Acebutolol (Oral)

Acebutolol is a drug that affects responses to impulses of the nerves in some body parts such as the heart. Below is detailed information about the drug.

Overview

The U.S. brand name of this drug is Sectral, and it is available as a tablet or capsule which is administered orally. It is a prescription-only medication commonly marketed in the form of capsules of 200mg and 400mg in bottles of 100 pills each. The 200mg capsules are opaque purple and orange while the larger ones are opaque brown and orange.

Acebutolol is available as generics which are apparently cheaper than the brand. The generic drugs are not necessarily presented in the same weight and form as the brand name.

It belongs to the drug classes of cardioselective beta blockers, intrinsic sympathomimetic and group II antiarrhythmics. It affects circulation (this refers to how blood flows through the arteries and veins) and the heart.

It works by blocking beta receptors found in the heart and blood vessels from being activated by certain hormones, such as adrenaline. When adrenaline does not activate the blood vessels and heart, they relax, which has the net effect of reducing heart rate and blood pressure. Acebutolol also reduces the heart's demand for oxygen.

Indications

Type of Drug

  • Beta-blocker

Side Effects

Acebutolol is a well-tolerated drug, and most adverse reactions that have been observed in patients are mild and do not warrant discontinuation of treatment. Most of the severe effects that have been seen subside as the therapy continues.

Here is a look at the adverse effects that are seen in patients given Acebutolol.

  • Fatigue is the most common complaint experienced by over 10% of people taking the drug.
  • 6% of patients experience dizziness. The same percentage also experience headaches.
  • 4% experience constipation. The same percentage also experience dyspnea, diarrhea, nausea, and dyspepsia.
  • Insomnia and flatulence are both experienced by 3% of patients taking acebutolol.
  • 2% of people on acebutolol experience the following conditions: abdominal pain, chest pain, edema, hypotension, impotence, heart failure, wheezing, vomiting, rhinitis, pruritus, pharyngitis, myalgia, dysuria, anxiety, hyper/hypoesthesia, nocturia, and bradycardia.
  • Less than 1% experience hepatotoxicity.
  • Depression, bronchospasm, Raynaud's phenomenon and decreased exercise tolerance are also experienced by patients taking acebutolol, but the percentages observed for this have not been adequately defined. Also not well established is the percentage of patients in which this drug increases insulin resistance and triglyceride levels, and decreases HDL levels.

A doctor should be immediately informed if any signs of allergic reaction to acebutolol occur while ingesting the drug. The following, as well, are not so often seen side effects but should be immediately reported to a healthcare professional.

  • Pain in the chest
  • Labored and difficult breathing
  • Shortness of breath
  • Wheezing
  • Tightness in the chest
  • Changes in vision
  • Swelling of the lower legs, feet, fingers or face

The following are signs of overdosing and emergency help should be sought immediately if they are experienced while taking acebutolol.

  • Anxiety
  • Blurred vision
  • Chills
  • Chest discomfort
  • Confusion
  • Coma
  • Cold sweats
  • Convulsions
  • Cough
  • Pale skin that is also cool
  • Depression
  • Urinating much less and losing control of bladder movements
  • Neck veins being dilated
  • Lightheadedness, faintness or dizziness when waking up from a sitting or a lying position suddenly.
  • Excessive fatigue and weakness
  • Headache
  • Experiencing unusual hunger
  • Breathing that is not regular and is troubled
  • Jerking movement of all extremities or muscle spasms
  • Nightmares
  • Nervousness
  • Nausea
  • Jaw, neck, back and shoulder pain
  • Pounding, slow, fast or irregular heartbeat
  • Shakiness
  • Slurred speech
  • Losing consciousness, especially when this happens suddenly.
  • Sweating
  • Weight gain

Some of the side effects of acebutolol do not constitute medical emergencies and do go away as the body continues to adjust to the medication. A healthcare professional should be able to advise on how to reduce or prevent such effects in case they become bothersome.

Dosage

Acebutolol is administered orally and is presented as a tablet or capsule.

All possible dosages prescribed for this drug are not listed here. The dosage, form, and frequency of taking the medication are determined by the following:

  • Age of the patient
  • The reason for the prescription
  • How the patient reacts to the first dose
  • The severity of the condition being treated
  • Other medical conditions that the patient may have

PEDRIATIC DOSAGES

Efficacy and safety of this drug for use for persons under 18 years of age has not been established. It should not be prescribed for such persons.

ADULTS DOSAGES

Dosage of hypertension

  • For adults who have mild to moderate hypertension, 400mg per day is adequate. This can be given once a day or as two doses to ensure hypertension control for the entire 24 hours of a day. This should be the initial dose.
  • The optimal maintenance dose is between 400 and 800mg per day. Some patients have been maintained on as little as 200mg per day, however.
  • Patients who have inadequately controlled hypertension or those with severe cases can have 600mg per day administered twice. This dose has proven to be adequate or the addition of a second hypertension drug. Selectivity of beta-1 diminishes as dose increases.

Dosage of Ventricular Arrhythmia

400mg daily administered as 200mg b.i.d. Dosage is usually gradually increased to an optimal level. The desired response often happens at 600mg to 1200mg per day. When treatment requires being discontinued, reduction of the drug is made gradually for about two weeks. Suddenly stopping treatment with this drug is not recommended.

Dosage of Angina

  • The recommended dose is 400 to 1200mg per day. It should be divided PO q12hr. 1200mg should not be exceeded per day.
  • Renal dose adjustments
  • CrCl is lower than 50mL/min, i.e., 25-49mL/min, reduce daily dose by 50%
  • CrCl lower than 25mL/min, reduce daily dose by 75%
  • Hepatic dose adjustment
  • No dose adjustments are necessary in such a case, but acebutolol should be used with caution.
  • Dialysis dose adjustment
  • No data is available for this.

GERIATRIC DOSAGES

In geriatric patients, the bioavailability of acebutolol has been found to increase almost twofold. Lower dosages should be given to elderly patients.

Hypertension

The initial dose should be 200 - 400mg per day PO. The dosage should not be increased to exceed 800mg per day.

Ventricular Arrhythmias

The initial dose should be 200 - 400mg per day PO. Similarly, this dose should not exceed 800mg per day.

Angina

200 - 400mg per day PO should be the initial dose. Again, do not exceed 800mg per day.

Missed Dose

If for some reason a dose of this medicine is missed, it should be taken as soon as possible. However, a double dose is to be avoided, and should never be chosen to make up for a missed dose. The missed treatment should not be considered if time to take the next one is less than 4 hours away. That would come very close to a double dose which can be harmful.

Interactions

DRUGS

A total of 5971 generic and brand name medications, comprising of 883 different drugs, are known to interact with acebutolol. 179 generic and brand names which include a total of 34 distinct drugs have significant interactions with acebutolol. 5057 generic and brand names, including 761 different drugs, interact moderately with acebutolol. 735 generic and brand names, 88 different medications, have minor interactions with acebutolol.

The drug interactions described above can be defined as follows:

  • Major drug interactions are highly clinically significant, and combinations of such drugs should be avoided. The risks of such drug combinations interacting far outweigh the benefits. Such two medicines should never be used together.
  • Moderate drug interactions are moderately clinically significant and only in exceptional circumstances should such drugs be used together. Priority should be given to seeking an alternative medicine.
  • Minor drug interactions are minimally clinically significant. Risk of such combinations should be accessed, and an alternative medication should be provided. The drugs can be used together if steps are taken to minimize interaction or a monitoring plan is instituted.

Here are some 18 drugs that should never be combined with acebutolol.

  • Atenolol
  • Betaxolol
  • Bisoprolol
  • Carvedilol
  • Celiprolol
  • Esmolol
  • Labetalol
  • Metoprolol
  • Nadolol
  • Nebivolol
  • Penbutolol
  • Pindolol
  • Propranolol
  • Saquinavir
  • Sotalol
  • Timolol
  • Umeclidinium bromide/vilanterol inhaled
  • Vilanterol/fluticasone furoate inhaled

FOOD/ALCOHOL/LIFESTYLE INTERACTIONS

Acebutolol has moderate interactions with the following:

  • Multivitamins with minerals. The vitamins that should mainly be checked when taking acebutolol include all vitamin B12, C, D2, and D3.
  • Ethanol
  • High cholesterol (Hypertriglyceridemia, Hyperlipoproteinemia, Sitosterolemia)

DISEASE INTERACTIONS

Acebutolol interacts with 19 diseases. These are the following:

Warnings

Some conditions are contraindicated for acebutolol. Where a patient presents any one of the following conditions, acebutolol should not be prescribed, or there should be a dose adjustment and careful monitoring done during the treatment.

  • Diabetes
  • Depression¬†Asthma, bronchitis, emphysema
  • A problem in the heart such as sick sinus syndrome, heart block, a heart rate that is slow, or congestive heart failure.
  • Low blood pressure
  • A thyroid disorder
  • Kidney or liver disease
  • Myasthenia gravis
  • Pheochromocytoma
  • Raynaud's syndrome or other circulation problems

Pregnancy

The drug is placed in US FDA pregnancy category B. It is not expected to harm a human fetus. However, this medication should be given with caution to pregnant women, and only if the benefits of using the drug far outweigh the risks.

Animal studies have failed to show any risk to the fetus when the drug is given, but there are no well-controlled and adequate studies in pregnant women. Animal studies have evidence of fetotoxicity and embryolethality at doses that also caused maternal toxicity.

Breastfeeding

Acebutolol passes into breast milk and can harm a nursing infant. Breastfeeding women should avoid it.

Other warnings

  • Therapy with this drug should not be interrupted without the advice of a physician. Suddenly discontinuing use of acebutolol is harmful and raises the risk of a heart attack. Sudden stopping of the drug could also worsen chest pain or cause thyroid problems that could be fatal.
  • Physical activity should be minimized when acebutolol is being discontinued.
  • Severe hypertensive reactions may be experienced from using alpha-adrenergic stimulants concomitantly. These are such as nasal decongestants which can be purchased over the counter.
  • A physician should be consulted immediately if a patient experiences unexplained respiratory symptoms or signs that suggest impending congestive heart failure.
  • Patients with diabetes should be warned of the likelihood of experiencing masked hypoglycemia.
  • The drug should not be taken by someone who has ever had an allergic reaction to it.
  • For geriatric cases, the drug is processed a lot more slowly than in other adults. Too much of this drug in the body of a senior could be toxic. If the drug is given to such patients, they should be started on a low dose.

Storage

  • The right temperature to store the drug is between 20 and 25 degrees centigrade.
  • Acebutolol should be stored away from light.
  • The drug should be kept away from areas where there are very high temperatures such as in the kitchen or boiler room.
  • It should also be stored away from damp, moist rooms such as in the bathroom.
  • The medicine should be kept out of pets and children's reach.
  • A pharmacist should advise on how to get rid of unused drugs.

REFILL

The prescription for this medication is refillable and the doctor prescribing it should authorize the correct number of refills.

TRAVEL

  • When traveling by air, a patient using this medicine should store it in a carry-on bag. It should never be put in a checked bag. A patient who is traveling should always have their medicine with them.
  • X-rays found at an airport do not harm acebutolol.
  • This medication should not be stored in a vehicle's glove compartment, especially when temperatures are either too high or too low. The extreme temperatures harm acebutolol. It should also not be left or carried around in the vehicle.

Summary

Acebutolol is a beta blocker which has been found to be useful for what it is purposed for. It can be prescribed for medical conditions including hypertension and angina, among others. It does, however, interact with a high number of diseases and medications. To remain safe while taking acebutolol, inform a healthcare practitioner of any issue a patient may have and anything they may be using.

Acebutolol is one of those drugs that interact with natural products, vitamins, and mineral supplements. Such products are considered harmless in any combination by most patients such that they do not even remember to tell their doctor they use them. A medical practitioner must be given be a complete list of such products that a patient may be taking so that they can access the risks versus benefits of prescribing acebutolol.

The patient must be careful to take the drug as prescribed. The risks involved in taking acebutolol irregularly or suddenly stopping can be severe. Overdosing also does pose a serious threat to health, while underdosing may not achieve the intended results.

Acebutolol does as well have a fair share of risks and warnings. Despite these concerns, a doctor may prescribe it, where the benefits outweigh the risks of using it.

A patient should discuss with their physician any concern they may have about this drug. A doctor should be informed if acebutolol is prescribed but symptoms do not improve, or they get worse than before. A successful outcome can only be reached with this drug if the advice of the healthcare professional is followed.

The preceding information on acebutolol is not conclusive as not all relevant information about the drug can be included. The facts outlined do not in any way endorse the medicine as safe, effective or recommended for treating a patient with any medical condition. Only a healthcare professional can assess the myriad factors involved in a patient's situation and determine the required intervention.

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Last Reviewed:
December 10, 2017
Last Updated:
April 04, 2018
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