VISKEN
Clinical safety rating: caution
Comprehensive clinical and safety monograph for VISKEN (VISKEN).
Non-selective beta-adrenergic receptor antagonist; competitively blocks beta1- and beta2-adrenergic receptors, decreasing heart rate, myocardial contractility, and blood pressure.
| Metabolism | Hepatic metabolism primarily via glucuronidation; also undergoes N-dealkylation and oxidation. Not extensively metabolized by CYP450 enzymes. |
| Excretion | Renal (60-70% unchanged) and fecal (30-40% via biliary excretion as metabolites). |
| Half-life | Terminal elimination half-life: 10-12 hours in healthy adults; prolonged to 20-40 hours in significant renal impairment. |
| Protein binding | 57% bound primarily to albumin. |
| Volume of Distribution | 1.5-3.0 L/kg; indicates extensive tissue distribution, particularly to the lungs and heart. |
| Bioavailability | Oral: 50-70% due to first-pass metabolism. Not available in other routes for clinical use. |
| Onset of Action | Oral: 1-2 hours; intravenous: 2-5 minutes. |
| Duration of Action | Oral: 12-24 hours; intravenous: 4-6 hours. Dosing interval typically once daily due to long half-life. |
| Molecular Weight | 248.4 Da |
| Action Class | Beta blocker- Non selective |
5 mg orally twice daily, titrated to 10-20 mg twice daily based on response.
| Dosage form | TABLET |
| Renal impairment | GFR 30-50 mL/min: 2.5 mg twice daily; GFR <30 mL/min: 2.5 mg once daily. |
| Liver impairment | Child-Pugh A: no adjustment; Child-Pugh B: 2.5 mg twice daily; Child-Pugh C: not recommended. |
| Pediatric use | 0.2-0.5 mg/kg/day divided twice daily; maximum 1 mg/kg/day. |
| Geriatric use | Start at 2.5 mg once daily; titrate cautiously to 5 mg twice daily as tolerated. |
| 1st trimester | Use only if clearly needed; risk of fetal bradycardia, growth restriction, and hypoglycemia. Avoid in first trimester unless essential. |
| 2nd trimester | May be used if benefits outweigh risks; monitor fetal growth and heart rate. |
| 3rd trimester | Avoid if possible; risk of neonatal bradycardia, hypotension, and hypoglycemia. Discontinue 48-72 hours before delivery. |
Clinical note
Comprehensive clinical and safety monograph for VISKEN (VISKEN).
| Placental transfer | Crosses placenta; fetal concentrations may reach maternal levels. Associated with fetal growth restriction and adverse neonatal effects. |
| Breastfeeding | Excreted into breast milk in small amounts. Monitor infant for bradycardia, hypotension, and hypoglycemia. Use with caution, especially in preterm or low birth weight infants. |
■ FDA Black Box Warning
No FDA black box warning.
| Serious Effects |
Bronchial asthma or bronchospasmCardiogenic shockSinus bradycardiaHeart block (second or third degree)Overt cardiac failureHypersensitivity to pindolol
| Precautions | Abrupt discontinuation may exacerbate angina or precipitate myocardial infarction in patients with coronary artery disease., May mask signs of hypoglycemia in diabetic patients., Beta-blockers can worsen heart failure; use with caution in patients with compensated heart failure., May precipitate bronchospasm in patients with asthma or COPD., May cause bradycardia, hypotension, and Raynaud's phenomenon. |
| Food/Dietary | Avoid excessive consumption of alcohol, which may enhance hypotensive effects. Grapefruit and grapefruit juice have not been shown to interact significantly with pindolol, but it is prudent to maintain consistent dietary habits. |
Loading safety data…
| Lactation Rating |
| L3 (Moderately Safe) |
| Teratogenic Risk | VISKEN (pindolol) is a beta-adrenergic receptor antagonist. In the first trimester, studies suggest a potential increased risk of congenital anomalies, particularly cardiovascular defects, though data are limited. In the second and third trimesters, exposure may cause fetal bradycardia, hypoglycemia, and growth restriction. Due to its intrinsic sympathomimetic activity, risk may be lower compared to other beta-blockers, but caution is warranted throughout pregnancy. |
| Fetal Monitoring | Monitor maternal heart rate, blood pressure, and signs of bronchospasm. Assess fetal growth and heart rate via ultrasound and nonstress tests during the second and third trimesters. Monitor neonatal heart rate and glucose levels after delivery. |
| Fertility Effects | Pindolol may potentially affect fertility in both males and females due to beta-blockade effects on reproductive function, though human data are limited. Animal studies show no significant adverse effects on fertility. |
| Clinical Pearls | VISKEN (pindolol) is a non-selective beta-blocker with intrinsic sympathomimetic activity (ISA), making it less likely to cause bradycardia and bronchospasm at rest. Use caution in patients with hyperthyroidism, as it may mask symptoms of thyrotoxicosis. Monitor for signs of heart failure exacerbation, especially in patients with impaired myocardial function. Abrupt withdrawal may precipitate angina or myocardial infarction; taper over 1-2 weeks. |
| Patient Advice | Take this medication exactly as prescribed, usually twice daily with or without food. · Do not stop taking this medication suddenly without consulting your doctor, as this may cause chest pain or heart attack. · Monitor your blood pressure and heart rate regularly; report low heart rate or dizzy spells. · Avoid driving or operating heavy machinery until you know how this medication affects you. · Tell your doctor if you have a history of asthma, COPD, or other breathing problems. · Inform all healthcare providers that you are taking pindolol, especially before surgery or dental procedures. · Store at room temperature away from moisture and heat. |