Nurses Compass
Drug Guide
Pinacidil
Classification
Therapeutic: Antihypertensive, vasodilator
Pharmacological: Potassium channel opener
FDA Approved Indications
- Hypertension
Mechanism of Action
Pinacidil opens ATP-sensitive potassium channels in vascular smooth muscle, leading to hyperpolarization and relaxation of the vascular smooth muscle, resulting in vasodilation and decreased blood pressure.
Dosage and Administration
Adult: Typically 10-30 mg orally, divided into 2-3 doses. Dose adjustments are based on response and tolerance.
Pediatric: Limited data; use in children not well established, consult specialist.
Geriatric: Start at lower doses due to increased risk of hypotension and other side effects.
Renal Impairment: Use with caution; may require dose adjustment based on patient's renal function.
Hepatic Impairment: Data limited; caution advised, consider dose adjustments.
Pharmacokinetics
Absorption: Well absorbed orally.
Distribution: Widely distributed; specific data limited.
Metabolism: Primarily hepatic metabolism; detailed pathways not well defined.
Excretion: Excreted mainly via urine.
Half Life: Approximately 1-2 hours.
Contraindications
- Known hypersensitivity to pinacidil or other potassium channel activators.
Precautions
- Use with caution in patients with severe hypotension, recent myocardial infarction, or bleeding disorders. Risk of reflex tachycardia and hypotension.
Adverse Reactions - Common
- Headache (Common)
- Reflex tachycardia (Common)
- Flushing (Common)
- Hypotension (Common)
Adverse Reactions - Serious
- Arrhythmias (Rare)
- Severe hypotension (Rare)
- Angina exacerbation (Rare)
Drug-Drug Interactions
- Other antihypertensives (may enhance hypotensive effect)
- CYP3A4 inhibitors/inducers (may alter metabolism)
Drug-Food Interactions
- No significant food interactions noted
Drug-Herb Interactions
- Limited data; exercise caution with herbal supplements affecting blood pressure or potassium levels
Nursing Implications
Assessment: Monitor blood pressure, heart rate, and signs of hypotension. Assess for symptoms of reflex tachycardia.
Diagnoses:
- Ineffective tissue perfusion related to hypotension.
- Risk for decreased cardiac output related to reflex tachycardia.
Implementation: Administer as prescribed, typically orally, with meals to reduce gastrointestinal upset. Monitor vital signs regularly.
Evaluation: Assess blood pressure and heart rate for effectiveness and adverse effects. Adjust dose as necessary.
Patient/Family Teaching
- Do not discontinue suddenly; consult healthcare provider before stopping.
- Report symptoms of dizziness, rapid heartbeat, or chest pain.
- Take medication exactly as prescribed, with or without food.
- Be cautious when changing position to avoid falls due to hypotension.
Special Considerations
Black Box Warnings:
- None currently issued.
Genetic Factors: No specific genetic considerations documented.
Lab Test Interference: No known interference with laboratory tests.
Overdose Management
Signs/Symptoms: Severe hypotension, dizziness, tachycardia, arrhythmias, syncope.
Treatment: Supportive care, intravenous fluids, vasopressors if necessary, and continuous cardiac monitoring.
Storage and Handling
Storage: Store at room temperature, 20-25°C (68-77°F).
Stability: Stable under recommended storage conditions for the duration of the shelf life.