Table 10

Drug Treatment for Pheochromocytoma

Drug Action Indication Advantage Disadvantage

Phenoxybenzamine Noncompetitive, nonselective i-blocker All patients Long duration Efficacious Tachycardia, Hypotension

Phentolamine Competitive i-blocker Hypertensive crisis Rapid onset, I.V. Bolus can cause hypotension

Metoprolol, atenolol ß₁-blocker Persistent tachycardia Myocardial ischemia ß₁-selective, less likely to increase BP or impair caridac function; I.V. or oral. Hypertension crisis if incomplete i-blockade

Labetalol Combined i- and ß- adrenoceptor blocker Persistent tachycarida Myocardial ischemia I.V. or oral. Combined blockade Hypertensive crisis if insufficient i- blockade

i- methylparatyrosine Tyrosine hydroxylase inhibitor. Reduces catecholamine biosynthesis Cardiomyopathy, Refractory to phenoxybenzamine Reduces catecholamine levels Extrapyramidal side effects, crystalluria,

Captopril ACE inhibitor Heart failure, hypertension Afterload reduction BP control Hypotension when combined with i-blocker

NaCl (IV or tablets) Volume expansion Postural hypotension on i-blocker Optimize volume status before surgery Edema, volume overload

(From: Blumenfeld JD and Vaughan Ed Jr: Hypertensive adrenal disorders, In: Therapy in Nephrology and Hypertension, Brady H and Wilcox CS (Eds.). W.B. Saunders (In Press).

Drug	Action	Indication	Advantage	Disadvantage
Phenoxybenzamine	Noncompetitive, nonselective i-blocker	All patients	Long duration Efficacious	Tachycardia, Hypotension
Phentolamine	Competitive i-blocker	Hypertensive crisis	Rapid onset, I.V.	Bolus can cause hypotension
Metoprolol, atenolol	ß₁-blocker	Persistent tachycardia Myocardial ischemia	ß₁-selective, less likely to increase BP or impair caridac function; I.V. or oral.	Hypertension crisis if incomplete i-blockade
Labetalol	Combined i- and ß- adrenoceptor blocker	Persistent tachycarida Myocardial ischemia	I.V. or oral. Combined blockade	Hypertensive crisis if insufficient i- blockade
i- methylparatyrosine	Tyrosine hydroxylase inhibitor. Reduces catecholamine biosynthesis	Cardiomyopathy, Refractory to phenoxybenzamine	Reduces catecholamine levels	Extrapyramidal side effects, crystalluria,
Captopril	ACE inhibitor	Heart failure, hypertension	Afterload reduction BP control	Hypotension when combined with i-blocker
NaCl (IV or tablets)	Volume expansion	Postural hypotension on i-blocker	Optimize volume status before surgery	Edema, volume overload

Table 10

Drug Treatment for Pheochromocytoma

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