acebutolol

Contraindicated in:

Decompensated HF;
Pulmonary edema;
Cardiogenic shock;
Bradycardia or heart block;
Obstructive airway disease including asthma;
Lactation: Lactation.

Use Cautiously in:

Thyrotoxicosis (may mask symptoms);
Diabetes mellitus (may mask symptoms of hypoglycemia);
History of severe allergic reactions (intensity of reactions may be ↑);
Renal impairment (↓ dose if CCr <50 mL/min);
Hepatic impairment;
OB: Use during pregnancy may result in neonates with ↓ birth weight, hypotension, and bradycardia; use during pregnancy only if potential maternal benefit justifies potential fetal risk;
Pedi: Safety and effectiveness not established in children;
Geri: Older adults may have ↑ sensitivity to adverse reactions.

Adv. Reactions/Side Effects ⬆ ⬇

CV: BRADYCARDIA, HF, hypotension, PULMONARY EDEMA

Derm: rash

EENT: blurred vision, stuffy nose

Endo: hyperglycemia, hypoglycemia

GI: constipation, diarrhea, nausea, vomiting

GU: erectile dysfunction, ↓libido, urinary frequency

MS: arthralgia, joint pain

Neuro: fatigue, weakness, anxiety, depression, dizziness, drowsiness, insomnia, memory loss, nervousness, nightmares

Resp: bronchospasm, wheezing

Misc: drug-induced lupus syndrome

Interactions ⬆ ⬇

Drug-drug:

General anesthetics, IV phenytoin, and verapamil may cause additive myocardial depression.
↑risk of bradycardia when used with digoxin, verapamil, diltiazem, clonidine, or ivabradine.
Antihypertensives, acute ingestion of alcohol, or nitrates may cause additive hypotension.
Use with epinephrine may result in unopposed alpha-adrenergic stimulation.
Thyroid preparations may ↓ effectiveness.
Insulin may result in prolonged hypoglycemia.
May ↓ effectiveness of theophylline.

Availability ⬆ ⬇

(Generic available)

Capsules: 200 mg; 400 mg
Tablets: 100 mg; 200 mg; 400 mg

Route/Dosage ⬆ ⬇

PO (Adults ): 400–800 mg/day in 1–2 divided doses (may ↑ up to 1200 mg/day; max = 800 mg/day in older adults).

Renal Impairment

PO (Adults ): CCr 26–50 mL/min: ↓dose by 50%. CCr <25 mL/min: ↓dose by 75%.

US Brand Names ⬆ ⬇

Action ⬆ ⬇

Blocks stimulation of beta₁–(myocardial)-adrenergic receptors. Does not usually affect beta₂ (pulmonary, vascular, or uterine) receptor sites.
Mild intrinsic sympathomimetic activity (ISA).

Therapeutic effects:

Decreased heart rate.
Decreased BP.

Classifications ⬆ ⬇

Therapeutic Classification: antiarrhythmics (class II), antihypertensives

Pharmacologic Classification: beta blockers

Pharmacokinetics ⬆ ⬇

Absorption: Well absorbed following oral administration.

Distribution: Minimal penetration of the CNS.

Metabolism/Excretion: Mostly metabolized to diacetolol, which is also a beta blocker.

Half-Life: Acebutolol:3–4 hr; diacetolol:8–13 hr.

Time/Action Profile ⬆ ⬇

ROUTE	ONSET	PEAK	DURATION
PO (effect on BP)	1–1.5 hr	2–8 hr	12–24 hr
PO (antiarrhythmic)	1 hr	4–6 hr	up to 10 hr

Patient/Family Teaching ⬆ ⬇

Explain the purpose and side effects of acebutolol. Instruct patient to take s directed, at the same time each day, even if feeling well; do not skip or double up on missed doses. Take missed doses as soon as possible if ≥4 hr before next dose. Keep out of children's reach. Abrupt withdrawal may precipitate life-threatening arrhythmias, hypertension, or myocardial ischemia. Advise patient to read Patient Information before starting and with each Rx refill in case of changes. Instruct patient to notify health care professional of all Rx or OTC medications, vitamins, or herbal products being taken and to consult health care professional before taking any Rx, OTC, or herbal products, especially cold preparations, concurrently with this medication. Patients on antihypertensive therapy should also avoid excessive amounts of coffee, tea, and cola.
- Advise patient to make sure enough medication is available for weekends, holidays, and vacations. An electronic prescription refill may be available for emergency use.
- Teach patient and family how to check BP and HR. Instruct them to check HR daily and BP biweekly and to report significant changes to health care professional. Advise patient to hold dose and contact health care provider if HR <50 bpm or BP changes significantly.
- May cause drowsiness or dizziness. Caution patients to avoid driving or other activities that require alertness until response to the drug is known.
- Caution patient that this medication may ↑ sensitivity to cold.
- Caution patients with diabetes to closely monitor blood glucose, especially if weakness, malaise, irritability, or fatigue occurs. May mask tachycardia and BP changes as signs of hypoglycemia, but dizziness and sweating may still occur.
- Advise patient to notify health care professional if difficulty breathing, wheezing, cold hands and feet, dizziness, light-headedness, confusion, depression, rash, fever, sore throat, unusual bleeding, or bruising occurs.
- Instruct patient to inform health care professional of medication regimen prior to treatment or surgery.
- Advise patient to carry identification describing disease process and medication regimen at all times.
Hypertension: Reinforce the need to continue additional therapies for hypertension (weight loss, sodium restriction, stress reduction, regular exercise, moderation of alcohol consumption, and smoking cessation). Acebutolol controls but does not cure hypertension.
Rep: Advise women of reproductive potential to notify health care provider if pregnancy is planned or suspected or if breastfeeding. Beta blockers are generally considered drugs of choice (with labetalol having the most evidence) for managing mild hypertension in pregnancy. If a beta blocker is taken during 3rd trimester, monitor fetal growth and for bradycardia, hypotension, and hypoglycemia; the newborn should be monitored for bradycardia, hypotension, hypoglycemia, and respiratory depression for 48 hr after delivery.

section name header

Indications ⬇

Contraind./Precautions ⬆ ⬇