Dosing & Uses
Dosage Forms & Strengths
tablet
- 20mg
Arterial Hypertension
Initial 10mg PO qDay (full effect after 4-6weeks)
Maintenance dose: 10-40mg PO qDay (full effect after 2 weeks)
No more than 80mg PO qDay
May admininster alone or in combination with other antihypertensive agents
Additional Information
Less effective than thiazide diuretics in black and geriatric patients
Shown to decrease mortality in hypertension and post-myocardial infarction
<18 years old: Safety and efficacy not established
Arterial hypertension
Initial 10mg PO qDay (full effect after 4-6weeks)
Maintenance dose: 10-40mg PO qDay (full effect after 2 weeks)
No more than 80mg PO qDay
May admininster alone or in combination with other antihypertensive agents
Interactions
Interaction Checker
No Results
Contraindicated
Serious - Use Alternative
Significant - Monitor Closely
Minor
Contraindicated (0)
Serious - Use Alternative (21)
- acebutolol
acebutolol and penbutolol both increase anti-hypertensive channel blocking. Avoid or Use Alternate Drug.
- atenolol
atenolol and penbutolol both increase anti-hypertensive channel blocking. Avoid or Use Alternate Drug.
- betaxolol
betaxolol and penbutolol both increase anti-hypertensive channel blocking. Avoid or Use Alternate Drug.
- bisoprolol
bisoprolol and penbutolol both increase anti-hypertensive channel blocking. Avoid or Use Alternate Drug.
- carvedilol
carvedilol and penbutolol both increase anti-hypertensive channel blocking. Avoid or Use Alternate Drug.
- celiprolol
celiprolol and penbutolol both increase anti-hypertensive channel blocking. Avoid or Use Alternate Drug.
- esmolol
esmolol and penbutolol both increase anti-hypertensive channel blocking. Avoid or Use Alternate Drug.
- fexinidazole
fexinidazole, penbutolol. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid coadministration of fexinidazole with drugs known to induce bradycardia. .
- iobenguane I 131
penbutolol will decrease the level or effect of iobenguane I 131 by Other (see comment). Avoid or Use Alternate Drug. Based on the mechanism of action of iobenguane, drugs that reduce catecholamine uptake or that deplete catecholamine stores may interfere with iobenguane uptake into cells, and thus, reduce iobenguane efficacy. Discontinue interfering drugs for at least 5 half-lives before administration of either the dosimetry or an iobenguane dose. Do not administer these drugs until at least 7 days after each iobenguane dose.
- labetalol
labetalol and penbutolol both increase anti-hypertensive channel blocking. Avoid or Use Alternate Drug.
- lofexidine
lofexidine, penbutolol. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid coadministration with other drugs that decrease pulse or blood pressure to mitigate risk of excessive bradycardia and hypotension.
- mavacamten
penbutolol, mavacamten. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Expect additive negative inotropic effects of mavacamten and other drugs that reduce cardiac contractility.
- metoprolol
metoprolol and penbutolol both increase anti-hypertensive channel blocking. Avoid or Use Alternate Drug.
- nadolol
nadolol and penbutolol both increase anti-hypertensive channel blocking. Avoid or Use Alternate Drug.
- nebivolol
nebivolol and penbutolol both increase anti-hypertensive channel blocking. Avoid or Use Alternate Drug.
- pindolol
penbutolol and pindolol both increase anti-hypertensive channel blocking. Avoid or Use Alternate Drug.
- propranolol
penbutolol and propranolol both increase anti-hypertensive channel blocking. Avoid or Use Alternate Drug.
- sotalol
penbutolol and sotalol both increase anti-hypertensive channel blocking. Avoid or Use Alternate Drug.
- timolol
penbutolol and timolol both increase anti-hypertensive channel blocking. Avoid or Use Alternate Drug.
- umeclidinium bromide/vilanterol inhaled
penbutolol, umeclidinium bromide/vilanterol inhaled. pharmacodynamic antagonism. Avoid or Use Alternate Drug. If a beta-blocker must be used in patients with COPD taking a beta-agonist, consider using a beta-blocker that is beta-1 selective .
- vilanterol/fluticasone furoate inhaled
penbutolol, vilanterol/fluticasone furoate inhaled. pharmacodynamic antagonism. Avoid or Use Alternate Drug. If a beta-blocker must be used in patients with COPD taking a beta-agonist, consider using a beta-blocker that is beta-1 selective .
Monitor Closely (172)
- acebutolol
acebutolol and penbutolol both increase serum potassium. Use Caution/Monitor.
- aceclofenac
penbutolol and aceclofenac both increase serum potassium. Use Caution/Monitor.
aceclofenac decreases effects of penbutolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis. - acemetacin
penbutolol and acemetacin both increase serum potassium. Use Caution/Monitor.
acemetacin decreases effects of penbutolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis. - albuterol
penbutolol increases and albuterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
penbutolol decreases effects of albuterol by pharmacodynamic antagonism. Use Caution/Monitor. - aldesleukin
aldesleukin increases effects of penbutolol by pharmacodynamic synergism. Use Caution/Monitor. Risk of hypotension.
- alfuzosin
alfuzosin and penbutolol both increase anti-hypertensive channel blocking. Modify Therapy/Monitor Closely.
- aluminum hydroxide
aluminum hydroxide decreases levels of penbutolol by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.
- amifostine
amifostine, penbutolol. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration with blood pressure lowering agents may increase the risk and severity of hypotension associated with amifostine. When amifostine is used at chemotherapeutic doses, withhold blood pressure lowering medications for 24 hr prior to amifostine; if blood pressure lowering medication cannot be withheld, do not administer amifostine.
- amiloride
penbutolol and amiloride both increase serum potassium. Modify Therapy/Monitor Closely.
- amiodarone
amiodarone, penbutolol. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Risk of cardiotoxicity with bradycardia.
- amlodipine
penbutolol and amlodipine both increase anti-hypertensive channel blocking. Modify Therapy/Monitor Closely.
- amobarbital
amobarbital decreases levels of penbutolol by increasing metabolism. Use Caution/Monitor. Consider a higher beta-blocker dose during coadministration of amobarbital. Atenolol, sotalol, nadolol less likely to be affected than other beta blockers.
- arformoterol
penbutolol increases and arformoterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
penbutolol decreases effects of arformoterol by pharmacodynamic antagonism. Use Caution/Monitor. - asenapine
asenapine and penbutolol both increase anti-hypertensive channel blocking. Modify Therapy/Monitor Closely.
- aspirin
penbutolol and aspirin both increase serum potassium. Use Caution/Monitor.
aspirin decreases effects of penbutolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis. - aspirin rectal
penbutolol and aspirin rectal both increase serum potassium. Use Caution/Monitor.
aspirin rectal decreases effects of penbutolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis. - aspirin/citric acid/sodium bicarbonate
aspirin/citric acid/sodium bicarbonate decreases effects of penbutolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.
penbutolol and aspirin/citric acid/sodium bicarbonate both increase serum potassium. Use Caution/Monitor. - atazanavir
atazanavir increases effects of penbutolol by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of hypotension, bradycardia, AV block, and prolonged PR interval. Consider lowering beta blocker dose.
- atenolol
atenolol and penbutolol both increase serum potassium. Use Caution/Monitor.
- avanafil
avanafil increases effects of penbutolol by pharmacodynamic synergism. Use Caution/Monitor. Risk of hypotension.
- bendroflumethiazide
penbutolol increases and bendroflumethiazide decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- betaxolol
betaxolol and penbutolol both increase serum potassium. Use Caution/Monitor.
- bismuth subsalicylate
bismuth subsalicylate, penbutolol. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Blockage of renal prostaglandin synthesis; may cause severe hypertension.
- bisoprolol
bisoprolol and penbutolol both increase serum potassium. Use Caution/Monitor.
- bretylium
penbutolol, bretylium. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Each drug may cause hypotension.
- bumetanide
penbutolol increases and bumetanide decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- butabarbital
butabarbital decreases levels of penbutolol by increasing metabolism. Use Caution/Monitor. Consider a higher beta-blocker dose during coadministration of butabarbital. Atenolol, sotalol, nadolol less likely to be affected than other beta blockers.
- butalbital
butalbital decreases levels of penbutolol by increasing metabolism. Use Caution/Monitor. Consider a higher beta-blocker dose during coadministration of butalbital. Atenolol, sotalol, nadolol less likely to be affected than other beta blockers.
- calcium acetate
calcium acetate decreases effects of penbutolol by unspecified interaction mechanism. Use Caution/Monitor.
- calcium carbonate
calcium carbonate decreases effects of penbutolol by unspecified interaction mechanism. Use Caution/Monitor.
calcium carbonate decreases levels of penbutolol by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours. - calcium chloride
calcium chloride decreases effects of penbutolol by unspecified interaction mechanism. Use Caution/Monitor.
- calcium citrate
calcium citrate decreases effects of penbutolol by unspecified interaction mechanism. Use Caution/Monitor.
- calcium gluconate
calcium gluconate decreases effects of penbutolol by unspecified interaction mechanism. Use Caution/Monitor.
- candesartan
candesartan and penbutolol both increase serum potassium. Use Caution/Monitor.
penbutolol, candesartan. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Risk of fetal compromise if given during pregnancy. - carbenoxolone
penbutolol increases and carbenoxolone decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- carbidopa
carbidopa increases effects of penbutolol by pharmacodynamic synergism. Use Caution/Monitor. Therapy with carbidopa, given with or without levodopa or carbidopa-levodopa combination products, is started, dosage adjustment of the antihypertensive drug may be required.
- carvedilol
carvedilol and penbutolol both increase serum potassium. Use Caution/Monitor.
- celecoxib
penbutolol and celecoxib both increase serum potassium. Use Caution/Monitor.
celecoxib decreases effects of penbutolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis. - celiprolol
celiprolol and penbutolol both increase serum potassium. Use Caution/Monitor.
- chlorothiazide
penbutolol increases and chlorothiazide decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- chlorthalidone
penbutolol increases and chlorthalidone decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- choline magnesium trisalicylate
penbutolol and choline magnesium trisalicylate both increase serum potassium. Use Caution/Monitor.
choline magnesium trisalicylate decreases effects of penbutolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis. - clevidipine
penbutolol and clevidipine both increase anti-hypertensive channel blocking. Modify Therapy/Monitor Closely.
- clonidine
penbutolol, clonidine. Mechanism: pharmacodynamic synergism. Modify Therapy/Monitor Closely. Selective beta blocker administration during withdrawal from centrally acting alpha agonists may result in rebound hypertension.
- cyclopenthiazide
penbutolol increases and cyclopenthiazide decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- dasiglucagon
penbutolol decreases effects of dasiglucagon by unknown mechanism. Use Caution/Monitor. Dasiglucagon may stimulate catecholamine release; whereas beta blockers may inhibit catecholamines released in response to dasiglucagon. Coadministration may also transiently increase pulse and BP.
- desflurane
desflurane, penbutolol. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Risk of hypotension.
- diclofenac
penbutolol and diclofenac both increase serum potassium. Use Caution/Monitor.
diclofenac decreases effects of penbutolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis. - diflunisal
penbutolol and diflunisal both increase serum potassium. Use Caution/Monitor.
diflunisal decreases effects of penbutolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis. - digoxin
penbutolol and digoxin both increase serum potassium. Use Caution/Monitor.
penbutolol increases effects of digoxin by pharmacodynamic synergism. Use Caution/Monitor. Enhanced bradycardia. - diltiazem
penbutolol and diltiazem both increase anti-hypertensive channel blocking. Modify Therapy/Monitor Closely.
- dobutamine
penbutolol increases and dobutamine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
penbutolol decreases effects of dobutamine by pharmacodynamic antagonism. Use Caution/Monitor. - dopexamine
penbutolol increases and dopexamine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
penbutolol decreases effects of dopexamine by pharmacodynamic antagonism. Use Caution/Monitor. - doxazosin
doxazosin and penbutolol both increase anti-hypertensive channel blocking. Modify Therapy/Monitor Closely.
- drospirenone
penbutolol and drospirenone both increase serum potassium. Modify Therapy/Monitor Closely.
- ephedrine
penbutolol increases and ephedrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
penbutolol decreases effects of ephedrine by pharmacodynamic antagonism. Use Caution/Monitor. - epinephrine
penbutolol increases and epinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
penbutolol decreases effects of epinephrine by pharmacodynamic antagonism. Use Caution/Monitor. - epinephrine inhaled
penbutolol decreases effects of epinephrine inhaled by pharmacodynamic antagonism. Use Caution/Monitor. Beta2-adrenergic blockers may may inhibit bronchodilatory effects of epinephrine.
- epinephrine racemic
penbutolol increases and epinephrine racemic decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
penbutolol decreases effects of epinephrine racemic by pharmacodynamic antagonism. Use Caution/Monitor. - eprosartan
eprosartan and penbutolol both increase serum potassium. Use Caution/Monitor.
penbutolol, eprosartan. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Risk of fetal compromise if given during pregnancy. - esmolol
esmolol and penbutolol both increase serum potassium. Use Caution/Monitor.
- ethacrynic acid
penbutolol increases and ethacrynic acid decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- ether
penbutolol, ether. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Both beta blockers and ether depress the myocardium; consider lowering beta blocker dose if ether used for anesthesia.
- etodolac
penbutolol and etodolac both increase serum potassium. Use Caution/Monitor.
etodolac decreases effects of penbutolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis. - etomidate
etomidate, penbutolol. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Risk of hypotension.
- felodipine
penbutolol and felodipine both increase anti-hypertensive channel blocking. Modify Therapy/Monitor Closely.
- fenbufen
penbutolol and fenbufen both increase serum potassium. Use Caution/Monitor.
- fenoprofen
penbutolol and fenoprofen both increase serum potassium. Use Caution/Monitor.
fenoprofen decreases effects of penbutolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis. - fingolimod
penbutolol increases effects of fingolimod by pharmacodynamic synergism. Use Caution/Monitor. Both medications decrease heart rate. Monitor patients on concomitant therapy, particularly in the first 6 hours after fingolimod is initiated or after a treatment interruption of at least two weeks, for bradycardia and atrioventricular block. To identify underlying risk factors of bradycardia and AV block, obtain a new or recent ECG in patients using beta-blockers prior to starting fingolimod.
- flurbiprofen
penbutolol and flurbiprofen both increase serum potassium. Use Caution/Monitor.
flurbiprofen decreases effects of penbutolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis. - formoterol
penbutolol increases and formoterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
penbutolol decreases effects of formoterol by pharmacodynamic antagonism. Use Caution/Monitor. - furosemide
penbutolol increases and furosemide decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- gentamicin
penbutolol increases and gentamicin decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- glucagon
glucagon decreases toxicity of penbutolol by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. Coadministration of glucagon with beta-blockers may have transiently increased pulse and blood pressure.
- glucagon intranasal
glucagon intranasal decreases toxicity of penbutolol by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. Coadministration of glucagon with beta-blockers may have transiently increased pulse and blood pressure.
- hydralazine
hydralazine increases effects of penbutolol by pharmacodynamic synergism. Use Caution/Monitor. Additive hypotensive effects.
- hydrochlorothiazide
penbutolol increases and hydrochlorothiazide decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- ibuprofen
penbutolol and ibuprofen both increase serum potassium. Use Caution/Monitor.
ibuprofen decreases effects of penbutolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis. - ibuprofen IV
ibuprofen IV decreases effects of penbutolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.
penbutolol and ibuprofen IV both increase serum potassium. Use Caution/Monitor. - indacaterol, inhaled
indacaterol, inhaled, penbutolol. Other (see comment). Use Caution/Monitor. Comment: Beta-blockers and indacaterol may interfere with the effect of each other when administered concurrently. Beta-blockers may produce severe bronchospasm in COPD patients. Therefore, patients with COPD should not normally be treated with beta-blockers. However, under certain circumstances, e.g. as prophylaxis after myocardial infarction, there may be no acceptable alternatives to the use of beta-blockers in patients with COPD. In this setting, cardioselective beta-blockers could be considered, although they should be administered with caution.
- indapamide
penbutolol increases and indapamide decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- indomethacin
penbutolol and indomethacin both increase serum potassium. Use Caution/Monitor.
indomethacin decreases effects of penbutolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis. - insulin degludec
penbutolol, insulin degludec. Other (see comment). Modify Therapy/Monitor Closely. Comment: Beta-blockers may either increase or decrease the blood glucose lowering effect of insulin; beta-blockers can prolong hypoglycemia (interference with glycogenolysis) or cause hyperglycemia (insulin secretion inhibited).
- insulin degludec/insulin aspart
penbutolol, insulin degludec/insulin aspart. Other (see comment). Modify Therapy/Monitor Closely. Comment: Beta-blockers may either increase or decrease the blood glucose lowering effect of insulin; beta-blockers can prolong hypoglycemia (interference with glycogenolysis) or cause hyperglycemia (insulin secretion inhibited).
- insulin inhaled
penbutolol, insulin inhaled. Other (see comment). Modify Therapy/Monitor Closely. Comment: Beta-blockers may either increase or decrease the blood glucose lowering effect of insulin; beta-blockers can prolong hypoglycemia (interference with glycogenolysis) or cause hyperglycemia (insulin secretion inhibited).
- irbesartan
irbesartan and penbutolol both increase serum potassium. Use Caution/Monitor.
penbutolol, irbesartan. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Risk of fetal compromise if given during pregnancy. - isoproterenol
penbutolol increases and isoproterenol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
penbutolol decreases effects of isoproterenol by pharmacodynamic antagonism. Use Caution/Monitor. - isradipine
penbutolol and isradipine both increase anti-hypertensive channel blocking. Modify Therapy/Monitor Closely.
- ivabradine
ivabradine, penbutolol. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Most patients receiving ivabradine will also be treated with a beta-blocker. The risk of bradycardia increases with coadministration of drugs that slow heart rate (eg, digoxin, amiodarone, beta-blockers). Monitor heart rate in patients taking ivabradine with other negative chronotropes.
- ketamine
ketamine, penbutolol. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Risk of hypotension.
- ketoprofen
penbutolol and ketoprofen both increase serum potassium. Use Caution/Monitor.
ketoprofen decreases effects of penbutolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis. - ketorolac
penbutolol and ketorolac both increase serum potassium. Use Caution/Monitor.
ketorolac decreases effects of penbutolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis. - ketorolac intranasal
penbutolol and ketorolac intranasal both increase serum potassium. Use Caution/Monitor.
ketorolac intranasal decreases effects of penbutolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis. - labetalol
labetalol and penbutolol both increase serum potassium. Use Caution/Monitor.
- lasmiditan
penbutolol increases effects of lasmiditan by pharmacodynamic synergism. Use Caution/Monitor. Lasmiditan has been associated with a lowering of heart rate (HR). In a drug interaction study, addition of a single 200-mg dose of lasmiditan to propranolol decreased HR by an additional 5 bpm compared to propranolol alone, for a mean maximum of 19 bpm.
- levalbuterol
penbutolol increases and levalbuterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
penbutolol decreases effects of levalbuterol by pharmacodynamic antagonism. Use Caution/Monitor. - levodopa
levodopa increases effects of penbutolol by pharmacodynamic synergism. Use Caution/Monitor. Consider decreasing dosage of antihypertensive agent.
- lornoxicam
penbutolol and lornoxicam both increase serum potassium. Use Caution/Monitor.
lornoxicam decreases effects of penbutolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis. - losartan
losartan and penbutolol both increase serum potassium. Use Caution/Monitor.
penbutolol, losartan. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Risk of fetal compromise if given during pregnancy. - lurasidone
lurasidone increases effects of penbutolol by Other (see comment). Use Caution/Monitor. Comment: Potential for increased risk of hypotension with concurrent use. Monitor blood pressure and adjust dose of antihypertensive agent as needed.
- maraviroc
maraviroc, penbutolol. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of orthostatic hypotension.
- meclofenamate
meclofenamate decreases effects of penbutolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.
penbutolol and meclofenamate both increase serum potassium. Use Caution/Monitor. - mefenamic acid
penbutolol and mefenamic acid both increase serum potassium. Use Caution/Monitor.
mefenamic acid decreases effects of penbutolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis. - mefloquine
mefloquine increases levels of penbutolol by decreasing metabolism. Use Caution/Monitor. Risk of arrhythmia.
- meloxicam
penbutolol and meloxicam both increase serum potassium. Use Caution/Monitor.
meloxicam decreases effects of penbutolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis. - metaproterenol
penbutolol increases and metaproterenol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
penbutolol decreases effects of metaproterenol by pharmacodynamic antagonism. Use Caution/Monitor. - methyclothiazide
penbutolol increases and methyclothiazide decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor. .
- methylphenidate
methylphenidate will decrease the level or effect of penbutolol by pharmacodynamic antagonism. Use Caution/Monitor. Methylphenidate may diminish antihypertensive effects. Monitor BP.
- metolazone
penbutolol increases and metolazone decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- metoprolol
metoprolol and penbutolol both increase serum potassium. Use Caution/Monitor.
- moxisylyte
moxisylyte and penbutolol both increase anti-hypertensive channel blocking. Modify Therapy/Monitor Closely.
- nabumetone
penbutolol and nabumetone both increase serum potassium. Use Caution/Monitor.
nabumetone decreases effects of penbutolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis. - nadolol
nadolol and penbutolol both increase serum potassium. Use Caution/Monitor.
- naproxen
penbutolol and naproxen both increase serum potassium. Use Caution/Monitor.
naproxen decreases effects of penbutolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis. - nebivolol
nebivolol and penbutolol both increase serum potassium. Use Caution/Monitor.
- nicardipine
penbutolol and nicardipine both increase anti-hypertensive channel blocking. Modify Therapy/Monitor Closely.
- nifedipine
penbutolol and nifedipine both increase anti-hypertensive channel blocking. Modify Therapy/Monitor Closely.
- nisoldipine
penbutolol and nisoldipine both increase anti-hypertensive channel blocking. Modify Therapy/Monitor Closely.
- nitroglycerin rectal
nitroglycerin rectal, penbutolol. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Beta-blockers blunt the reflex tachycardia produced by nitroglycerin without preventing its hypotensive effects. If beta-blockers are used with nitroglycerin in patients with angina pectoris, additional hypotensive effects may occur.
- norepinephrine
penbutolol increases and norepinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
penbutolol decreases effects of norepinephrine by pharmacodynamic antagonism. Use Caution/Monitor. - olmesartan
olmesartan and penbutolol both increase serum potassium. Use Caution/Monitor.
penbutolol, olmesartan. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Risk of fetal compromise if given during pregnancy. - olodaterol inhaled
penbutolol, olodaterol inhaled. Either decreases effects of the other by pharmacodynamic antagonism. Use Caution/Monitor. Beta-blockers and olodaterol may interfere with the effect of each other when administered concurrently. Beta-blockers may produce severe bronchospasm in COPD patients. Therefore, patients with COPD should not normally be treated with beta-blockers. However, under certain circumstances, e.g. as prophylaxis after myocardial infarction, there may be no acceptable alternatives to the use of beta-blockers in patients with COPD. In this setting, cardioselective beta-blockers could be considered, although they should be administered with caution.
- oxaprozin
penbutolol and oxaprozin both increase serum potassium. Use Caution/Monitor.
oxaprozin decreases effects of penbutolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis. - oxymetazoline intranasal
penbutolol increases effects of oxymetazoline intranasal by pharmacodynamic synergism. Use Caution/Monitor. When beta-2 receptors are antagonized by nonselective beta blockers, alpha1 vasoconstriction may be unopposed, thus increasing hypertensive effect. When oxymetazoline is combined with intranasal tetracaine for dental anesthesia, avoid or use an alternant anesthetic in patients taking nonselective beta blockers.
- oxymetazoline topical
oxymetazoline topical increases and penbutolol decreases sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- parecoxib
penbutolol and parecoxib both increase serum potassium. Use Caution/Monitor.
parecoxib decreases effects of penbutolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis. - pentobarbital
pentobarbital decreases levels of penbutolol by increasing metabolism. Use Caution/Monitor. Consider a higher beta-blocker dose during coadministration of pentobarbital. Atenolol, sotalol, nadolol less likely to be affected than other beta blockers.
- phenobarbital
phenobarbital decreases levels of penbutolol by increasing metabolism. Use Caution/Monitor. Consider a higher beta-blocker dose during coadministration of phenobarbital. Atenolol, sotalol, nadolol less likely to be affected than other beta blockers.
- phenoxybenzamine
phenoxybenzamine and penbutolol both increase anti-hypertensive channel blocking. Modify Therapy/Monitor Closely.
- phentolamine
phentolamine and penbutolol both increase anti-hypertensive channel blocking. Modify Therapy/Monitor Closely.
- pindolol
penbutolol and pindolol both increase serum potassium. Use Caution/Monitor.
- pirbuterol
penbutolol increases and pirbuterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
penbutolol decreases effects of pirbuterol by pharmacodynamic antagonism. Use Caution/Monitor. - piroxicam
penbutolol and piroxicam both increase serum potassium. Use Caution/Monitor.
piroxicam decreases effects of penbutolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis. - ponesimod
ponesimod and penbutolol both increase pharmacodynamic synergism. Use Caution/Monitor. Beta-blockers may have additive effects on lowering HR. Consider resting HR before initiating ponesimod in patients on stable dose of beta-blocker. Refer to the ponesimod prescribing information for more dosing information.
- potassium acid phosphate
penbutolol and potassium acid phosphate both increase serum potassium. Modify Therapy/Monitor Closely.
- potassium chloride
penbutolol and potassium chloride both increase serum potassium. Modify Therapy/Monitor Closely.
- potassium citrate
penbutolol and potassium citrate both increase serum potassium. Modify Therapy/Monitor Closely.
- prazosin
prazosin and penbutolol both increase anti-hypertensive channel blocking. Modify Therapy/Monitor Closely.
- primidone
primidone decreases levels of penbutolol by increasing metabolism. Use Caution/Monitor. Consider a higher beta-blocker dose during coadministration of primidone. Atenolol, sotalol, nadolol less likely to be affected than other beta blockers.
- propofol
propofol, penbutolol. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Risk of hypotension.
- propranolol
penbutolol and propranolol both increase serum potassium. Use Caution/Monitor.
- sacubitril/valsartan
sacubitril/valsartan and penbutolol both increase serum potassium. Use Caution/Monitor.
penbutolol, sacubitril/valsartan. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Risk of fetal compromise if given during pregnancy. - salicylates (non-asa)
penbutolol and salicylates (non-asa) both increase serum potassium. Use Caution/Monitor.
salicylates (non-asa) decreases effects of penbutolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis. - salmeterol
penbutolol increases and salmeterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
penbutolol decreases effects of salmeterol by pharmacodynamic antagonism. Use Caution/Monitor. - salsalate
penbutolol and salsalate both increase serum potassium. Use Caution/Monitor.
salsalate decreases effects of penbutolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis. - saquinavir
saquinavir, penbutolol. Either increases toxicity of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Use alternatives if available. Increased risk of PR prolongation and cardiac arrhythmias.
- secobarbital
secobarbital decreases levels of penbutolol by increasing metabolism. Use Caution/Monitor. Consider a higher beta-blocker dose during coadministration of secobarbital. Atenolol, sotalol, nadolol less likely to be affected than other beta blockers.
- sevoflurane
sevoflurane, penbutolol. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Risk of hypotension.
- sildenafil
penbutolol increases effects of sildenafil by additive vasodilation. Use Caution/Monitor. Sildenafil has systemic vasodilatory properties and may further lower blood pressure in patients taking antihypertensive medications. Monitor blood pressure response to sildenafil in patients receiving concurrent blood pressure lowering therapy.
- silodosin
silodosin and penbutolol both increase anti-hypertensive channel blocking. Modify Therapy/Monitor Closely.
- siponimod
siponimod, penbutolol. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Caution when siponimod is initiated in patients receiving beta-blocker treatment because of additive effects on lowering heart rate. Temporary interruption of beta-blocker may be needed before initiating siponimod. Beta-blocker treatment can be initiated in patients receiving stable doses of siponimod.
- sodium bicarbonate
sodium bicarbonate decreases levels of penbutolol by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.
- sodium citrate/citric acid
sodium citrate/citric acid decreases levels of penbutolol by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.
- sotalol
penbutolol and sotalol both increase serum potassium. Use Caution/Monitor.
- spironolactone
penbutolol and spironolactone both increase serum potassium. Modify Therapy/Monitor Closely.
- succinylcholine
penbutolol and succinylcholine both increase serum potassium. Use Caution/Monitor.
- sulfasalazine
penbutolol and sulfasalazine both increase serum potassium. Use Caution/Monitor.
sulfasalazine decreases effects of penbutolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis. - sulindac
penbutolol and sulindac both increase serum potassium. Use Caution/Monitor.
sulindac decreases effects of penbutolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis. - tadalafil
tadalafil increases effects of penbutolol by pharmacodynamic synergism. Use Caution/Monitor. Risk of hypotension.
- telmisartan
telmisartan and penbutolol both increase serum potassium. Use Caution/Monitor.
penbutolol, telmisartan. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Risk of fetal compromise if given during pregnancy. - terazosin
terazosin and penbutolol both increase anti-hypertensive channel blocking. Modify Therapy/Monitor Closely.
- terbutaline
penbutolol increases and terbutaline decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
penbutolol decreases effects of terbutaline by pharmacodynamic antagonism. Use Caution/Monitor. - theophylline
penbutolol, theophylline. Other (see comment). Use Caution/Monitor. Comment: Beta blockers (esp. non selective) antagonize theophylline effects, while at the same time increasing theophylline levels and toxicity (mechanism: decreased theophylline metabolism). Smoking increases risk of interaction.
- timolol
penbutolol and timolol both increase serum potassium. Use Caution/Monitor.
- tolfenamic acid
penbutolol and tolfenamic acid both increase serum potassium. Use Caution/Monitor.
tolfenamic acid decreases effects of penbutolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis. - tolmetin
penbutolol and tolmetin both increase serum potassium. Use Caution/Monitor.
tolmetin decreases effects of penbutolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis. - tolvaptan
penbutolol and tolvaptan both increase serum potassium. Use Caution/Monitor.
- torsemide
penbutolol increases and torsemide decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- triamterene
penbutolol and triamterene both increase serum potassium. Modify Therapy/Monitor Closely.
- valsartan
valsartan and penbutolol both increase serum potassium. Use Caution/Monitor.
penbutolol, valsartan. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Risk of fetal compromise if given during pregnancy. - verapamil
penbutolol and verapamil both increase anti-hypertensive channel blocking. Modify Therapy/Monitor Closely.
- xipamide
xipamide increases effects of penbutolol by pharmacodynamic synergism. Use Caution/Monitor.
Minor (28)
- adenosine
penbutolol, adenosine. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Bradycardia.
- agrimony
agrimony increases effects of penbutolol by pharmacodynamic synergism. Minor/Significance Unknown.
- brimonidine
brimonidine increases effects of penbutolol by pharmacodynamic synergism. Minor/Significance Unknown.
- cevimeline
cevimeline increases effects of penbutolol by unspecified interaction mechanism. Minor/Significance Unknown.
- ciprofloxacin
ciprofloxacin increases levels of penbutolol by decreasing metabolism. Minor/Significance Unknown.
- cocaine topical
penbutolol increases effects of cocaine topical by pharmacodynamic synergism. Minor/Significance Unknown. Risk of angina.
- cornsilk
cornsilk increases effects of penbutolol by pharmacodynamic synergism. Minor/Significance Unknown.
- dihydroergotamine
dihydroergotamine, penbutolol. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Additive vasospasm.
- dihydroergotamine intranasal
dihydroergotamine intranasal, penbutolol. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Additive vasospasm.
- dipyridamole
dipyridamole, penbutolol. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Risk of bradycardia.
- escitalopram
escitalopram increases levels of penbutolol by decreasing metabolism. Minor/Significance Unknown.
- fenoldopam
fenoldopam increases effects of penbutolol by pharmacodynamic synergism. Minor/Significance Unknown. Additive hypotensive effects.
- forskolin
forskolin increases effects of penbutolol by pharmacodynamic synergism. Minor/Significance Unknown.
- guanfacine
penbutolol, guanfacine. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Selective beta blocker administration during withdrawal from centrally acting alpha agonists may result in rebound hypertension.
- imaging agents (gadolinium)
penbutolol, imaging agents (gadolinium). Mechanism: unknown. Minor/Significance Unknown. Increased risk of anaphylaxis from contrast media.
- levobetaxolol
levobetaxolol increases effects of penbutolol by pharmacodynamic synergism. Minor/Significance Unknown.
- maitake
maitake increases effects of penbutolol by pharmacodynamic synergism. Minor/Significance Unknown.
- metipranolol ophthalmic
metipranolol ophthalmic increases effects of penbutolol by pharmacodynamic synergism. Minor/Significance Unknown.
- neostigmine
penbutolol, neostigmine. Either increases effects of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive bradycardia.
- noni juice
penbutolol and noni juice both increase serum potassium. Minor/Significance Unknown.
- octacosanol
octacosanol increases effects of penbutolol by pharmacodynamic synergism. Minor/Significance Unknown.
- physostigmine
penbutolol, physostigmine. Either increases effects of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive bradycardia.
- pilocarpine
pilocarpine increases effects of penbutolol by pharmacodynamic synergism. Minor/Significance Unknown.
- reishi
reishi increases effects of penbutolol by pharmacodynamic synergism. Minor/Significance Unknown.
- shepherd's purse
shepherd's purse, penbutolol. Other (see comment). Minor/Significance Unknown. Comment: Theoretically, shepherd's purse may interfere with BP control.
- tizanidine
tizanidine increases effects of penbutolol by pharmacodynamic synergism. Minor/Significance Unknown. Risk of hypotension.
- treprostinil
treprostinil increases effects of penbutolol by pharmacodynamic synergism. Minor/Significance Unknown.
- yohimbe
penbutolol decreases toxicity of yohimbe by pharmacodynamic antagonism. Minor/Significance Unknown.
Adverse Effects
Frequency Not Defined
Aggravate CHF
Depression
Fatigue
Mask symptoms of hypoglycemia
May increase triglyceride levels
Decrease HDL (less than other beta blockers)
Bronchospasm
Decreased exercise tolerance
Raynaud's phenomenon
May increase insulin resistance
Warnings
Contraindications
Severe peripheral vascular disease, sinus bradycardia, 2°/3° heart block, cardiogenic shock, hypersensitivity, asthma/COPD, sick sinus syndrome without permanent pacemaker
Cautions
IDDM, CHF, hyperthyroidism, renal impairment, liver disease
Sudden discontinuation can exacerbate angina and lead to myocardial infarction
Increased risk of stroke after surgery, cerebrovascular insufficiency, peripheral vascular disease, anesthesia/surgery (myocardial depression), use in pheochromocytoma
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
Pregnancy & Lactation
Pregnancy Category: C
Lactation: unknown; use with caution
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.Pharmacology
Mechanism of Action
Beta adrenergic receptor blocker; intrinsic sympathomimetic activity (lowers BP with little decrease in HR)
Pharmacokinetics
Half-Life: 5 hr
Peak Plasma: 2-3 hr
Duration: >20 hr
Peak effect: 1.3-3 hr
Protein bound: 80-98%
Metabolism: Liver (oxidation and conjugation)
Excretion: Urine
