PINDOLOL

PINDOLOL (pin'doe-lole) Visken Classifications: beta-adrenergic antagonist; antihypertensive; Therapeutic: antihypertensive Prototype: Propranolol Pregnancy Category: B

Availability

5 mg, 10 mg tablets

Action

Nonselective beta-adrenergic antagonist. Hypotensive mechanism results from its competitively blocking the beta-adrenergic receptors primarily in myocardium, and beta receptors within bronchial and smooth muscle. Lowers blood pressure by also decreasing peripheral vascular resistance.

Therapeutic Effect

Exerts vasodilation as well as hypotensive effects.

Uses

Management of hypertension concurrently with a thiazide diuretic or as single agent. Used in patient who has failed to respond to diet, exercise, and weight reduction.

Unlabeled Uses

Stress and exercise-induced chronic stable angina pectoris.

Contraindications

Bronchospastic diseases; severe bradycardia, cardiogenic shock, AV block, sick sinus syndrome; cardiac failure; pulmonary failure; lactation. Safety in children is not established.

Cautious Use

Nonallergic bronchospasm; COPD; CHF; diabetes mellitus; hyperthyroidism; myasthenia gravis; impaired liver and kidney function; pregnancy (category B).

Route & Dosage

Hypertension Adult: PO 5 mg b.i.d., may increase by 10 mg/d q2–3wk if needed up (max: 60 mg/d in 2–3 divided doses) Geriatric: PO Start with 5 mg q.d. Angina Pectoris Adult: PO 15–40 mg/d in 3–4 divided doses

Administration

Oral

• Give drug at same time of day each day with respect to time of food intake for most predictable results.
• Withdraw or discontinue treatment gradually over a period of 1–2 wk.

Adverse Effects (≥1%)

CNS: Fatigue, dizziness, insomnia, drowsiness, confusion, fainting, decreased libido. CV: Bradycardia, hypotension, CHF. GI: Nausea, diarrhea, constipation, flatulence. Respiratory: Bronchospasm, pulmonary edema, dyspnea. Body as a Whole: Back or joint pain. Sensitivity reactions seen as antinuclear antibodies (ANA) (10–30% of patients). Hematologic: Agranulocytosis. Urogenital: Impotence. Metabolic: Hypoglycemia (may mask symptoms of a hypoglycemic reaction).

Interactions

Drug: diuretics and other hypotensive agents increase hypotensive effect; effects of albuterol, metaproterenol, terbutaline, pirbuterol and pindolol antagonized; nsaids blunt hypotensive effect; decreases hypoglycemic effect of glyburide; amiodarone increases risk of bradycardia and sinus arrest.

Pharmacokinetics

Absorption: Rapidly from GI tract; 50–95% reaches systemic circulation (first pass metabolism). Onset: 3 h. Peak: 1–2 h. Duration: 24 h. Distribution: Distributed into breast milk. Metabolism: 40–60% in liver. Elimination: In urine. Half-Life: 3–4 h.

Nursing Implications

Assessment & Drug Effects

• Monitor HR and BP. Report bradycardia and hypotension. Dosage adjustment may be indicated.
• Note: Hypotensive effect may begin within 7 d but is not at maximum therapeutically until about 2 wk after beginning of treatment.
• Lab test: Periodic CBC with differential, kidney function tests, and blood glucose.

Patient & Family Education

• Pindolol masks the dizziness and sweating symptoms of hypoglycemia. Monitor blood glucose for loss of glycemic control.
• Adhere to the prescribed drug regimen; if a change is desired, consult physician first. Abrupt withdrawal of drug might precipitate a thyroid crisis in a patient with hyperthyroidism, and angina in the patient with ischemic heart disease, leading to an MI.

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Common adverse effects in italic, life-threatening effects underlined; generic names in bold; classifications in SMALL CAPS; Canadian drug name; Prototype drug