Visken

Visken,

trademark for a beta blocker (pindolol).

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pindolol

Apo-Pindol (CA), Novo-Pindol (CA), Nu-Pindol (CA), Visken

Pharmacologic class: Beta-adrenergic blocker (nonselective)

Therapeutic class: Antihypertensive

Pregnancy risk category B

Action

Competes with beta-adrenergic agonists for receptor sites, inhibiting both beta₁ (myocardial) and beta₂ (respiratory) sites

Availability

Tablets: 5 mg, 10 mg

⊘Indications and dosages

➣ Hypertension

Adults: Initially, 5 mg b.i.d.; may increase by 10 mg/day q 3 to 4 weeks p.r.n. to a maximum of 60 mg/day

Contraindications

• Hypersensitivity to beta-adrenergic blockers
• Overt heart failure
• Cardiogenic shock
• Severe bradycardia
• Second- or third-degree heart block
• Bronchial asthma (including severe chronic obstructive pulmonary disease)

Precautions

Use cautiously in:
• renal or hepatic impairment, pulmonary disease, diabetes mellitus, thyrotoxicosis, severe allergic reactions, major surgery
• elderly patients
• pregnant or breastfeeding patients
• children (safety not established).

Administration

• Give with or without food.
• Know that drug may be used alone or with other antihypertensives.

Route	Onset	Peak	Duration
P.O.	Rapid	1 hr	8-15 hr

Adverse reactions

CNS: dizziness, drowsiness, lethargy, weakness, anxiety, depression, insomnia, nervousness, paresthesia

CV: orthostatic hypotension, peripheral vasoconstriction, chest pain, palpitations, tachycardia, bradycardia, heart failure

EENT: blurred vision, dry eyes

GI: nausea, vomiting, constipation, diarrhea

GU: erectile dysfunction, decreased libido

Musculoskeletal: joint pain, back pain, muscle cramps

Metabolic: hyperglycemia, hypoglycemia

Respiratory: wheezing, dyspnea, bronchospasm

Skin: itching, rash

Other: drug-induced lupus syndrome, edema, cold extremities

Interactions

Drug-drug. Amphetamines, ephedrine, epinephrine, norepinephrine, phenylephrine, pseudoephedrine: excessive hypertension and bradycardia

Beta-adrenergic bronchodilators, theophylline: decreased theophylline antagonism or antagonism of both drugs

Catecholamine-depleting drugs (such as reserpine): additive beta blockade

Insulin, oral hypoglycemics: altered efficacy of these drugs

Nonsteroidal anti-inflammatory drugs: decreased antihypertensive action

Other antihypertensives, nitrates: additive hypotension

Thyroid preparations: decreased pindolol efficacy

Drug-diagnostic tests. Alanine aminotransferase, alkaline phosphatase, aspartate aminotransferase, lactate dehydrogenase, uric acid: increased levels

Glucose: increased or decreased level

Drug-herbs. Cocaine, ephedra (ma huang): unopposed alpha-adrenergic stimulation

Patient monitoring

• Monitor apical heart rate. Withhold drug and notify prescriber if rate is below 60 beats/minute.
• Closely monitor ECG, vital signs, and cardiovascular status. Stay alert for signs and symptoms of heart failure.
• Assess respiratory status, especially for wheezing and dyspnea.
• Monitor blood glucose level in patients with diabetes. (Drug may mask signs and symptoms of hypoglycemia.)

Patient teaching

• Instruct patient to take at same time each day, with or without food.
☞ Caution patient that stopping drug abruptly may worsen angina or cause severe cardiac problems.
• Advise patient to rise slowly from a lying or sitting position, to avoid dizziness from sudden blood pressure drop.
☞ Instruct patient to report signs and symptoms of heart failure (such as swelling in legs and shortness of breath when lying down) or other breathing difficulties.
• Advise diabetic patient to monitor blood glucose level closely.
• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs, tests, and herbs mentioned above.

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Visken®

Pindolol, see there