What medications are effective for managing uncontrolled hypertension secondary to pheochromocytoma?

From the Guidelines

For patients with uncontrolled hypertension due to pheochromocytoma, alpha-adrenergic blockers such as phentolamine, doxazosin, or terazosin are the first-line medications, with the goal of controlling blood pressure and preventing adrenergic crises. The choice of alpha-blocker may depend on the specific clinical scenario and patient characteristics. According to the most recent guidelines, phentolamine is a suitable option for intravenous use, while doxazosin or terazosin can be used orally 1. These medications block the effects of excess catecholamines produced by the tumor, preventing vasoconstriction and reducing blood pressure.

• Key considerations in the management of pheochromocytoma include:
  • The use of alpha-blockers as first-line therapy to control blood pressure and prevent adrenergic crises
  • The importance of adequate fluid administration to prevent profound hypotension after tumor excision
  • The need for careful monitoring and management of blood pressure and volume status in the perioperative period
• Beta-blockers like propranolol or metoprolol may be added, but only after adequate alpha blockade is established to avoid hypertensive crisis from unopposed alpha stimulation 1.
• Other options such as urapidil, nicardipine, and nitroprusside may also be considered in specific clinical scenarios 1.
• The definitive treatment remains surgical resection of the tumor, and preoperative management should include alpha blockade and volume expansion to prevent severe hypotension after tumor removal.

From the FDA Drug Label

Phenoxybenzamine hydrochloride capsules are indicated in the treatment of pheochromocytoma, to control episodes of hypertension and sweating. If tachycardia is excessive, it may be necessary to use a beta-blocking agent concomitantly. In patients with pheochromocytoma, who produce excessive amounts of norepinephrine and epinephrine, administration of one gram to four grams of metyrosine per day has reduced catecholamine biosynthesis from about 35% to 80% as measured by the total excretion of catecholamines and their metabolites Most patients with pheochromocytoma treated with metyrosine experience decreased frequency and severity of hypertensive attacks with their associated headache, nausea, sweating, and tachycardia

The effective and commonly used medicines for patients who have uncontrolled hypertension secondary to pheochromocytoma are:

• Phenoxybenzamine to control episodes of hypertension and sweating, and
• Metyrosine to reduce catecholamine biosynthesis and decrease the frequency and severity of hypertensive attacks. In some cases, a beta-blocking agent may be necessary to control excessive tachycardia 2 3.

From the Research

Effective Medicines for Uncontrolled Hypertension in Pheochromocytoma

The following medicines are commonly used to manage uncontrolled hypertension in patients with pheochromocytoma:

• Alpha-adrenergic blockers, such as:
  • Phenoxybenzamine 4, 5, 6, 7, 8
  • Prazosin 4, 6
  • Doxazosin 4, 5, 6, 7
• Beta-adrenergic blockers, such as:
  • Propranolol 6
  • Atenolol 6
• Calcium channel blockers, such as:
  • Nicardipine 6
  • Nifedipine 6, 7

Preoperative Treatment

Preoperative treatment with alpha-adrenergic blockers is crucial to prevent hemodynamic instability during surgery 4, 5, 6, 7. The choice of alpha-blocker may depend on the patient's specific needs and the potential side effects of each medication 5, 7.

Perioperative Management

Perioperative management of patients with pheochromocytoma requires careful monitoring of blood pressure and volume status 4, 5, 6. The use of vasoactive agents and fluid infusion may be necessary to control blood pressure and prevent hypotension 4, 5, 6.