Acebutolol

Administration

• Type: Beta blocker
• Dosage Forms: Cap: 200mg, 400mg
• Routes of Administration: Oral
• Common Trade Names: Sectral

Adult Dosing

Hypertension

• 400-800 mg PO bid
  • Max: 1200 mg/day (800mg in elderly pts)

Ventricular arrhythmia

• 300-600 mg PO bid
  • Max: 1200 mg/day (800mg in elderly pts)

Pediatric Dosing

Safety/efficacy not established in pediatric patients

Special Populations

• Pregnancy Rating: Possible risk of intrauterine growth restriction
• Lactation risk: Avoid during breastfeeding

Renal Dosing

• Adult:
  • CrCl 25-50: Decrease dose 50%
  • CrCl <25: Decrease dose 75%
  • HD/PD: No supplement
• Pediatric: Not defined

Hepatic Dosing

• Adult: Caution advised
• Pediatric: Not defined

Contraindications

• Allergy to class/drug
• Sinus bradycardia
• 2nd or 3rd degree AV block
• Heart failure, uncompensated
• Cardiogenic shock
• Sick sinus syndrome w/o pacemaker
• Breastfeeding
• Avoid abrupt withdrawal

Adverse Reactions

Serious

• CHF
• Bradycardia, severe
• Heart block
• Angina, MI if abrupt discontinuation
• Ventricular arrhythmia if abrupt discontinuation
• Raynaud phenomenon
• Bronchospasm
• Lupus erythematosus

Common

• Fatigue, Dizziness, Headache
• Constipation, Diarrhea
• Dyspepsia
• Nausea
• Dyspnea
• Insomnia
• Urinary frequency
• Chest pain
• Edema
• Abnormal dreams
• Rash
• Arthralgia/Myalgia
• Visual disturbance

Pharmacology

• Half-life: 3-4 hours (8-13h diacetolol)
• Metabolism: Liver; Production of active metabolite (diacetolol)
• Excretion: Bile/feces/gut wall 50-60%; Urine 30-40% (12-29% unchanged)

Mechanism of Action

• Selectively antagonizes beta-1 adrenergic receptors
• Class II antiarrhythmic

References

• Acebutolol hydrochloride [prescribing information]. Bridgewater, NJ: Amneal Pharmaceuticals; January 2016
• Al-Khatib SM, Stevenson WG, Ackerman MJ, et al. 2017 AHA/ACC/HRS guideline for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society [published online ahead of print October 30, 2017]. Circulation. 2017. doi: 10.1161/CIR.0000000000000549. [PubMed 29084731]
• American College of Obstetricians and Gynecologists (ACOG), Committee on Obstetric Practice. Committee Opinion No. 623: emergent therapy for acute-onset, severe hypertension during pregnancy and the postpartum period. Obstet Gynecol. 2015;125(2):521-525. [PubMed 25611642]