penbutolol (Discontinued)

Brand and Other Names:Levatol
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Dosing & Uses

AdultPediatricGeriatric

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

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Interactions

Interaction Checker

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              Serious - Use Alternative (20)

              • 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.

              • 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 (29)

              • 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

                penbutolol increases effects of cocaine 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.

              • melatonin

                melatonin decreases toxicity of penbutolol by pharmacodynamic antagonism. Minor/Significance Unknown. Melatonin may correct beta blocker induced sleep disturbances.

              • 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.

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              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

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              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

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              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.

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              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

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              Images

              No images available for this drug.
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              Patient Handout

              A Patient Handout is not currently available for this monograph.
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              Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.