pindolol
Regulatory sources consulted
Approved indications
- Treatment of hypertension, alone or with other antihypertensive agents, particularly a thiazide diuretic.
Contraindications
Absolute
- Bronchial asthma.
- Overt heart failure or cardiogenic shock.
- Second- or third-degree atrioventricular block or severe bradycardia.
Clinical warnings
- Major warning · May precipitate or worsen heart failure; monitor for decompensation. — DailyMed pindolol label
- Major warning · Do not stop abruptly: taper over 1–2 weeks and monitor for angina or myocardial infarction. — DailyMed pindolol label
- Major warning · May cause bronchospasm and mask hypoglycemia or thyrotoxicosis; close clinical monitoring is required. — DailyMed pindolol label
- Major warning · Beta blockade may increase the risks of general anesthesia and surgical procedures; whether it should be withdrawn before major surgery is controversial. Inform the anesthetist. — DailyMed pindolol label
- Major warning · In people with a history of severe anaphylaxis, beta blockers may increase reactivity to repeated exposure and reduce the response to usual epinephrine doses. — DailyMed pindolol label
Drug interactions
- HighDigoxin and other drugs that slow atrioventricular conduction
Mechanism: Additive effects on heart rate and atrioventricular conduction.
Recommendation: Monitor for bradycardia and atrioventricular block.
https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=0daed7b3-6017-4611-8c3a-2f390470f8bc
- HighReserpine and other catecholamine-depleting drugs
Mechanism: Additive effect that may cause hypotension or marked bradycardia.
Recommendation: Closely monitor for vertigo, syncope, and postural hypotension.
https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=0daed7b3-6017-4611-8c3a-2f390470f8bc
- ModerateThioridazine
Mechanism: Pindolol increases serum thioridazine concentrations; pindolol may also increase.
Recommendation: Avoid the combination when possible or monitor for adverse effects of both drugs.
https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=0daed7b3-6017-4611-8c3a-2f390470f8bc
Adverse events
Common (≥1%)
Insomnia (10%) · Myalgia (10%) · Dizziness (9%) · Fatigue (8%) · Nervousness and arthralgia (7% each) · Edema (6%) · Dyspnea, nausea, and vivid dreams (5% each) · Pruritus (1%) and rash (<1%)
Rare but serious
Heart failure · Hallucinations
Pregnancy and lactation
FDA category: B (clasificación histórica de la FDA)
Use during pregnancy only if the potential benefit justifies the fetal risk. Pindolol is excreted in human milk; the label advises against breastfeeding during treatment.
Recent literature (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