Pindolol
Skeletal formula of pindolol
Space-filling model of the pindolol molecule
Clinical data
Trade namesVisken, others[1]
AHFS/Drugs.comMonograph
MedlinePlusa684032
Pregnancy
category
  • AU: C
Routes of
administration		By mouth, intravenous
ATC code
Legal status
Legal status
  • In general: ℞ (Prescription only)
Pharmacokinetic data
Bioavailability50% to 95%
MetabolismHepatic
Elimination half-life3–4 hours
ExcretionRenal
Identifiers
  • (RS)-1-(1H-indol-4-yloxy)-3-(isopropylamino)propan-2-ol
CAS Number
PubChem CID
IUPHAR/BPS
DrugBank
ChemSpider
UNII
KEGG
ChEBI
ChEMBL
CompTox Dashboard (EPA)
ECHA InfoCard100.033.501
Chemical and physical data
FormulaC14H20N2O2
Molar mass248.326 g·mol−1
3D model (JSmol)
ChiralityRacemic mixture
  • CC(C)NCC(O)COc2cccc1[nH]ccc12
  • InChI=1S/C14H20N2O2/c1-10(2)16-8-11(17)9-18-14-5-3-4-13-12(14)6-7-15-13/h3-7,10-11,15-17H,8-9H2,1-2H3 ☒N
  • Key:JZQKKSLKJUAGIC-UHFFFAOYSA-N ☒N
 ☒NcheckY (what is this?)  (verify)

Pindolol, sold under the brand name Visken among others, is a nonselective beta blocker which is used in the treatment of hypertension.[1][2] It is also an antagonist of the serotonin 5-HT1A receptor, preferentially blocking inhibitory 5-HT1A autoreceptors, and has been researched as an add-on therapy to various antidepressants, such as clomipramine and the selective serotonin reuptake inhibitors (SSRIs), in the treatment of depression[3][4][5] and obsessive-compulsive disorder.[6][7]

Medical uses

Pindolol is used for hypertension in the United States, Canada, and Europe, and also for angina pectoris outside the United States.[2] When used alone for hypertension, pindolol can significantly lower blood pressure and heart rate, but the evidence base for its use is weak as the number of subjects in published studies is small.[2] In some countries, pindolol is also used for arrhythmias and prophylaxis of acute stress reactions.

Contraindications

Similar to propranolol with an extra contraindication for hyperthyroidism. In patients with thyrotoxicosis, possible deleterious effects from long-term use of pindolol have not been adequately appraised. Beta-blockade may mask the clinical signs of continuing hyperthyroidism or complications, and give a false impression of improvement. Therefore, abrupt withdrawal of pindolol may be followed by an exacerbation of the symptoms of hyperthyroidism, including thyroid storm.[8]

Pindolol has intrinsic sympathomimetic activity and is therefore used with caution in angina pectoris.[8]

Pharmacology

Pharmacodynamics

Pindolol[9]
SiteKi (nM)SpeciesRef
5-HT1A15–81Human[10][11][12]
5-HT1B4,100
34–151		Human
Rodent		[11]
[9][13]
5-HT1D4,900Human[11]
5-HT1E>10,000Human[14]
5-HT1F>10,000Human[15]
5-HT2A9,333Human[16]
5-HT2B2,188Human[16]
5-HT2C>10,000Human[16]
5-HT3≥6,610Multiple[17][18][19]
5-HT5B>1,000Rat[20]
5-HT6>10,000 (–)Mouse[21]
5-HT7>10,000Human[22][23]
α17,585Pigeon[17]
α2NDNDND
β10.52–2.6Human[12][24]
β20.40–4.8Human[12][24]
β344Human[24]
D2-like>10,000Rat[25]
  D2>10,000Pigeon[17]
  D3>10,000Pigeon[17]
Values are Ki (nM), unless otherwise noted. The smaller the value, the more strongly the drug binds to the site.

Pindolol is a first generation,[26] non-selective beta blocker in the class of β-adrenergic receptor antagonists. On the receptor level it is a competitive partial agonist. It possesses intrinsic sympathomimetic activity, meaning it has some degree of agonist effects in the absence of competing ligands. Pindolol shows membrane-stabilizing effects like quinidine, possibly accounting for its antiarrhythmic effects. It also acts as a serotonin 5-HT1A receptor partial agonist (intrinsic activity = 20–25%) or functional antagonist.[27]

Pharmacokinetics

Pindolol is rapidly and well absorbed from the GI tract. It undergoes some first-pass-metabolization leading to an oral bioavailability of 50-95%. Patients with uremia may have a reduced bioavailability. Food does not alter the bioavailability, but may increase the resorption. Following an oral single dose of 20 mg peak plasma concentrations are reached within 1–2 hours. The effect of pindolol on pulse rate (lowering) is evident after 3 hours. Despite the rather short halflife of 3–4 hours, hemodynamic effects persist for 24 hours after administration. Plasma halflives are increased to 3–11.5 hours in patients with renal impairment, to 7–15 hours in elderly patients, and from 2.5 to 30 hours in patients with liver cirrhosis. Approximately 2/3 of pindolol is metabolized in the liver giving hydroxylates, which are found in the urine as gluconurides and ethereal sulfates. The remaining 1/3 of pindolol is excreted in urine in unchanged form.

History

Pindolol was patented by Sandoz in 1969 and was launched in the US in 1977.[28] Towards end of February 2020 FDA added this product to their "DRUG SHORTAGE" list stating this is due to "Shortage of an active ingredient" and this is likely to be related to Coronavirus outbreak and related supply chain impacts.

Research

Depression

Pindolol has been investigated as an add-on drug to antidepressant therapy with SSRIs like fluoxetine in the treatment of depression since 1994.[29][5] The rationale behind this strategy has its basis in the fact that pindolol is an antagonist of the serotonin 5-HT1A receptor.[4] Presynaptic and somatodendritic 5-HT1A receptors act as inhibitory autoreceptors, inhibit serotonin release, and are pro-depressive in their action.[4] This is in contrast to postsynaptic 5-HT1A receptors, which mediate antidepressant effects.[4] By blocking 5-HT1A autoreceptors at doses that are selective for them over postsynaptic 5-HT1A receptors, pindolol may be able to disinhibit serotonin release and thereby improve the antidepressant effects of SSRIs.[4] The results of augmentation therapy with pindolol have been encouraging in early studies of low quality.[3] A 2015 systematic review and meta-analysis of five randomized controlled trials found no overall significant benefit at 2.5 mg although, with regard to patients with SSRI-resistant depression, "once-daily high-dose pindolol (7.5 mg qd) appears to show a promising benefit in these patients".[5] On the other hand, a 2017 systematic review indicated that pindolol's efficacy has been demonstrated in high evidence studies.[30] Initiating pharmacotherapy with an SSRI plus pindolol might accelerate the SSRI's therapeutic impact.[4][30] Pindolol's antidepressive efficacy may predominantly result from its ability to desensitize 5-HT1A autoreceptors.[31]

Others

  • Pindolol is a potent scavenger of nitric oxide. This effect is potentiated by sodium bicarbonate. Inhibition of nitric oxide synthesis has an anxiolytic effect in animals.[32]
  • Augmentation therapy of premature ejaculation: According to a recent study, pindolol can be effectively added to a standard anti-premature-ejaculation therapy, which usually consists of daily doses of an SSRI antidepressant such as fluoxetine or paroxetine. Augmentation of pindolol results in substantial increase of ejaculatory latency, even in those who previously did not experience in an improvement with the SSRI monotherapy.[33]

See also

References

  1. 1 2 Drugs.com International brand names for pindolol Archived 2017-10-01 at the Wayback Machine Page accessed Sept 4, 2015
  2. 1 2 3 Wong GW, Boyda HN, Wright JM (November 2014). "Blood pressure lowering efficacy of partial agonist beta blocker monotherapy for primary hypertension". The Cochrane Database of Systematic Reviews. 2014 (11): CD007450. doi:10.1002/14651858.CD007450.pub2. PMC 6486122. PMID 25427719.
  3. 1 2 Blier P, Bergeron R (1998). "The use of pindolol to potentiate antidepressant medication". The Journal of Clinical Psychiatry. 59 (Suppl 5): 16–23, discussion 24–5. PMID 9635544.
  4. 1 2 3 4 5 6 Celada P, Bortolozzi A, Artigas F (September 2013). "Serotonin 5-HT1A receptors as targets for agents to treat psychiatric disorders: rationale and current status of research". CNS Drugs. 27 (9): 703–716. doi:10.1007/s40263-013-0071-0. PMID 23757185. S2CID 31931009.
  5. 1 2 3 Liu Y, Zhou X, Zhu D, Chen J, Qin B, Zhang Y, et al. (May 2015). "Is pindolol augmentation effective in depressed patients resistant to selective serotonin reuptake inhibitors? A systematic review and meta-analysis". Human Psychopharmacology. 30 (3): 132–142. doi:10.1002/hup.2465. PMID 25689398. S2CID 205925716.
  6. ↑ Mundo, Emanuela, Emanuela Guglielmo, and Laura Bellodi. "Effect of adjuvant pindolol on the antiobsessional response to fluvoxamine: a double blind, placedo-controlled study." International clinical psychopharmacology 13, no. 5 (1998): 219-224.
  7. ↑ Sassano-Higgins, S.A. and Pato, M.T., 2015. Pindolol augmentation of selective serotonin reuptake inhibitors and clomipramine for the treatment of obsessive-compulsive disorder: A meta-analysis. Journal of Pharmacology and Pharmacotherapeutics, 6(1), pp.36-38.
  8. 1 2 "RxMed: Pharmaceutical Information - VISKEN". Archived from the original on 2011-09-27. Retrieved 2010-08-15.
  9. 1 2 Roth BL, Driscol J. "PDSP Ki Database". Psychoactive Drug Screening Program (PDSP). University of North Carolina at Chapel Hill and the United States National Institute of Mental Health. Retrieved 14 August 2017.
  10. ↑ Hamon M, Lanfumey L, el Mestikawy S, Boni C, Miquel MC, Bolaños F, et al. (1990). "The main features of central 5-HT1 receptors". Neuropsychopharmacology. 3 (5–6): 349–360. PMID 2078271.
  11. 1 2 3 Weinshank RL, Zgombick JM, Macchi MJ, Branchek TA, Hartig PR (April 1992). "Human serotonin 1D receptor is encoded by a subfamily of two distinct genes: 5-HT1D alpha and 5-HT1D beta". Proceedings of the National Academy of Sciences of the United States of America. 89 (8): 3630–3634. Bibcode:1992PNAS...89.3630W. doi:10.1073/pnas.89.8.3630. PMC 48922. PMID 1565658.
  12. 1 2 3 Krushinski JH, Schaus JM, Thompson DC, Calligaro DO, Nelson DL, Luecke SH, et al. (October 2007). "Indoloxypropanolamine analogues as 5-HT(1A) receptor antagonists". Bioorganic & Medicinal Chemistry Letters. 17 (20): 5600–5604. doi:10.1016/j.bmcl.2007.07.086. PMID 17804228.
  13. ↑ Boess FG, Martin IL (1994). "Molecular biology of 5-HT receptors". Neuropharmacology. 33 (3–4): 275–317. doi:10.1016/0028-3908(94)90059-0. PMID 7984267. S2CID 35553281.
  14. ↑ Zgombick JM, Schechter LE, Macchi M, Hartig PR, Branchek TA, Weinshank RL (August 1992). "Human gene S31 encodes the pharmacologically defined serotonin 5-hydroxytryptamine1E receptor". Molecular Pharmacology. 42 (2): 180–185. PMID 1513320.
  15. ↑ Adham N, Kao HT, Schecter LE, Bard J, Olsen M, Urquhart D, et al. (January 1993). "Cloning of another human serotonin receptor (5-HT1F): a fifth 5-HT1 receptor subtype coupled to the inhibition of adenylate cyclase". Proceedings of the National Academy of Sciences of the United States of America. 90 (2): 408–412. Bibcode:1993PNAS...90..408A. doi:10.1073/pnas.90.2.408. PMC 45671. PMID 8380639.
  16. 1 2 3 Knight AR, Misra A, Quirk K, Benwell K, Revell D, Kennett G, Bickerdike M (August 2004). "Pharmacological characterisation of the agonist radioligand binding site of 5-HT(2A), 5-HT(2B) and 5-HT(2C) receptors". Naunyn-Schmiedeberg's Archives of Pharmacology. 370 (2): 114–123. doi:10.1007/s00210-004-0951-4. PMID 15322733. S2CID 8938111.
  17. 1 2 3 4 Mos J, Van Hest A, Van Drimmelen M, Herremans AH, Olivier B (May 1997). "The putative 5-HT1A receptor antagonist DU125530 blocks the discriminative stimulus of the 5-HT1A receptor agonist flesinoxan in pigeons". European Journal of Pharmacology. 325 (2–3): 145–153. doi:10.1016/s0014-2999(97)00131-3. PMID 9163561.
  18. ↑ Neijt HC, Karpf A, Schoeffter P, Engel G, Hoyer D (May 1988). "Characterisation of 5-HT3 recognition sites in membranes of NG 108-15 neuroblastoma-glioma cells with [3H]ICS 205-930". Naunyn-Schmiedeberg's Archives of Pharmacology. 337 (5): 493–499. doi:10.1007/bf00182721. PMID 3412489. S2CID 1594844.
  19. ↑ Hoyer D, Neijt HC (March 1988). "Identification of serotonin 5-HT3 recognition sites in membranes of N1E-115 neuroblastoma cells by radioligand binding". Molecular Pharmacology. 33 (3): 303–309. PMID 3352595.
  20. ↑ Wisden W, Parker EM, Mahle CD, Grisel DA, Nowak HP, Yocca FD, et al. (October 1993). "Cloning and characterization of the rat 5-HT5B receptor. Evidence that the 5-HT5B receptor couples to a G protein in mammalian cell membranes". FEBS Letters. 333 (1–2): 25–31. doi:10.1016/0014-5793(93)80368-5. PMID 8224165.
  21. ↑ Plassat JL, Amlaiky N, Hen R (August 1993). "Molecular cloning of a mammalian serotonin receptor that activates adenylate cyclase". Molecular Pharmacology. 44 (2): 229–236. PMID 8394987.
  22. ↑ Bard JA, Zgombick J, Adham N, Vaysse P, Branchek TA, Weinshank RL (November 1993). "Cloning of a novel human serotonin receptor (5-HT7) positively linked to adenylate cyclase". The Journal of Biological Chemistry. 268 (31): 23422–23426. doi:10.1016/S0021-9258(19)49479-9. PMID 8226867.
  23. ↑ Jasper JR, Kosaka A, To ZP, Chang DJ, Eglen RM (September 1997). "Cloning, expression and pharmacology of a truncated splice variant of the human 5-HT7 receptor (h5-HT7b)". British Journal of Pharmacology. 122 (1): 126–132. doi:10.1038/sj.bjp.0701336. PMC 1564895. PMID 9298538.
  24. 1 2 3 Hoffmann C, Leitz MR, Oberdorf-Maass S, Lohse MJ, Klotz KN (February 2004). "Comparative pharmacology of human beta-adrenergic receptor subtypes--characterization of stably transfected receptors in CHO cells". Naunyn-Schmiedeberg's Archives of Pharmacology. 369 (2): 151–159. doi:10.1007/s00210-003-0860-y. PMID 14730417. S2CID 878491.
  25. ↑ Luedtke RR, Freeman RA, Boundy VA, Martin MW, Huang Y, Mach RH (December 2000). "Characterization of (125)I-IABN, a novel azabicyclononane benzamide selective for D2-like dopamine receptors". Synapse. 38 (4): 438–449. doi:10.1002/1098-2396(20001215)38:4<438::AID-SYN9>3.0.CO;2-5. PMID 11044891. S2CID 9578132.
  26. ↑ Wiysonge CS, Volmink J, Opie LH (2007). "Beta-blockers and the treatment of hypertension: it is time to move on". Cardiovascular Journal of Africa. 18 (6): 351–352. PMC 4170499. PMID 18092107.
  27. ↑ Artigas F, Adell A, Celada P (February 2006). "Pindolol augmentation of antidepressant response". Current Drug Targets. 7 (2): 139–147. doi:10.2174/138945006775515446. PMID 16475955.
  28. ↑ "Discovery and Development of Major Drugs. Chapter 2 in Pharmaceutical Innovation: Revolutionizing Human Health. Volume 2 of Chemical Heritage Foundation series in innovation and entrepreneurship. Eds Ralph Landau, Basil Achilladelis, Alexander Scriabine. Chemical Heritage Foundation, 1999. ISBN 9780941901215 p 185
  29. ↑ Pérez, V., Gilaberte, I., Faries, D., Alvarez, E. and Artigas, F., 1997. Randomised, double-blind, placebo-controlled trial of pindolol in combination with fluoxetine antidepressant treatment. The Lancet, 349(9065), pp.1594-1597.
  30. 1 2 Kleeblatt J, Betzler F, Kilarski LL, Bschor T, Köhler S (May 2017). "Efficacy of off-label augmentation in unipolar depression: A systematic review of the evidence". European Neuropsychopharmacology. 27 (5): 423–441. doi:10.1016/j.euroneuro.2017.03.003. PMID 28318897. S2CID 3740987.
  31. ↑ Haddjeri N, Blier P (September 2000). "Effects of sustained (+/-)pindolol administration on serotonin neurotransmission in rats". Journal of Psychiatry & Neuroscience. 25 (4): 378–388. PMC 1407726. PMID 11022403.
  32. ↑ Fernandes E, Gomes A, Costa D, Lima JL (September 2005). "Pindolol is a potent scavenger of reactive nitrogen species". Life Sciences. 77 (16): 1983–1992. doi:10.1016/j.lfs.2005.02.018. PMID 15916777.
  33. ↑ Safarinejad MR (February 2008). "Once-daily high-dose pindolol for paroxetine-refractory premature ejaculation: a double-blind, placebo-controlled and randomized study". Journal of Clinical Psychopharmacology. 28 (1): 39–44. doi:10.1097/jcp.0b013e31816073a5. PMID 18204339. S2CID 9936458.
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