1 What is Visken?

Brand: Visken, Alti-Pindolol

Generic: Pindolol

Visken is a potent beta-blocker with prominent intrinsic sympathomimetic activity.

It has been used primarily as an antihypertensive drug which may be advantageous in patients who develop marked bradycardia with propranolol.

Chances of rebound hypertension on withdrawal are also less. The effective dose range is rather narrow.

2 What to Know Before Using

Before using Visken, you must know all about the risks and complications associated with it. This is a decision that your doctor will make with your active participation.

For this medicine, certain factors that may alter the drug action should be considered:

Present and past illness, drug interactions, hypersensitivity reactions, pregnancy, lactation and metabolic impairment should be considered cautiously.

Always try to answer each question appropriately asked by your physician. If you have had any allergic reaction to such medications or any other medicines, tell your doctor about that.

This is the medicine which is used irrespective of age and sex. Animal studies have shown an adverse effect but there are no adequate studies in pregnancy and lactation.

Hence, potential benefit may warrant use of the drug in pregnant women despite potential risk.

Certain drugs should not be used concurrently with such medications. It is always recommended to consult with your doctor if you are in need of some drugs for another health problem.

Use of pindolol is contraindicated in bronchial asthma, bronchospasm, history of obstructive airway disease, bradycardia (heart rate less than 55/min), cardiogenic shock, 2nd and 3rd degree AV block, metabolic acidosis etc.

Patients with left ventricular failure or severe uncompensated CCF should not use this medicine. Diabetic patients who are receiving hypoglycemic agent mainly insulin are not given this drug.

Pindolol therapy to the patients with peripheral vascular disease (e.g. Buerger’s disease) aggravates the condition. Hypotensive patients with systolic blood pressure less than 90 mm Hg are strongly prohibited to take such medications.

3 Proper Usage

To use Visken properly, you must follow all instructions given by your doctor. The dose of this medicine will vary according to patient’s condition or requirements.

You should follow the doctor's directions and advice. The amount of medicine that you take must not exceed the maximum therapeutic dose.

Also, the frequency of your daily drug administration and the duration of drug therapy depend on the particular medical problem for which you are taking the medicine.

Visken is the drug which is preferably used in a wide variety of diseases such as:

Hypertension: beta-blockers (e.g. pindolol) are relatively mild antihypertensive drugs. All agents, irrespective of associated properties, are nearly equally effective.

They are one of the first choice drugs because of good patient acceptability and cardioprotective potential.

Angina pectoris: all beta-blockers benefit angina of effort. Taken on a regular schedule they decrease the frequency of attacks and increase exercise tolerance.

High doses, however, may worsen angina in some patients by increasing the ventricular size and reducing coronary flow. Thus, pindolol not suitable for variant angina.

Cardiac arrhythmias: beta-blockers suppress extrasystoles and tachycardias, especially those mediated adrenergically during anesthesia or digitalis-induced.

Pindolol controls ventricular rate in atrial fibrillation and flutter, but only occasionally restores sinus rhythm.

Adults should be given 80 mg/day in 1-2 divided doses in order to treat supraventricular and ventricular arrhythmias. The maximum therapeutic dose of pindolol is 640 mg/day.

Myocardial infarction (MI): in relation to MI, beta-blockers have been used for secondary prophylaxis of MI in order to decrease subsequent mortality by 20%.

They may act by preventing re-infarction and sudden ventricular fibrillation at the subsequent attack of MI.

Dissecting aortic aneurysm: beta-blockers help by reducing cardiac contractile force and aortic pulsation.

Phaeochromocytoma: beta-blockers may be used to control tachycardia and arrhythmia, but should never be administered unless an alpha-blocker has been given before, the otherwise dangerous rise in blood pressure can occur.

Thyrotoxicosis: pindolol rapidly controls the sympathetic symptoms (palpitation, nervousness, tremor, fixed stare, severe myopathy, and sweating) without significantly affecting thyroid status.

It also inhibits peripheral conversion of T₄ to T₃ and is highly valuable during thyroid storm.

Anxiety: pindolol exerts an apparent antianxiety effect, especially under conditions which provoke nervousness and panic, e.g. examination, unaccustomed public appearance etc.

Essential tremor: nonselective beta-blockers have now established a place in treating essential tremor but they do not benefit parkinsonian tremor.

Glaucoma: ocular beta-blockers are widely used for chronic simple (wide angle) glaucoma; also used as an adjuvant in angle closure glaucoma.

Hypertrophic obstructive cardiomyopathy: beta-blockers improve cardiac output in these patients during exercise by reducing left ventricular outflow obstruction, though they have little effect while at rest.

4 Precautions to Take

In using Visken, you must be careful and take some precautions as advised by your doctor. In the case of such drug therapy, you may not need to discontinue the therapy as there are least chances of drug toxicity.

Although pindolol is well tolerated by most of the patients, but it may bring unwanted effects like nausea, sleep disorders, lassitude, diarrhea, palpitations, bradycardia, weakness, dyspnea, decreased sexual activity, impotence, extremity pain, back pain, asthma, visual disturbances, cardiac arrhythmias etc.

If the drug is withdrawn abruptly, rebound angina and myocardial infarction may occur. Potentially fatal medical emergencies like polymorphic ventricular tachycardia, rebound hypertension etc. also happen but rarely.

Sometimes you may need to consult with the doctor if you feel any of these discomforts. Firstly, you have to stop using this drug and then consult with your physician immediately.

In the case of children, be careful not to exceed the maximum safe dose. You should not take certain medicines during this drug therapy.

It is safe to consult with your doctor if you are in need of some drugs for another health problem. Additive depression of sinus node and A-V conduction take place when pindolol is concurrently taken with digitalis and verapamil.

Digitalis increases the risk of bradycardia and even cardiac arrest may also occur in some cases. There is also enhanced the risk of arrhythmias with diuretics.

Rebound hypertension may happen with clonidine. When used with indomethacin or other NSAIDs there is decreased beta blockers effect. Cimetidine inhibits pindolol metabolism.

However, the dose range of pindolol is wide, and this may not be clinically significant. On the other hand, pindolol retards lidocaine metabolism by reducing hepatic blood flow resulting in more toxicity.

It also increases the bioavailability of chlorpromazine by decreasing its first pass metabolism.

Prolonged refractoriness with disopyramide, quinidine, procainamide, amiodarone, and bepridil has been reported. Moreover, pindolol prolongs QT interval with TCAs, phenothiazines, terfenadine and astemizole.

There is increased the risk of medical emergency when used with potassium-depleting diuretics, intravenous erythromycin, halofantrine, pentamidine, and quinolones.

When it used in diabetic persons who are receiving insulin or with sulphonylureas there is more hypoglycemia. It may prolong neuromuscular blockade of tubocurarine.

AV block becomes worse when beta blocker i.e. pindolol is used with calcium channel antagonists. Potentially fatal conditions arise with verapamil and diltiazem.

Because of such a wide variety of drug interactions, you should be more conscious about using other drugs during or before you start the pindolol therapy and even after completion of therapy.

There is positive evidence of human fetal risk based on adverse reaction data from investigational or marketing experience or studies in humans, but potential benefits may warrant use of the drug in pregnant women despite potential risks.

Gradual withdrawal is recommended in pregnancy, renal insufficiency, and compensated heart failure.

5 Potential Side Effects

As with many medications, there are several potential side effects associated with Visken. These side-effects usually go away during the treatment episode as your body adjusts to the medicine.

Additionally, your health care professional may advise you about the ways how to prevent or reduce those unwanted side-effects. Sometimes you may need to consult with the doctor if you feel any serious discomfort.

You should seek medical help when the following problems become significant:

  • Pindolol can accentuate myocardial insufficiency and can precipitate CHF/edema by blocking sympathetic support to the heart, especially during cardiovascular stress.
  • Resting heart rate may be reduced to 60/min or less. Patients of sick sinus are more prone to severe bradycardia.
  • It worsens chronic obstructive lung disease precipitating life-threatening attack of bronchial asthma.
  • Carbohydrate tolerance may be impaired in pre-diabetics.
  • Plasma lipid profile is altered on long-term use that may enhance the risk of coronary artery disease.
  • Withdrawn of pindolol after chronic use should be gradual, otherwise, rebound HTN, worsening of angina and even sudden death may occur.
  • Tiredness and reduced exercise capacity because of beta-2 mediated increase in blood flow to the exercising muscles.
  • Worsening of peripheral vascular disease is noticed due to blockade of vasodilator beta-2 receptors.
  • Side effects are not overtly due to beta-receptors blockade are GIT upset, lack of drive, nightmares, forgetfulness and rarely hallucinations.
  • Male patients more frequently complain of a decrease in sexual desire.