TABLE 1.

Medications used in preoperative management of pheochromocytoma and paraganglioma

Drug	Class	Starting dose	Final dose	Side effects
Phenoxybenzaminea	Alpha-blocker	10 mg bid	1 mg/kg/day	Tachycardia, postural hypotension, nasal congestion, miosis, inhibition of ejaculation
Doxazosina	Alpha-blocker	2 mg/day	32 mg/day	Dizziness, fatigue, somnolence, edema, dyspnea, hypotension, dry mouth
Propranolol	Beta-blocker	20 mg tid	40 mg tid	Fatigue, nausea, drowsiness, diarrhea, bronchitis, bradycardia, impotence, dry eyes
Atenolol	Beta-blocker	25 mg/day	50 mg/day	Fatigue, nausea, dizziness, bradycardia, postural hypotension, vertigo
Nifedipine	Calcium channel blocker	30 mg/day	60 mg/day	Dizziness, flushing, headache, weakness, nausea, muscle cramps, peripheral edema, anxiety, palpitation, dyspnea, nasal congestion
Amlodipine	Calcium channel blocker	5 mg/day	10 mg/day	Edema, dizziness, flushing, palpitation, fatigue, nausea, abdominal pain, somnolence
Metyrosine	Tyrosine hydroxylase inhibitor	250 mg/qid	4 g/day	Sedation, diarrhea, extrapyramidal signs such as drooling, speech difficulty, and tremor, anxiety, depression, confusion

^aAlpha blockade should start 714 days prior to surgery. Beta blockade should be initiated 34 days after alpha-blockade when necessary. Calcium channel blockers should be added as needed post alpha and beta blockade. Metyrosine should be offered as a fourth-line agent for patients who are refractory to alpha and calcium channel blockade