pindolol
Fuentes regulatorias consultadas
Indicaciones aprobadas
- Tratamiento de la hipertensión, solo o junto con otros antihipertensivos, en particular un diurético tiazídico.
Contraindicaciones
Absolutas
- Asma bronquial.
- Insuficiencia cardiaca manifiesta o choque cardiogénico.
- Bloqueo auriculoventricular de segundo o tercer grado o bradicardia grave.
Advertencias clínicas
- Advertencia mayor · Puede precipitar o agravar la insuficiencia cardiaca; vigilar signos de descompensación. — DailyMed pindolol label
- Advertencia mayor · No suspender bruscamente: reducir gradualmente durante 1–2 semanas y vigilar angina o infarto de miocardio. — DailyMed pindolol label
- Advertencia mayor · Puede causar broncoespasmo y enmascarar hipoglucemia o tirotoxicosis; extremar la vigilancia clínica. — DailyMed pindolol label
- Advertencia mayor · El betabloqueo puede aumentar los riesgos de la anestesia general y de los procedimientos quirúrgicos; la conveniencia de retirarlo antes de una cirugía mayor es controvertida. Informa al anestesista. — DailyMed pindolol label
- Advertencia mayor · En personas con antecedentes de anafilaxia grave, los betabloqueantes pueden aumentar la reactividad a exposiciones repetidas y reducir la respuesta a las dosis habituales de epinefrina. — DailyMed pindolol label
Interacciones medicamentosas
- SeveraDigoxina y otros fármacos que reducen la conducción auriculoventricular
Mecanismo: Efectos aditivos sobre la frecuencia cardiaca y la conducción auriculoventricular.
Recomendación: Vigilar bradicardia y bloqueo auriculoventricular.
https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=0daed7b3-6017-4611-8c3a-2f390470f8bc
- SeveraReserpina y otros fármacos que reducen catecolaminas
Mecanismo: Efecto aditivo que puede producir hipotensión o bradicardia marcada.
Recomendación: Vigilar estrechamente vértigo, síncope e hipotensión postural.
https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=0daed7b3-6017-4611-8c3a-2f390470f8bc
- ModeradaTioridazina
Mecanismo: Pindolol aumenta las concentraciones séricas de tioridazina; también puede aumentar el pindolol.
Recomendación: Evitar la combinación cuando sea posible o vigilar efectos adversos de ambos fármacos.
https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=0daed7b3-6017-4611-8c3a-2f390470f8bc
Eventos adversos
Comunes (≥1%)
Insomnio (10%) · Mialgia (10%) · Mareo (9%) · Fatiga (8%) · Nerviosismo y artralgia (7% cada uno) · Edema (6%) · Disnea, náuseas y sueños vívidos (5% cada uno) · Prurito (1%) y erupción cutánea (<1%)
Raros pero graves
Insuficiencia cardiaca · Alucinaciones
Embarazo y lactancia
Categoría FDA: B (clasificación histórica de la FDA)
Usar durante el embarazo solo si el beneficio potencial justifica el riesgo fetal. Pindolol se excreta en la leche humana; la etiqueta indica no amamantar durante el tratamiento.
Bibliografía reciente (PubMed)
Treatment resistance in anxiety disorders (TR-ADs) constitutes a major clinical challenge conferring a considerable burden regarding quality of life and societal health costs. This systematic review provides an overview of pharmacological, psychotherapeutic, and neurostimulatory treatment options in adults with treatment-resistant generalized anxiety disorder (TR-GAD), panic disorder (TR-PD)/agoraphobia, and social anxiety disorder (TR-SAD). A total of 26 randomized controlled trials (RCTs) and 36 open label studies were identified, with, however, mostly small sample sizes and several methodological limitations. According to RCTs, selective serotonin reuptake inhibitors (SSRIs) or clomipramine are effective in TR-PD after failure to respond to cognitive behavioral therapy (CBT). In pharmacological TR-SAD, switching from one SSRI to another or to venlafaxine was found helpful in open label trials. RCTs further suggest augmentation with quetiapine, risperidone, olanzapine, or pregabalin in TR-GAD, pindolol in TR-PD, and clonazepam in TR-SAD. Open label studies in TR-AD provide preliminary evidence for ketamine or augmentation with nefazodone, reboxetine, buspirone, aripiprazole, olanzapine, quetiapine, risperidone, ziprasidone, divalproex sodium, levetiracetam, zonisamide, flumazenil, pregabalin, cannabidiol, and acamprosate. For pharmacological TR, CBT was effective in several RCTs. Following nonresponse to CBT, first evidence suggests effectiveness of Acceptance and Commitment Therapy and Mindfulness-Based Cognitive Therapy. Only inconclusive support was identified for repetitive transcranial magnetic stimulation in TR-AD. In summary, this integrative review may provide an evidence base for expert recommendations, inform clinical guidelines, and inspire further research into innovative, personalized treatment of TR-AD increasing response rates and lowering the considerable individual and public health burden of anxiety disorders.
Noradrenergic signaling declines in Parkinson's disease (PD) following locus coeruleus neurodegeneration. Epidemiologic studies demonstrate that β-acting drugs slow PD progression. The primary objective was to compare the safety and effects of 3 β-adrenoceptor (β-AR) acting drugs on central nervous system (CNS) function after a single dose in healthy volunteers (HVs) and evaluate the effects of multiple doses of β-AR acting drugs in HVs and PD-patients. In Part A, HVs received single doses of 32 mg salbutamol, 160μg clenbuterol, 60 mg pindolol and placebo administered in a randomized, 4-way cross-over study. In Part B (randomized cross-over) and Part C (parallel, 2:1 randomized), placebo and/or clenbuterol (20μg on Day 1, 40μg on Day 2, 80μg on Days 3-7) were administered. CNS functions were assessed using the NeuroCart test battery, including pupillometry, adaptive tracking and recall tests. Twenty-seven HVs and 12 PD-patients completed the study. Clenbuterol improved and pindolol reduced the adaptive tracking and immediate verbal recall performance. Clenbuterol and salbutamol increased and pindolol decreased pupil-to-iris ratios. Clenbuterol was selected for Parts B and C. In Part B, clenbuterol significantly increased performance in adaptive tracking with a tendency toward improved performance in immediate and delayed verbal recall. In Part C trends toward improved performance in immediate and delayed verbal recall were observed in PD-patients. Typical cardiovascular peripheral β2-AR effects were observed with clenbuterol. This study demonstrates the pro-cognitive effects of clenbuterol in HVs with similar trends in PD-patients. The mechanism of action is likely activation of β2-ARs in the CNS. Aims and Purpose of the Research:This research aimed to explore how three different drugs affect brain function. These drugs are salbutamol, clenbuterol, and pindolol and work in the brain by stimulating specific brain cells that can improve aspects like memory and coordin