Penbutolol

Contraindications

Severe peripheral vascular disease, sinus bradycardia, 2°/3° heart block, cardiogenic shock, hypersensitivity, asthma/COPD, sick sinus syndrome without permanent pacemaker

Cautions

IDDM, CHF, hyperthyroidism, renal impairment, liver disease

Sudden discontinuation can exacerbate angina and lead to myocardial infarction

Increased risk of stroke after surgery, cerebrovascular insufficiency, peripheral vascular disease, anesthesia/surgery (myocardial depression), use in pheochromocytoma

Anesthesia/surgery (myocardial depression): chronically administered beta-blocking therapy should not be routinely withdrawn prior to major surgery, however the impaired ability of the heart to respond to reflex adrenergic stimuli may augment the risks of general anesthesia and surgical procedures

This medication may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be alert.

Drinking alcohol can increase certain side effects of penbutolol.

Tell your doctor about all other medicines you use, especially:

• digoxin (digitalis, Lanoxin);
• tizanidine (Zanaflex);
• a diuretic (water pill);
• asthma medications such as albuterol (Ventolin, Proventil), aminophylline (Phyllocontin, Truphylline), metaproterenol (Alupent), pirbuterol (Maxair), salmeterol (Advair, Serevent), terbutaline (Brethaire, Brethine, Bricanyl), or theophylline (Elixophyllin, Theo-24, Theochron, Uniphyl);
• blood pressure medications also used to treat a prostate disorder, such as doxazosin (Cardura), prazosin (Minipress), or terazosin (Hytrin);
• a calcium channel blocker such as amlodipine (Norvasc, Caduet, Exforge, Lotrel, Tekamlo, Tribenzor, Twynsta, Amturnide), diltiazem (Cartia, Cardizem), nifedipine (Nifedical, Procardia), verapamil (Calan, Covera, Isoptin, Verelan), and others; or
• heart or blood pressure medication such as clonidine (Catapres), guanabenz (Wytensin), guanfacine (Intuniv, Tenex), hydralazine (Apresoline, BiDil), methyldopa (Aldomet), or minoxidil (Loniten).

This list is not complete and other drugs may interact with penbutolol. Tell your doctor about all medications you use. This includes prescription, over-the-counter, vitamin, and herbal products. Do not start a new medication without telling your doctor.

Penbutolol is a prescription medication used to treat high blood pressure. Penbutolol belongs to a group of medications called beta blockers. These work by blocking beta receptors on the heart, relaxing blood vessels and slowing the heart rate to decrease blood pressure.

Penbutolol comes as a tablet to take by mouth and is usually taken once daily.

Common side effects of penbutolol include headache, tiredness, and nausea. Penbutolol can also cause dizziness. Do not drive or operate heavy machinery until you know how penbutolol affects you.

Penbutolol is used alone or together with other medicines, including a diuretic or "water pill" such as hydrochlorothiazide (HCTZ) to treat high blood pressure (hypertension). High blood pressure adds to the workload of the heart and arteries. If it continues for a long time, the heart and arteries may not function properly. This can damage the blood vessels of the brain, heart, and kidneys, resulting in a stroke, heart failure, or kidney failure. High blood pressure may also increase the risk of heart attacks. These problems may be less likely to occur if blood pressure is controlled.

penbutolol is a beta-blocker. It works by affecting the response to nerve impulses in certain parts of the body, like the heart. As a result, the heart beats slower and decreases the blood pressure. When the blood pressure is lowered, the amount of blood and oxygen is increased to the heart.

penbutolol is available only with your doctor's prescription.

• Tell all of your health care providers that you take this medicine. This includes your doctors, nurses, pharmacists, and dentists.
• Avoid driving and doing other tasks or actions that call for you to be alert until you see how penbutolol affects you.
• To lower the chance of feeling dizzy or passing out, rise slowly if you have been sitting or lying down. Be careful going up and down stairs.
• Check blood pressure and heart rate as the doctor has told you. Talk with the doctor.
• This medicine may affect certain lab tests. Tell all of your health care providers and lab workers that you take this medicine.
• Do not stop taking penbutolol all of a sudden. If you do, chest pain that is worse and in some cases heart attack may occur. The risk may be greater if you have certain types of heart disease. To avoid side effects, you will want to slowly stop this medicine as ordered by your doctor. Call your doctor right away if you have new or worse chest pain or if other heart problems occur.
• Talk with your doctor before you drink alcohol.
• This medicine may hide the signs of low blood sugar. Talk with the doctor.
• If you have high blood sugar (diabetes), you will need to watch your blood sugar closely.
• Talk with your doctor before using OTC products that may raise blood pressure. These include cough or cold drugs, diet pills, stimulants, ibuprofen or like products, and some natural products or aids.
• Tell your doctor if you are pregnant or plan on getting pregnant. You will need to talk about the benefits and risks of using penbutolol while you are pregnant.
• Tell your doctor if you are breast-feeding. You will need to talk about any risks to your baby.

• Levatol [DSC]

• Antihypertensive
• Beta-Blocker With Intrinsic Sympathomimetic Activity

Response rates to penbutolol are greater in caucasians than blacks.

Hypertension: Treatment of mild-to-moderate arterial hypertension

The 2014 guideline for the management of high blood pressure in adults (JNC 8) recommends initiation of pharmacologic treatment to lower blood pressure for the following patients (JNC8 [James, 2013]):

• Patients ≥60 years of age, with systolic blood pressure (SBP) ≥150 mm Hg or diastolic blood pressure (DBP) ≥90 mm Hg. Goal of therapy is SBP <150 mm Hg and DBP <90 mm Hg.

• Patients <60 years of age, with SBP ≥140 mm Hg or DBP is ≥90 mm Hg. Goal of therapy is SBP <140 mm Hg and DBP <90 mm Hg.

• Patients ≥18 years of age with diabetes, with SBP ≥140 mm Hg or DBP ≥90 mm Hg. Goal of therapy is SBP <140 mm Hg and DBP <90 mm Hg.

• Patients ≥18 years of age with chronic kidney disease (CKD), with SBP ≥140 mm Hg or DBP ≥90 mm Hg. Goal of therapy is SBP <140 mm Hg and DBP <90 mm Hg.

In patients with chronic kidney disease (CKD), regardless of race or diabetes status, the use of an ACE inhibitor (ACEI) or angiotensin receptor blocker (ARB) as initial therapy is recommended to improve kidney outcomes. In the general nonblack population (without CKD) including those with diabetes, initial antihypertensive treatment should consist of a thiazide-type diuretic, calcium channel blocker, ACEI, or ARB. In the general black population (without CKD) including those with diabetes, initial antihypertensive treatment should consist of a thiazide-type diuretic or a calcium channel blocker instead of an ACEI or ARB.

Refer to adult dosing.