Penbutolol

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Penbutolol
Penbutolol Enantiomer Structural Formulae.png
Clinical data
Trade names Levatol
AHFS/Drugs.com Consumer Drug Information
MedlinePlus a601091
ATC code
Identifiers
  • (S)-1-(tert-butylamino)-3-(2-cyclopentylphenoxy)propan-2-ol
CAS Number
PubChem CID
IUPHAR/BPS
DrugBank
ChemSpider
UNII
KEGG
ChEMBL
CompTox Dashboard (EPA)
Chemical and physical data
Formula C18H29NO2
Molar mass 291.435 g·mol−1
3D model (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 Yes check.svgY
  • Key:KQXKVJAGOJTNJS-HNNXBMFYSA-N Yes check.svgY
 X mark.svgNYes check.svgY  (what is this?)    (verify)

Penbutolol (brand names Levatol, Levatolol, Lobeta, Paginol, Hostabloc, Betapressin) is a medication in the class of beta blockers, used in the treatment of high blood pressure. [1] 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]

Contents

It was approved by the FDA in 1987 [4] and was withdrawn from the US market by January 2015.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 high blood pressure. [1] Like other 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 cardiac output to lower 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 partial agonist proves useful in the prevention of bradycardia as a result of decreasing the heart rate excessively. [3] Penbutolol binding β1 adrenergic receptors also alters kidney functions. Under normal physiological conditions, the enzyme renin converts angiotensinogen to angiotensin I, which will then be converted to 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 bioavailability over 90%, [8] and has a rapid onset of effect. Penbutolol 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]

Related Research Articles

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Propranolol Beta blocker drug

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Adrenergic receptor Class of G protein-coupled receptors

The adrenergic receptors or adrenoceptors are a class of G protein-coupled receptors that are targets of many catecholamines like norepinephrine (noradrenaline) and epinephrine (adrenaline) produced by the body, but also many medications like beta blockers, beta-2 (β2) agonists and alpha-2 (α2) agonists, which are used to treat high blood pressure and asthma, for example.

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Pindolol Chemical compound

Pindolol, sold under the brand name Visken among others, is a nonselective beta blocker which is used in the treatment of hypertension. 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 selective serotonin reuptake inhibitors (SSRIs) in the treatment of depression.

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Bisoprolol Beta blocker medication

Bisoprolol, marketed under the tradename Concor among others, is a beta blocker medication most commonly used for heart diseases. This specifically includes high blood pressure, chest pain from not enough blood flow to the heart, and heart failure. It is taken by mouth.

Carvedilol Oral blood-pressure medication

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Fenoldopam Antihypertensive agent, also used in hypertensive crisis

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The alpha-2 (α2) adrenergic receptor is a G protein-coupled receptor (GPCR) associated with the Gi heterotrimeric G-protein. It consists of three highly homologous subtypes, including α2A-, α2B-, and α2C-adrenergic. Some species other than humans express a fourth α2D-adrenergic receptor as well. Catecholamines like norepinephrine (noradrenaline) and epinephrine (adrenaline) signal through the α2-adrenergic receptor in the central and peripheral nervous systems.

Nebivolol Chemical compound

Nebivolol is a beta blocker used to treat high blood pressure and heart failure. As with other β-blockers, it is generally a less preferred treatment for high blood pressure. It may be used by itself or with other blood pressure medication. It is taken by mouth.

Alpha-adrenergic agonist Class of drugs

Alpha-adrenergic agonists are a class of sympathomimetic agents that selectively stimulates alpha adrenergic receptors. The alpha-adrenergic receptor has two subclasses α1 and α2. Alpha 2 receptors are associated with sympatholytic properties. Alpha-adrenergic agonists have the opposite function of alpha blockers. Alpha adrenoreceptor ligands mimic the action of epinephrine and norepinephrine signaling in the heart, smooth muscle and central nervous system, with norepinephrine being the highest affinity. The activation of α1 stimulates the membrane bound enzyme phospholipase C, and activation of α2 inhibits the enzyme adenylate cyclase. Inactivation of adenylate cyclase in turn leads to the inactivation of the secondary messenger cyclic adenosine monophosphate and induces smooth muscle and blood vessel constriction.

Adrenergic antagonist

An adrenergic antagonist is a drug that inhibits the function of adrenergic receptors. There are five adrenergic receptors, which are divided into two groups. The first group of receptors are the beta (β) adrenergic receptors. There are β1, β2, and β3 receptors. The second group contains the alpha (α) adrenoreceptors. There are only α1 and α2 receptors. Adrenergic receptors are located near the heart, kidneys, lungs, and gastrointestinal tract. There are also α-adreno receptors that are located on vascular smooth muscle.

A sympatholytic drug is a medication that opposes the downstream effects of postganglionic nerve firing in effector organs innervated by the sympathetic nervous system (SNS). They are indicated for various functions; for example, they may be used as antihypertensives. They are also used to treat anxiety, such as generalized anxiety disorder, panic disorder and PTSD.

Alpha blocker Class of pharmacological agents

Alpha-blockers, also known as α-blockers or α-adrenoreceptor antagonists, are a class of pharmacological agents that act as antagonists on α-adrenergic receptors (α-adrenoceptors).

Beta-adrenergic agonist Medications that relax muscles of the airways

Beta adrenergic agonists or beta agonists are medications that relax muscles of the airways, causing widening of the airways and resulting in easier breathing. They are a class of sympathomimetic agents, each acting upon the beta adrenoceptors. In general, pure beta-adrenergic agonists have the opposite function of beta blockers: beta-adrenoreceptor agonist ligands mimic the actions of both epinephrine- and norepinephrine- signaling, in the heart and lungs, and in smooth muscle tissue; epinephrine expresses the higher affinity. The activation of β1, β2 and β3 activates the enzyme, adenylate cyclase. This, in turn, leads to the activation of the secondary messenger cyclic adenosine monophosphate (cAMP); cAMP then activates protein kinase A (PKA) which phosphorylates target proteins, ultimately inducing smooth muscle relaxation and contraction of the cardiac tissue.

Discovery and development of beta-blockers

β adrenergic receptor antagonists were initially developed in the 1960s, for the treatment of angina pectoris but are now also used for hypertension, congestive heart failure and certain arrhythmias. In the 1950s, dichloroisoproterenol (DCI) was discovered to be a β-antagonist that blocked the effects of sympathomimetic amines on bronchodilation, uterine relaxation and heart stimulation. Although DCI had no clinical utility, a change in the compound did provide a clinical candidate, pronethalol, which was introduced in 1962.

The β3 adrenergic receptor agonist or β3-adrenoceptor agonist, also known as β3-AR agonist, are a class of medicine that bind selectively to β3-adrenergic receptors.

Autonomic drugs can either inhibit or enhance the functions of the parasympathetic and sympathetic nervous systems. This type of drug can be used to treat a wide range of diseases, such as glaucoma, asthma, urinary, gastrointestinal and cardiopulmonary disorders.

Adrenergic blocking agents are a class of drugs that exhibit its pharmacological action through inhibiting the action of the sympathetic nervous system in the body. The sympathetic nervous system(SNS) is an autonomic nervous system, in which we can not control by will. It triggers a series of responses after the body releases chemicals named noradrenaline and epinephrine. These chemicals will act on adrenergic receptors, with subtypes Alpha-1, Alpha-2, Beta-1, Beta-2, Beta-3, which ultimately allow the body to trigger a "fight-or-flight" response to handle external stress. These responses include vessel constriction in general vessels whereas there is vasodilation in vessels that supply skeletal muscles or in coronary vessels. Additionally, the heart rate and contractile force increase when SNS is activated, which may be harmful to cardiac function as it increases metabolic demand.

References

  1. 1 2 3 4 5 6 FDA Penbutolol label Last updated Dec 2010
  2. 1 2 3 4 Katzung, Bertram G. Basic and Clinical Pharmacology (13th ed.) McGraw-Hill Education, 2015. ISBN   9780071826419
  3. 1 2 3 Frishman WH, Covey S (1990). "Penbutolol and carteolol: two new beta-adrenergic blockers with partial agonism". Journal of Clinical Pharmacology. 30 (5): 412–21. doi:10.1002/j.1552-4604.1990.tb03479.x. PMID   2189902. S2CID   12950442.
  4. 1 2 FDA History NDA 018976
  5. 1 2 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. Schoenberger JA (Jun 1989). "Usefulness of penbutolol for systemic hypertension. Penbutolol Research Group". Am J Cardiol. 63 (18): 1339–42. doi:10.1016/0002-9149(89)91045-x. PMID   2658525.
  8. 1 2 Vallner JJ, et al. (1977). "Plasma level studies of penbutolol after oral dose in man". Journal of Clinical Pharmacology. 17 (4): 231–23. doi:10.1177/009127007701700407. PMID   14976. S2CID   31794332.
  9. Berdeaux A, Duhaze P, Giudicelli JF (1982). "Pharmacological analysis of beta adrenoceptor blockade-induced coronary blood flow redistribution in dogs using l-penbutolol". The Journal of Pharmacology and Experimental Therapeutics. 221 (3): 740–747. PMID   6123586.
  10. Dent, M. R., Singal, T., Tappia, P. S., Sethi, R., Dhall, N. S. (2008). β-Adrenoceptor-Linked Signal Transduction Mechanisms in Congestive Heart Failure. Chapter 2, pp 27-49 in Signal transduction in the cardiovascular system in health and disease, Eds Srivastava, Ashok K., Anand-Srivastava, Madhu B. Springer Science & Business Media, 2008 ISBN   9780387095523
  11. Finkel, Richard; Clark, Michelle A.; Cubeddu, Luigi X. Lippincott's Illustrated Reviews: Pharmacology, 4th Edition Lippincott Williams & Wilkins, 2009. ISBN   9780781771559
  12. Langlois M, Brémont B, Rousselle D, Gaudy F (1993). "Structural analysis by the comparative molecular field analysis method of the affinity of beta-adrenoreceptor blocking agents for 5-HT1A and 5-HT1B receptors". Eur. J. Pharmacol. 244 (1): 77–87. doi:10.1016/0922-4106(93)90061-d. PMID   8093601.
  13. Glennon RA. Strategies for the Development of Selective Serotonergic Agents. Chapter 4 in The Serotonin Receptors: From Molecular Pharmacology to Human Therapeutics. Ed. Bryan L. Roth. Springer Science & Business Media, 2008 ISBN   9781597450805