Table 2.
Brief instructions of preoperative drugs for pheochromocytoma and paraganglioma (PPGL).
| Drugs | Doses | Starting time | Advantages | Adverse effects and points for attention | |
|---|---|---|---|---|---|
| α-AR antagonists | Phenoxybenzamine | Initially 10mg BID, usually 1mg/kg/d |
1–2 weeks before surgery | The effect is profound and long-acting. | Prolonged hypotension postoperatively, orthostatic hypotension, reflex tachycardia, nasal congestion, central sedation |
| Prazosin | Initially 0.5–1 mg BID-TID, usually 6–15 mg/d, maximum dose of 20 mg/d | Lower risk of postoperative hypotension, seldom cause reflex tachycardia, nasal congestion and central sedation | Orthostatic hypotension, the anti-hypertensive effect may not as profound as phenoxybenzamine | ||
| Perazosin | Usually 2–10 mg/d, maximum dose of 20 mg/d | ||||
| Doxazosin | Initially 1mg QD, usually 2–8 mg/d, maximum dose of 16 mg/d |
||||
| β-AR antagonists | Propranol | Initially 10 mg TID-QID, maximum dose of 200 mg/d | After adequate α-AR blockade | Never be used alone or before adequate α-AR blockade, should not be used for patients with asthma, severe atrioventricular block or bradycardia, sick sinus syndrome, severe heart failure, and cardiogenic shock | |
| Atenolol | Usually 12.2–25 mg BID-TID | ||||
| Metoprolol | Usually 25–50 mg BID-TID | ||||
| Metoprolol controlled release tables | 25–200 mg QD | Long-acting | |||
| CCBs | Nicardipine | Initially 20 mg TID, maximum dose of 120 mg/d | 1–2 weeks before surgery if necessary | Do not cause drug-induced orthostatic hypotension and reflex tachycardia, prevention of CA-mediated coronary vasospasm and myocarditis | Monotherapy of CCBs may not be effective enough for patients with biochemically active PPGL, which should be combined with α-AR antagonists. |
| Amlodipine | 5–10 mg QD | ||||
| Nifedipine | Initially 10mg TID, maximum dose of 120mg/d | ||||
| Nifedipine controlled release tables | 30-60mg QD | ||||
| CA synthesis inhibitor | Metyrosine | Initially 500 mg/d, maximum dose of 4 g/d | At least 1-3 weeks before surgery | Directly inhibit the CAs biosynthesis | Sedation, somnolence, anxiety, depression, and rarely leading to extrapyramidal signs (such as parkinsonism) |