1% to 10%:

Cardiovascular: Chest pain (3%), edema (6%)

Central nervous system: Nightmares/vivid dreams (5%), dizziness (9%), insomnia (10%), fatigue (8%), nervousness (7%), anxiety (<2%)

Dermatologic: Rash, itching (4%)

Gastrointestinal: Nausea (5%), abdominal discomfort (4%)

Neuromuscular & skeletal: Weakness (4%), paresthesia (3%), arthralgia (7%), muscle pain (10%)

Respiratory: Dyspnea (5%)

<1%: Bradycardia, CHF, claudication, confusion, dry eyes, hallucinations, hypotension, impotence, mental depression, palpitation, thrombocytopenia, wheezing

Albuterol (and other beta2 agonists): Effects may be blunted by nonspecific beta-blockers

Alpha-blockers (prazosin, terazosin): Concurrent use of beta-blockers may increase risk of orthostasis

AV conduction-slowing agents (digoxin): Effects may be additive with beta-blockers.

Calcium channel blockers (diltiazem, verapamil): May have synergistic or additive pharmacological effects when taken concurrently with beta-blockers

Clonidine: Hypertensive crisis after or during withdrawal of either agent

CYP2D6 inhibitors: May increase the levels/effects of pindolol. Example inhibitors include chlorpromazine, delavirdine, fluoxetine, miconazole, paroxetine, pergolide, quinidine, quinine, ritonavir, and ropinirole.

Epinephrine (including local anesthetics with epinephrine): Pindolol may cause hypertension

Glucagon: Pindolol may blunt the hyperglycemic action

Insulin and oral hypoglycemics: May mask symptoms of hypoglycemia

NSAIDs (ibuprofen, indomethacin, naproxen, piroxicam): May reduce the antihypertensive effects of beta-blockers

Salicylates: May reduce the antihypertensive effects of beta-blockers

Sulfonylureas: Beta-blockers may alter response to hypoglycemic agents

Absorption: Rapid, 50% to 95%

Protein binding: 50%

Metabolism: Hepatic (60% to 65%) to conjugates

Half-life elimination: 2.5-4 hours; prolonged with renal impairment, age, and cirrhosis

Time to peak, serum: 1-2 hours

Excretion: Urine (35% to 50% as unchanged drug)

Adults:

Hypertension: Initial: 5 mg twice daily, increase as necessary by 10 mg/day every 3-4 weeks (maximum daily dose: 60 mg); usual dose range (JNC 7): 10-40 mg twice daily

Antidepressant augmentation: 2.5 mg 3 times/day

Elderly: Initial: 5 mg once daily, increase as necessary by 5 mg/day every 3-4 weeks

Dosing adjustment in renal and hepatic impairment: Reduction is necessary in severely impaired

Withdrawal: Beta-blocker therapy should not be withdrawn abruptly, but gradually tapered to avoid acute tachycardia and hypertension.

Hypertension: Beta-blocker therapy in the treatment of hypertension has been associated with improved cardiovascular outcomes. This class of drug is beneficial for elderly patients with hypertension. A recent UKPDS study showed that beta-blocker therapy (atenolol) was as effective as an ACE inhibitor in reducing cardiovascular events and that the benefits of therapy were related more to the degree of antihypertensive efficacy rather than the class of drug used.

Unstable angina/non-ST-segment elevation MI: In the treatment of unstable angina/non-ST-segment elevation MI, a beta-blocker, with the first dose administered intravenously if there is ongoing chest pain, followed by oral administration, is recommended (in the absence of contraindications).

Withdrawal: Beta-blocker therapy should not be withdrawn abruptly, but gradually tapered to avoid acute tachycardia and hypertension.

Braunwald E, Antman EM, Beasley JW, et al, "ACC/AHA 2002 Guideline Update for the Management of Patients With Unstable Angina and Non-ST-Segment Elevation Myocardial Infarction - Summary Article: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on the Management of Patients With Unstable Angina),"J Am Coll Cardiol, 2002, 40(7):1366-74. Available at: http://www.acc.org/clinical/guidelines/unstable/incorporated/index.htm. Accessed May 20, 2003.

Chobanian AV, Bakris GL, Black HR, et al, "The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: The JNC 7 Report,"JAMA, 2003, 289(19):2560-71.

Erstad BL and Barletta JF, "Treatment of Hypertension in the Perioperative Patient,"Ann Pharmacother, 2000, 34(1):66-79.

"Consensus Recommendations for the Management of Chronic Heart Failure. On Behalf of the Membership of the Advisory Council to Improve Outcomes Nationwide in Heart Failure,"Am J Cardiol, 1999, 83(2A):1A-38A.

Gibbons RJ, Abrams J, Chatterjee K, et al, "ACC/AHA 2002 Guideline Update for the Management of Patients With Chronic Stable Angina - Summary Article: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on the Management of Patients With Chronic Stable Angina),"J Am Coll Cardiol, 2003, 41(1):159-68.

Mokhlesi B, Leikin JB, Murray P, et al, "Adult Toxicology in Critical Care: Part II: Specific Poisonings,"Chest, 2003, 123(3):897-922.