pindolol
Sources réglementaires consultées
Indications approuvées
- Traitement de l’hypertension, seul ou avec d’autres antihypertenseurs, notamment un diurétique thiazidique.
Contre-indications
Absolues
- Asthme bronchique.
- Insuffisance cardiaque manifeste ou choc cardiogénique.
- Bloc auriculoventriculaire du deuxième ou troisième degré ou bradycardie sévère.
Mises en garde cliniques
- Mise en garde majeure · Peut déclencher ou aggraver une insuffisance cardiaque ; surveiller les signes de décompensation. — DailyMed pindolol label
- Mise en garde majeure · Ne pas arrêter brutalement : réduire progressivement sur 1 à 2 semaines et surveiller l’angor ou l’infarctus du myocarde. — DailyMed pindolol label
- Mise en garde majeure · Peut provoquer un bronchospasme et masquer une hypoglycémie ou une thyrotoxicose ; une surveillance clinique étroite est requise. — DailyMed pindolol label
- Mise en garde majeure · Le bêtablocage peut augmenter les risques liés à l’anesthésie générale et aux procédures chirurgicales ; l’opportunité de l’arrêter avant une chirurgie majeure est controversée. Informez l’anesthésiste. — DailyMed pindolol label
- Mise en garde majeure · Chez les personnes ayant des antécédents d’anaphylaxie sévère, les bêtabloquants peuvent accroître la réactivité lors d’expositions répétées et réduire la réponse aux doses habituelles d’épinéphrine. — DailyMed pindolol label
Interactions médicamenteuses
- SévèreDigoxine et autres médicaments ralentissant la conduction auriculoventriculaire
Mécanisme: Effets additifs sur la fréquence cardiaque et la conduction auriculoventriculaire.
Recommandation: Surveiller la bradycardie et le bloc auriculoventriculaire.
https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=0daed7b3-6017-4611-8c3a-2f390470f8bc
- SévèreRéserpine et autres médicaments diminuant les catécholamines
Mécanisme: Effet additif pouvant provoquer une hypotension ou une bradycardie marquée.
Recommandation: Surveiller étroitement les vertiges, la syncope et l’hypotension orthostatique.
https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=0daed7b3-6017-4611-8c3a-2f390470f8bc
- ModéréeThioridazine
Mécanisme: Le pindolol augmente les concentrations sériques de thioridazine ; le pindolol peut également augmenter.
Recommandation: Éviter l’association si possible ou surveiller les effets indésirables des deux médicaments.
https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=0daed7b3-6017-4611-8c3a-2f390470f8bc
Effets indésirables
Communs (≥1%)
Insomnie (10 %) · Myalgie (10 %) · Étourdissements (9 %) · Fatigue (8 %) · Nervosité et arthralgie (7 % chacune) · Œdème (6 %) · Dyspnée, nausées et rêves intenses (5 % chacun) · Prurit (1 %) et éruption cutanée (<1 %)
Rares mais graves
Insuffisance cardiaque · Hallucinations
Grossesse et allaitement
Catégorie FDA: B (clasificación histórica de la FDA)
N’utiliser pendant la grossesse que si le bénéfice potentiel justifie le risque fœtal. Le pindolol est excrété dans le lait maternel ; l’étiquette déconseille l’allaitement pendant le traitement.
Bibliographie récente (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