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acebutolol (Rx)Brand and Other Names:Sectral

 
 
 

Dosing & Uses

AdultPediatricGeriatric

Dosage Forms & Strengths

capsule

  • 200mg
  • 400mg
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Hypertension

400-1200 mg/day divided PO q12hr; not to exceed 1200 mg/day

Ventricular Arrhythmias

400-1200 mg/day divided PO q12hr; not to exceed 1200 mg/day  

Angina

400-1200 mg/day divided PO q12hr; not to exceed 1200 mg/day  

Renal Impairment

CrCl 25-49 mL/min: Reduce dose by 50%

CrCl < 25 mL/min: Reduce dose by 75%

Hepatic Impairment

Dose adjustment not necessary

Other Indications & Uses

Off-label: ventricular tachycardia, angina, essential tremor

Also used to control ventricular premature beats

Safety and efficacy not established

Hypertension

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

Ventricular Arrhythmias

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

Angina

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

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Interactions

Interaction Checker

acebutolol and

No Results

     
     activity indicator 
    No Interactions Found
    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

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            Adverse Effects

            >10%

            Fatigue (11%)

            1-10%

            Dizziness (6%)

            Headache (6%)

            Constipation (4%)

            Diarrhea (4%)

            Dyspnea (4%)

            Dyspepsia (4%)

            Nausea (4%)

            Flatulence (3%)

            Insomnia (3%)

            Abdominal pain (2%)

            Bradycardia (2%)

            Chest pain (2%)

            Dysuria (2%)

            Edema (2%)

            Heart failure (2%)

            Hypotension (2%)

            Impotence (2%)

            Myalgia (2%)

            Pharyngitis (2%)

            Pruritus (2%)

            Rhinitis (2%)

            Vomiting (2%)

            Wheezing (2%)

            <1%

            Hepatotoxicity

            SLE

            Frequency Not Defined

            Bronchospasm, depression, decreased exercise tolerance, Raynaud's phenomenon

            May increase triglyceride levels and insulin resistance, and decrease HDL levels

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            Warnings

            Contraindications

            Hypersensitivity

            Asthma/COPD, severe bradycardia, 2°/3° heart block, cardiogenic shock, overt heart failure, sinus bradycardia, sick sinus syndrome without permanent pacemaker

            Avoid during breastfeeding

            Cautions

            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

            Bronchospastic disease, cerebrovascular insufficiency, DM, hyperthyroidism/thyrotoxicosis, liver disease, renal impairment, peripheral vascular disease, compromised left ventricular function, elderly, use in pheochromocytoma, IDDM

            Avoid abrupt withdrawal; sudden discontinuation can exacerbate angina and lead to myocardial infarction

            May increase risk of stroke after surgery

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            Pregnancy & Lactation

            Pregnancy Category: B; D in 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

            Pregnancy Categories

            A:Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

            B:May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

            C:Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

            D:Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

            X:Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

            NA:Information not available.

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            Pharmacology

            Mechanism of Action

            Cardioselective for beta-1 at low doses; has intrinsic sympathomimetic activity, ie, can lower BP with less decrease in HR

            Class 2 antiarrhythmic

            Pharmacokinetics

            Peak Plasma Time: 2-3 hr

            Toxic range: acetabutalol >15-20 mcg/mL, & diacetolol (the active metabolite) < 90-150 mcg/mL

            Onset: 1.5-3 hr (initial response); 3-8 hr (peak response)

            Duration: 12-24 hr

            Bioavailability: 40%

            Absorption: 40% (oral)

            Protein Bound: 10-26%

            Vd: 1.2 L/kg

            Metabolism: metabolized in the liver to active met, diacetolol

            Metabolites: diacetolol (active), free amine of acebutolol (inactive)

            Excretion: principally in feces 56%, urine 30-40%, bile 3-8%

            Dialyzable: Yes (HD)

            Less effective than thiazide diuretics in black and geriatric patients  Shown to decrease mortality in hypertension and post-myocardial infarction

            Half-Life

            • Parent drug (acebutalol): 3-4 hr
            • Active metabolite (diacetolol): 8-13 hr
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            Images

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            Formulary

            FormularyPatient Discounts

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            The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

            Tier Description
            1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
            2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
            3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
            4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            NC NOT COVERED – Drugs that are not covered by the plan.
            Code Definition
            PA Prior Authorization
            Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
            QL Quantity Limits
            Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
            ST Step Therapy
            Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
            OR Other Restrictions
            Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
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