiac failure, or severe bradycardia.1
Possible precipitation of CHF.1 2
Avoid use in patients with decompensated CHF, may use cautiously in patients with well-compensated heart failure (e.g., those controlled with ACE inhibitors, cardiac glycosides, and/or diuretics).1
Adequate treatment (e.g., with a cardiac glycoside and/or diuretic) and close observation recommended if signs or symptoms of impending cardiac failure occur; if cardiac failure continues, discontinue therapy, gradually if possible.1
Abrupt Withdrawal of Therapy
Abrupt discontinuance of therapy is not recommended as it may exacerbate angina symptoms or precipitate MI in patients with CAD.1 Abrupt discontinuance of therapy is not recommended.1 Gradually decrease dosage over a period of about 1–2 weeks.1 Monitor patients carefully and advise to temporarily limit their physical activity.1 If exacerbation of angina occurs, reinstitute therapy promptly, and initiate appropriate measures for the management of unstable angina pectoris.1
Possible inhibition of bronchodilation produced by endogenous catecholamines.1
Generally should not be used in patients with bronchospastic disease, but may be used with caution in patients with nonallergic bronchospasm (e.g., chronic bronchitis, emphysema).1 (See Contraindications under Cautions.)
Possible risks associated with general anesthesia (e.g., severe hypotension, difficulty maintenaning heart beat) due to decreased ability of the heart to respond to reflex β-adrenergic stimuli.1 Use with caution in patients undergoing major surgery involving general anesthesia.1
Diabetes and Hypoglycemia
Possible decreased signs and symptoms of hypoglycemia (e.g., tachycardia, palpitation, BP changes, tremor, feelings of anxiety, but not sweating or dizziness).1 68
Use with caution in patients with diabetes mellitus receiving hypoglycemic drugs.1
Signs of hyperthyroidism (e.g., tachycardia) may be masked.1 Possible thyroid storm if therapy is abruptly withdrawn;1 carefully monitor patients having or suspected of developing thyrotoxicosis.1
Possible increased reactivity to repeated, accidental, diagnostic, or therapeutic challenges with a variety of allergens while taking β-blocking agents in patients with a history of anaphylactic reactions to a variety of allergens.1 Such patients may be unresponsive to usual doses of epinephrine.1
Distributed into milk.1 Use not recommended.1
Safety and efficacy not established.1
Hepatic elimination; use with caution.1
Common Adverse Effects
Insomnia, dizziness, fatigue, nervousness, bizzare dreams or increased dreaming, weakness, paresthesia, edema, dyspnea, muscle pain, joint pain, chest pain, muscle cramps, nausea, abdominal discomfort, pruritus.1
Interactions for Visken
|| Pharmacokinetic interaction unlikely1
|| Possible decreases in serum digoxin concentrations 1
|| Not considered clinically important1 18
|| Additive effects1
|| Monitor for signs of hypotension and bradycardia (e.g., vertigo, syncope, postural hypotension)1
| Hypotensive agents (hydralazine, hydrochlorothiazide)
|| Possible increased hypotensive effects1
|| Adjust dosage carefully1
|| Increased serum concentrations of thioridazine1 and metabolites; higher than expected serum concentrations of pindolol1 73 1
Increased thioridazine concentrations may cause prolongation of the QTc interval and a possible increase in the risk of serious, potentially fatal cardiac arrhythmia (e.g., torsades de pointes)73 1
| Concomitant use is contraindicated73
|| Pharmacokinetic interaction unlikely1
Rapidly absorbed from the GI tract with peak plasma concentrations reached within 1–2 hours.1 2
Bioavailability 502 –95%.1 2
Effect on heart rate is seen within 3 hours.2
Hypotensive effect is usually seen within 1 week, but maximum therapeutic response may not be observed until 2 weeks or longer.1
Acute hemodynamic effects persist for 24 hours after administration.2
Food may increase the rate,2 but not the extent of absorption.1
Bioavailability may be at the lower end of the range in uremic patients;2 extent of absorption may be decreased in patients with impaired renal function.19
Distributed into milk.1
Plasma Protein Binding
Approximately 40–60%.1 2
Extensively metabolized in the liver (approximately 60–65%) to metabolites.1 2
Excreted in urine (35–50%) unchanged.1 2 18
3–4 hours.1 2
In patients with creatinine clearances <20 mL/minute, <15% is excreted in urine unchanged.1 18 20
In patients with renal failure, plasma half-life is 3–11.5 hours.2 20
In geriatric patients, plasma half-life is 7–15 hours.1
In patients with hepatic cirrhosis, half-life is 2.5–30 hours.1
Tight, light-resistant containers at 15–30°C.1 31
- Inhibits response to adrenergic stimuli by competitively blocking β-adrenergic receptors within the myocardium (β1-receptors) and within bronchial and vascular smooth muscle (β2-receptors).2 4 5
- In addition, causes slight activation of the β-receptors, making the drug a partial β-agonist.2 4 5
- At higher than therapeutically obtained plasma concentrations, the drug has membrane-stabilizing activity or a quinidine-like effect.4
- Decreases stress- and exercise-stimulated heart rate.1 2 4 5 Has a lesser effect on resting heart rate (usually decreasing resting heart rate only by about 4–8 bpm or not at all),1 2 4 5 15 22 slowing of conduction in the AV node,4 and cardiac output,2 4 13 22 than do β-adrenergic blocking agents that do not possess intrinsic sympathomimetic activity (ISA).1 2 4 5 15 22
- The precise mechanism of hypotensive effect has not been determined;1 the drug does not consistently affect cardiac output or renin release, and other mechanisms (e.g., decreased peripheral resistance) probably contribute to its hypotensive effect.1 15 16
- May increase airway resistance,1 2 4 depending on the patient’s pretreatment sympathetic tone; patients with high pretreatment tone show a decrease in forced expiratory volume in 1 second (FEV1), whereas those with low pretreatment tone may show little, if any, change in FEV1.17
Advice to Patients
- Importance of taking pindolol exactly as prescribed.1
- Importance of not interrupting or discontinuing therapy without consulting clinician.1
- Importance of immediately informing clinician at the first sign or symptom of impending cardiac failure (e.g., weight gain, increased shortness of breath) or if any difficulty in breathing occurs.1
- In patients with heart failure, importance of informing clinician of signs or symptoms of exacerbation (e.g., weight gain, difficulty in breathing).1
- Importance of patients informing anesthesiologist or dentist that they are receiving pindolol therapy prior to undergoing major surgery.1
- Importance of informing clinicians of existing or contemplated concomitant therapy, including prescription and OTC drugs.1
- Importance of women informing clinicians if they are or plan to become pregnant or plan to breast-feed.1
- Importance of informing patients of other important precautionary information.1 (See Cautions.)
Excipients in commercially available drug preparations may have clinically important effects in some individuals; consult specific product labeling for details.
* available from one or more manufacturer, distributor, and/or repackager by generic (nonproprietary) name
|| Dosage Forms
|| Brand Names
|| 5 mg*
|| Pindolol Tablets
|| Genpharm, Mutual, Mylan, Sandoz, Teva, Watson
|| 10 mg*
|| Pindolol Tablets
|| Genpharm, Mutual, Mylan, Sandoz, Teva, Watson
This pricing information is subject to change at the sole discretion of DS Pharmacy. This pricing information was updated 02/2013. Actual costs to patients will vary depending on the use of specific retail or mail-order locations and health insurance copays.
Pindolol 10MG Tablets (MYLAN): 60/$70.99 or 180/$194.97
Pindolol 5MG Tablets (MYLAN): 60/$55.99 or 120/$105.98
This report on medications is for your information only, and is not considered individual patient advice. Because of the changing nature of drug information, please consult your physician or pharmacist about specific clinical use.
The American Society of Health-System Pharmacists, Inc. and Drugs.com represent that the information provided hereunder was formulated with a reasonable standard of care, and in conformity with professional standards in the field. The American Society of Health-System Pharmacists, Inc. and Drugs.com make no representations or warranties, express or implied, including, but not limited to, any implied warranty of merchantability and/or fitness for a particular purpose, with respect to such information and specifically disclaims all such warranties. Users are advised that decisions regarding drug therapy are complex medical decisions requiring the independent, informed decision of an appropriate health care professional, and the information is provided for informational purposes only. The entire monograph for a drug should be reviewed for a thorough understanding of the drug’s actions, uses and side effects. The American Society of Health-System Pharmacists, Inc. and Drugs.com do not endorse or recommend the use of any drug. The information is not a substitute for medical care.
AHFS Drug Information. © Copyright, 1959-2013, Selected Revisions March 1, 2007. American Society of Health-System Pharmacists, Inc., 7272 Wisconsin Avenue, Bethesda, Maryland 20814.
† Use is not currently included in the labeling approved by the US Food and Drug Administration.
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