Acebutolol

Class
Adrenergic receptor blockers
Subclass
Cardioselective β-blockers
Substance name
Acebutolol hydrochloride
Brand names
Sectral®
Common formulations
Capsule
Dosage and administration
Adults patients
Hypertension
•
Start at: 400 mg PO daily, in 1-2 divided doses
•
Maintenance: 400-800 mg PO daily, in 1-2 divided doses
•
Maximum: 1,200 mg per day
Premature ventricular contractions
•
Start at: 200 mg PO BID
•
Maintenance: 600-1,200 mg PO daily, in 1-2 divided doses
•
Maximum: 1,200 mg per day
Titrate gradually to response. Taper gradually over 2 weeks when discontinuing.
Alternative
•
200-600 mg PO q12-24h
Stable angina • Off-label
•
Start at: 200 mg PO TID
•
Maintenance: 200-400 mg PO TID
•
Maximum: 1,200 mg per day
Other off-label uses
•
Treatment of hypertension in pregnancy
•
Treatment of thyrotoxicosis
Indications for use
Labeled indications
Adults
•
Treatment of hypertension
•
Treatment of premature ventricular contractions
Off-label indications
Adults
•
Treatment of hypertension in pregnancy
•
Treatment of stable angina
•
Treatment of thyrotoxicosis
Safety risks
Contraindications
Hypersensitivity to acebutolol or its components
Overt HF or cardiogenic shock
•
Use caution in patients with controlled HF.
Persistently severe bradycardia or second- or third-degree AV block
Warnings and precautions
Arterial insufficiency
•
Use caution in patients with PAD or mesenteric vascular disease. Monitor for progression of arterial obstruction.
Bronchospasm
•
Use caution in patients with bronchospastic disease. Use the lowest possible dose initially, preferably in divided doses.
Exacerbation of angina pectoris
•
Do not discontinue abruptly in patients with coronary artery disease.
Mask symptoms of hyperthyroidism
•
Use caution in patients with thyroid disease.
Mask symptoms of hypoglycemia
•
Use caution in patients with diabetes.
Thyroid storm
•
Do not discontinue abruptly in patients with thyroid disease suspected of developing thyrotoxicosis.
Specific populations
Renal impairment
CrCl ≥ 50 mL/min
•
Use acceptable. No dose adjustment required.
CrCl 25-49 mL/min
•
Reduce dose by 50%.
CrCl < 25 mL/min
•
Reduce dose by 75%.
Renal replacement therapy
Continuous renal replacement
•
Dose as in eGFR < 25 mL/min/1.73 m².
Intermittent hemodialysis
•
Administer the dose after dialysis session. Dose as in eGFR < 25 mL/min/1.73 m².
Peritoneal dialysis
•
No guidance available.
Hepatic impairment
Any severity
•
Use with caution.
Pregnancy and breastfeeding
Pregnancy
All trimesters
•
Use only if benefits outweigh potential risks. Evidence of fetal harm in animals. Monitor neonates for bradycardia and hypoglycemia. Beta-blockers, including acebutolol, could potentially reduce uteroplacental blood flow, which could lead to congenital anomalies in the offspring. Meta-analyses have reported an association between β-blocker exposure and fetal congenital cardiovascular defects.
Breastfeeding
Do not use during breastfeeding.
High levels in breastfed infants (75-95%).
May potentially cause adverse effects in breastfed infants.
Adverse reactions
Very common > 10%
•
Fatigue
Common 1-10%
•
Bradycardia, conjunctivitis, hypotension, ↑ serum LDH, ↑ serum TBIL, ↑ serum transaminases, anxiety, arthralgia, back pain, blurred vision, chest pain, constipation, cough, dark urine, depression, diarrhea, dizziness, dry eyes, dyspepsia, dyspnea, dysuria, erectile dysfunction, eye pain, fever, flatulence, headache, hypoesthesia, insomnia, urinary frequency, loss of appetite, malaise, myalgia, nausea, nightmares, pruritus, skin rash, rhinitis
Uncommon < 1%
•
AV block, agranulocytosis, Peyronie's disease, purpura, emotional lability, hair loss, memory impairment, systemic lupus erythematosus
Interactions
Drug(s)
Check Interactions
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