Dosing and uses of Visken (pindolol)
Adult dosage forms and strengths
tablets
- 5mg
- 10mg
Hypertension
5 mg PO BID initially; may increase by 10 mg/d q3-4wk to up to 30 mg PO BId
Chronic Stable Angina (Off-label)
15-40 mg/d div TID/QID PO
Additional Information
Less effective than thiazide diuretics in black and geriatric patients
Shown to decrease mortality in hypertension and post-myocardial infarction
Other Indications & Uses
Off-label: angina, SVA, hyperthyroidism
Pediatric dosage forms and strengths
Safety & efficacy not established
Visken (pindolol) adverse (side) effects
1-10%
Insomnia (10%)
Muscle pain (10%)
Dizziness (9%)
Fatigue (8%)
Nervousness (7%)
Elevated liver enzymes (7%)
Joint pain (7%)
Edema (6%)
Vivid dreams (5%),
Abdominal discomfort (4-5%)
Nausea (4-5%)
Muscle cramps (3%)
Paresthesias (3%)
Bradycardia (2%)
Cold extremities (2%)
Hypotension (2%)
Palpitations (2%)
Syncope (2%)
Tachycardia (2%)
Anxiety (2%)
Lethargy (2%)
Diarrhea (2%)
Vomiting (2%)
Impotence/reduced libido (1-2%)
Frequency not defined
Heart failure
Syncope
Tachyarrythmia
Bronchospasm, depression, decreased exercise tolerance, Raynaud's phenomenon
May increase triglyceride levels and insulin resistance, and decrease HDL levels
Warnings
Contraindications
Overt heart failure, asthma/COPD, cardiogenic shock, hypersensitivity, sinus bradycardia, 2nd-3rd degree heart block, cardiogenic shock, sick sinus syndrome without permanent pacemaker
Cautions
Anesthesia/surgery (myocardial depression), bronchospastic disease, cerebrovascular insufficiency, CHF, DM, hyperthyroidism/thyrotoxicosis, liver disease, renal impairment, peripheral vascular disease, myasthenic conditions
Sudden discontinuation can exacerbate angina and lead to myocardial infarction
Increased risk of stroke after surgery
Pregnancy and lactation
Pregnancy category: B
Lactation: do not nurse
Pregnancy categories
A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.
B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.
C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.
D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.
X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.
NA: Information not available.
Pharmacology of Visken (pindolol)
Half-Life: 3-4 hr in healthy adults
Peak Plasma (single 20 mg dose)
Concentration: 45-167 mcg/L
Time: 1-2 hr
Other Information
Bioavailability: 50-95%
Protein Bound: 40-60%
Vd: 1.2-2 L/kg
Metabolism: 60-65% in liver, primarily to hydroxy metabolites which are excreted as glucuronides & ethereal sulfates
Clearance: tubular secretion
Excretion: principally in urine as unchanged drug 35-50%
Mechanism of action
Non-selective; has intrinsic sympathomimetic activity, ie, lowers BP with less bradycardia
