Acebutolol
SECTRAL
Pronunciation: a-se-BYOO-toe-loel
What it isBeta-1 selective blocker with intrinsic sympathomimetic activity; hypertension and ventricular arrhythmia.
Why this oneThe partial agonism means less bradycardia, which suits patients with a low resting rate.
What limits itThat same activity makes it a poor choice after myocardial infarction. Drug-induced lupus.
FDA-approved for
- hypertension (1984)
FDA label
Read the full label on DailyMed ↗
| FDA dosing | Population | Start | Target | Max |
|---|---|---|---|---|
| Hypertension | Adult | 400 mg QD | 400–800 mg/day (QD or BID) | 1200 mg/day (BID) |
| Ventricular arrhythmia | Adult | 200 mg BID | 600–1200 mg/day |
Renal Undefined
Hepatic Undefined
Elderly: ~2-fold higher bioavailability; use lower maintenance doses and avoid >800 mg/day.
Instructions
- If discontinuing, taper gradually over ~2 weeks (do not stop abruptly).
Available strengths
- cap 200, 400 mg
Contraindications
- Persistently severe bradycardia
- Second- or third-degree heart block
- Overt cardiac failure
- Cardiogenic shock
Cautions
- Do not withdraw abruptly — taper over ~2 weeks to avoid exacerbating angina/arrhythmia.
- Reversible hepatic enzyme abnormalities/hepatic injury reported.
- Rare agranulocytosis, thrombocytopenic purpura, and systemic lupus erythematosus reported.
- Beta-1 selectivity diminishes at higher doses (caution in bronchospastic disease).
Adverse reactions
- Hypotension, bradycardia, heart failure
- Fatigue, dizziness, anxiety
- Nausea, vomiting, abdominal pain
- Reversible liver enzyme (SGOT/SGPT/LDH) elevations
- Impotence, dysuria, nocturia
- Rare: agranulocytosis, thrombocytopenia
Pregnancy Undefined
Lactation Undefined
Cost
Generic entry1995
NO BOXED WARNINGS
Principal riskIntrinsic sympathomimetic activity makes it poor post-infarction
Classes and tags
Clinical profile
Legacy pregnancy categoryC
Defining liabilityBradycardia, hypotension and bronchospasm; overdose may cause conduction block or cardiogenic shock.