Penbutolol

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Penbutolol
Clinical data
Trade namesLevatol
AHFS/Drugs.comConsumer Drug Information
MedlinePlusa601091
ATC code
Identifiers
  • (S)-1-(tert-butylamino)-3-(2-cyclopentylphenoxy)propan-2-ol
JSmol)
  • O[C@@H](CNC(C)(C)C)COc1ccccc1C2CCCC2
  • InChI=1S/C18H29NO2/c1-18(2,3)19-12-15(20)13-21-17-11-7-6-10-16(17)14-8-4-5-9-14/h6-7,10-11,14-15,19-20H,4-5,8-9,12-13H2,1-3H3/t15-/m0/s1 checkY
  • Key:KQXKVJAGOJTNJS-HNNXBMFYSA-N checkY
 ☒NcheckY (what is this?)  (verify)

Penbutolol (brand names Levatol, Levatolol, Lobeta, Paginol, Hostabloc, Betapressin) is a

beta-2 adrenergic receptors (the two subtypes), thus making it a non-selective β blocker.[2]: Table 10–2, p 252  Penbutolol is a sympathomimetic drug with properties allowing it to act as a partial agonist at β adrenergic receptors.[3]

It was approved by the FDA in 1987[4] and was withdrawn from the US market by January 2015.[5]

Medical uses

Penbutolol is used to treat mild to moderate

beta blockers it is not a first line treatment for this indication.[6]

It should not be used or only used with caution in people with heart failure and people with asthma. It may mask signs of low blood sugar in people with diabetes and it may mask signs of hyperthyroidism.[1]

Animal studies showed some signs of potential trouble for women who are pregnant, and it has not been tested in women who are pregnant. It is not known if penbutolol is secreted in breast milk.[1]

Side effects

Penbutolol has a low frequency of side effects.[1][7] These side effects include dizziness, light headedness, and nausea.[1][8]

Pharmacology

Pharmacodynamics

Penbutolol is able to bind to both beta-1 adrenergic receptors and

beta-2 adrenergic receptors (the two subtypes), thus making it a non-selective β blocker.[2]: Table 10–2, p 252  Penbutolol is a sympathomimetic drug with properties allowing it to act as a partial agonist at β adrenergic receptors.[3]

Blocking β adrenergic receptors decreases the heart rate and

arterial blood pressure. β blockers also decrease renin levels, which ultimately results in less water being reabsorbed by the kidneys and therefore a lower blood volume and blood pressure.[9]

Penbutolol acts on the β1 adrenergic receptors in both the heart and the kidney. When β1 receptors are activated by a catecholamine, they stimulate a coupled G protein which activates adenylyl to convert adenosine triphosphate (ATP) to cyclic adenosine monophosphate (cAMP). The increase in cAMP ultimately alters the movement of calcium ions in heart muscle and increases heart rate.[2]: 213–214  Penbutolol blocks this and decreases heart rate, which lowers blood pressure.[10]: 40 

The ability of penbutolol to act as a

angiotensin II. Angiotensin II stimulates the release of aldosterone from the adrenal gland, causing a decrease in electrolyte and water retention, ultimately increasing water excretion and decreasing blood volume and pressure.[11]
: 221 

Like

propanolol and pindolol, it is a serotonin 5-HT1A and 5-HT1B receptor antagonist;[12] this discovery by several groups in the 1980s generated excitement among those doing research on the serotonin system as such antagonists were rare at that time.[13]
: 111–14 

Pharmacokinetics

Penbutolol is rapidly absorbed from the gastrointestinal tract, has a

half life of five hours.[2]
: Table 10–2, p 252 

Society and culture

Availability

Penbutolol was approved by the FDA in 1987.[4] In January 2015 the FDA acknowledged that the penbutolol was no longer marketed in the US, and determined that the drug was not withdrawn for safety reasons.[5]

References

  1. ^ a b c d e f FDA Penbutolol label Last updated Dec 2010
  2. ^
    ISBN 9780071826419
  3. ^
    S2CID 12950442
    .
  4. ^ a b FDA History NDA 018976
  5. ^ a b FDA notice in the Federal Register. Jan 9, 2015 Determination That TAGAMET (Cimetidine) Tablets and Other Drug Products Were Not Withdrawn From Sale for Reasons of Safety or Effectiveness
  6. ^ NICE Hypertension guidance Last updated 2013
  7. PMID 2658525
    .
  8. ^
    S2CID 31794332
    .
  9. PMID 6123586
    .
  10. ISBN 9780387095523
  11. ISBN 9780781771559
  12. PMID 8093601
    .
  13. ISBN 9781597450805
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