Pindolol

Indications
 Oral
Angina pectoris
Adult: 2.5-5 mg up to tid.
Renal impairment: Dosage reduction may be required in uremic patients.
Hepatic impairment: Dosage reduction may be required in severe hepatic impairment.
Oral
Hypertension
Adult: 5 mg bid to tid or 15 mg once daily; may increase gradually according to patient's response. Usual maintenance dose: 10-40 mg daily in divided doses. Max: 60 mg/day.
Renal impairment: Dosage reduction may be required in uremic patients.
Hepatic impairment: Dosage reduction may be required in severe hepatic impairment.
Contraindications
 2nd and 3rd degree heart block, severe bradycardia, sick sinus syndrome, cardiogenic shock, overt cardiac failure, bronchospasm or bronchial asthma, metabolic acidosis, peripheral circulatory disease, prinzmetals angina, history of cor pulmonale, prolonged fasting, severe renal failure.
Warnings / Precautions
 Patients with poor cardiac reserve should be stabilised with digitalis before treatment with Pindolol is considered. May mask clinical signs of hyperthyroidism and symptoms of hypoglycaemia (e.g. tremor, tachycardia). Caution in patients with history of non-asthmatic chronic obstructive lung disease or recent myocardial infarction. Abrupt withdrawal of beta-blocker may cause exacerbation of angina, and myocardial infarctions have occurred in some cases. Patients on long-term treatment should discontinue medication gradually over a period of 1-2 wk. Beta-blockers should be withdrawn well before major surgery if possible. Not to be used in patients with pheochromocytoma without concomitant α-adrenoceptor blocking therapy. Beta-blockers may increase sensitivity towards allergens and the seriousness of anaphylactic reactions. Safety and efficacy in paediatic patients have not been established. Caution in renal or hepatic impairment, psoriasis, pregnancy. Breastfeeding is not recommended during treatment.
Adverse Reactions
 Bradycardia, hypotension, peripheral oedema, heart failure, intensification of heart block, bronchospasm in patients with bronchial asthma, dizziness, fatigue, insomnia, bizarre dreams, dyspnoea, coldness of extremities, GI disturbances, skin rash; pruritus, male impotence, paraesthesia, chest pain, joint pain, muscle pain, increased AST and ALT.
Overdose Reactions
 May show symptoms as extensions of pharmacological effects (e.g. bradycardia, hypotension, bronchospasm, acute cardiac failure). Provide symptomatic and supportive treatment. May empty stomach by gastric lavage. Atropine or isoprenaline may be used cautiously in the event of excessive bradycardia. Vasopressor may be given for severe hypotension.
Drug Interactions
 Coadministration of Pindolol and Thioridazine may cause increase in serum levels of both drugs; concomitant use is not recommended due to risks of QT prolongation and cardiac arrhythmia. Combination use with MAO inhibitors is not recommended in view of the theoretical risk of significant hypertension. May have additive effect when given with catecholamine-depleting drugs (e.g. reserpine); monitor for hypotension and/or marked bradycardia. NSAIDs may antagonise the effects of pindolol.
Potentially Fatal: Increased risk of rebound hypertension follow the sudden withdrawal of clonidine in patients receiving a beta-blocker. (Pindolol should be withdrawn several days before slowly withdrawing clonidine). Not to be used with calcium channel blockers with negative inotropic effects (e.g. Verapamil, Diltiazem) as concomitant use may cause serious cardiodepression.
See Below for More pindolol Drug Interactions
Mechanism of Actions
 Pindolol is a non-cardioselective β-blocker with intrinsic sympathomimetic activity but little quinidine-like membrane-stabilizing property.
Absorption: Rapidly absorbed; bioavailability: 50-95%. Peak plasma concentrations achieved within 1 hr of drug admin.
Distribution: Protein binding: About 40-60%. Vd: About 2 L/kg in healthy adults; may be significantly reduced in uremic patients.
Metabolism: Extensive hepatic metabolism; about 60-65% is metabolised to hydroxy-metabolites.
Excretion: Plasma half-life: 3-4 hr (healthy adults); prolonged in elderly, renal failure and hepatic cirrhosis. Excreted in urine (35-40% as unchanged drug; the hydroxy-metabolites are excreted as glucuronides and ethereal sulfates). About 6-9% is excreted in faeces following admin of IV dose.
Administration
 May be taken with or without food. (May be taken w/ meals to reduce GI discomfort.)
Storage Conditions
 Oral: Store below 30°C.
ATC Classification
 C07AA03 - pindolol ; Belongs to the class of non-selective beta-blocking agents. Used in the treatment of cardiovascular diseases.
Storage
 Oral: Store below 30°C.
Available As
  • Pindolol 10 mg
  • Pindolol 15 mg

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