Acebutolol

Acebutolol is a prescription medication used for treating hypertension, ventricular arrhythmias, and angina. 

• Acebutolol  is available under the following different brand names: Sectral

Adult dosage

Capsule

• 200mg
• 400mg

Hypertension

Adult dosage

• 400-1200 mg/day divided orally every 12 hours; not to exceed 1200 mg/day

Geriatric dosage

• Initial dose: 200-400 mg orally daily; not to exceed 800 mg/day

Ventricular Arrhythmias

Adult dosage

• 400-1200 mg/day divided orally every 12 hours; not to exceed 1200 mg/day

Geriatric dosage

• Initial dose: 200-400 mg orally daily; not to exceed 800 mg/day

Angina

Adult dosage

• 400-1200 mg/day divided orally every 12 hours; not to exceed 1200 mg/day

Dosage Considerations – Should be Given as Follows: 

• See “Dosages”

Common side effects of Acebutolol include:

• headache,
• dizziness,
• tiredness,
• nausea,
• upset stomach,
• diarrhea,
• constipation, and
• sleep problems (insomnia)

Serious side effects of Acebutolol include:

• hives,
• difficulty breathing,
• swelling of the face, lips, tongue, or throat,
• shortness of breath,
• rapid weight gain,
• swelling,
• new or worsening chest pain,
• slow heartbeats,
• lightheadedness,
• severe headache,
• blurred vision,
• pounding in the neck or ears,
• nosebleeds,
• anxiety,
• confusion,
• severe chest pain,
• shortness of breath, and
• irregular heartbeats

Rare side effects of Acebutolol include:

• none 

This is not a complete list of side effects and other serious side effects or health problems that may occur as a result of the use of this drug. Call your doctor for medical advice about serious side effects or adverse reactions. You may report side effects or health problems to FDA at 1-800-FDA-1088.

If your medical doctor is using this medicine to treat your pain, your doctor or pharmacist may already be aware of any possible drug interactions and may be monitoring you for them. Do not start, stop, or change the dosage of any medicine before checking with your doctor, health care provider, or pharmacist first.

• Acebutolol has severe interactions with no other drugs.
• Acebutolol has serious interactions with the following drugs:
  • atenolol
  • betaxolol
  • bisoprolol
  • carvedilol
  • celiprolol
  • esmolol
  • labetalol
  • lofexidine
  • metoprolol
  • nadolol
  • nebivolol
  • penbutolol
  • pindolol
  • propranolol
  • saquinavir
  • sotalol
  • timolol
  • umeclidinium bromide/vilanterol inhaled
  • vilanterol/fluticasone furoate inhaled
• Acebutolol has moderate interactions with at least 169 other drugs.
• Acebutolol has minor interactions with at least 30 other drugs.

This information does not contain all possible interactions or adverse effects. Visit the RxList Drug Interaction Checker for any drug interactions. Therefore, before using this product, tell your doctor or pharmacist about all your products. Keep a list of all your medications with you and share this information with your doctor and pharmacist. Check with your health care professional or doctor for additional medical advice, or if you have health questions or concerns.

Contraindications

• Hypersensitivity
• Persistently severe bradycardia; 2°/3° heart block except for patients with functioning artificial pacemaker, overt cardiac failure, cardiogenic shock

Effects of drug abuse

• None

Short-Term Effects

• See “What Are Side Effects Associated with Using Acebutolol?”

Long-Term Effects

• See “What Are Side Effects Associated with Using Acebutolol?”

Cautions

• Use with caution in patients with myasthenia gravis
• Exacerbation or induction of psoriasis reported with therapy; cause and effect not established
• Use caution and monitor for progression of arterial obstruction in patients with peripheral vascular disease and Raynaud disease; therapy may precipitate or aggravate symptoms of arterial insufficiency
• Before using a β-blocker, an adequate alph1-receptor blockade is required in patients with pheochromocytoma
• While taking β-blockers, patients with a history of severe anaphylactic reaction to a variety of allergens may be more reactive to repeated challenges, either accidental, diagnostic, or therapeutic; such patients may be unresponsive to usual doses of epinephrine used to treat an allergic reaction
• Sympathetic stimulation may be essential for the support of the circulation in individuals with diminished myocardial contractility; inhibition by β-adrenergic receptor blockade may precipitate more severe failure; although β-blockers should be avoided in overt cardiac failure, acebutolol can be used with caution in patients with a history of heart failure who are controlled with digitalis and/or diuretics; both digitalis and acebutolol impair AV conduction; if the cardiac failure persists, therapy should be withdrawn
• In patients with aortic or mitral valve disease or compromised left ventricular function, continued depression of the myocardium with β-blocking agents over some time may lead to cardiac failure; at first signs of failure, patients should be digitalized and/or be given a diuretic and response observed closely; if cardiac failure continues despite adequate digitalization and/or diuretic, acebutolol therapy should be withdrawn
• Treatment with β-antagonists reduces cardiac output and can precipitate or aggravate symptoms of arterial insufficiency in patients with peripheral or mesenteric vascular disease; exercise caution with such patients, and observe closely for evidence of progression of arterial obstruction
• Chronically administered β-blocking therapy should not be routinely withdrawn before 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
• Beta-blockers may potentiate insulin-induced hypoglycemia and mask some of its manifestations such as tachycardia; however, dizziness and sweating are usually not significantly affected; patients with diabetes should be warned of the possibility of masked hypoglycemia
• Beta-adrenergic blockade may mask certain clinical signs (tachycardia) of hyperthyroidism; abrupt withdrawal of β-blockade may precipitate a thyroid storm; therefore, patients suspected of developing thyrotoxicosis from whom this drug is to be withdrawn should be monitored closely
• Bronchospastic disease
  • In general, patients with bronchospastic disease should not receive a β-blocker; because of its relative β1-selectivity, however, low doses of this drug may be used with caution in patients with bronchospastic disease who do not respond to, or who cannot tolerate, alternative treatment
  • Since β1-selectivity is not absolute and is dose-dependent, the lowest possible dose should be used initially, preferably in divided doses to avoid higher plasma levels associated with longer dose-interval; a bronchodilator, such as theophylline or a β2-stimulant, should be made available in advance with instructions concerning its use
• Impaired renal or hepatic function
  • Studies on the effect of this drug in patients with renal insufficiency have not been performed in the US; foreign published experience shows that it has been used successfully in chronic renal insufficiency
  • Acebutolol is excreted through the GI tract, but the active metabolite, diacetolol, is eliminated predominantly by the kidney; there is a linear relationship between renal clearance of diacetolol and creatinine clearance
  • Therefore, the daily dose of acebutolol should be reduced by 50% when creatinine clearance is less than 50 mL/min and by 75% when it is less than 25 mL/min; acebutolol should be used cautiously in patients with impaired hepatic function
  • This drug has been used successfully and without problems in elderly patients in the US clinical trials without specific adjustment of dosage; however, elderly patients may require lower maintenance doses because the bioavailability of both Acebutolol and its metabolite are approximately doubled in this age group
• Exacerbation of ischemic disease following withdrawal
  • Following abrupt cessation of therapy with certain β-blocking agents in patients with coronary artery disease, exacerbation of angina pectoris and, in some cases, myocardial infarction and death reported; such patients should be cautioned against interruption of therapy without a physician’s advice
  • Even in absence of overt ischemic heart disease, when discontinuation of the drug is planned, the patient should be carefully observed and should be advised to limit physical activity to a minimum while the drug is gradually withdrawn over about two weeks (if therapy with an alternative β-blocker desired, the patient may be transferred directly to comparable doses of another agent without interruption of β-blocking therapy)
  • If exacerbation of angina pectoris occurs, antianginal therapy should be restarted immediately in full doses and the patient hospitalized until the condition stabilizes

Pregnancy & Lactation

• May be acceptable in the first trimester of pregnancy, but use in life-threatening emergencies during the 2nd and 3rd trimesters (expert analysis). Neonates of mothers who have received acebutolol during pregnancy have reduced birth weight, decreased blood pressure, and decreased heart rate
• Lactation
  • Excreted into milk/not recommended