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. |
| 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 | Consult provider |
| 2nd trimester | Consult provider |
| 3rd trimester | Consult provider |
Clinical note
Comprehensive clinical and safety monograph for VISKEN (VISKEN).
| Breastfeeding | Pindolol is excreted into human milk. The milk-to-plasma (M/P) ratio is approximately 1.5, indicating significant transfer. Breastfeeding infants may be at risk for bradycardia and hypotension. Use only if potential benefit outweighs risk, and monitor infant for signs of beta-blockade. |
| 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. |
■ FDA Black Box Warning
No FDA black box warning.
| Serious Effects |
["Cardiogenic shock","Sinus bradycardia","Heart block greater than first degree","Uncompensated heart failure","Bronchial asthma","Hypersensitivity to pindolol or any component of the formulation"]
| 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."] |
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| 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. |