Atenolol
Classification
Antianginal Agent; Antihypertensive; Beta-Blocker, Beta-1 Selective
Indications
CCP: Angina
CCP: Hypertension
CCP: NSTEMI/STEMI
Contraindications
- Hypersensitivity
- Bradycardia
- Heart block greater than first-degree (except in patients with a functioning artificial pacemaker); cardiogenic shock
- Uncompensated cardiac failure
- Documentation of allergenic cross-reactivity for beta-blockers
- Cor pulmonale
- Hypotension
- Severe peripheral arterial disorders
- Anesthesia with agents that produce myocardial depression
- Pheochromocytoma (in the absence of alpha-blockade)
- Metabolic acidosis
Cautions
- Use with caution in patients with renal impairment; dosage adjustment required.
- Bradycardia may be observed more frequently in elderly patients (>65 years of age); dosage reductions may be necessary.
Adult dosages
CCP: Angina
- 50 mg once daily PO
CCP: Hypertension
- 25 mg once or twice daily
CCP: NSTEMI/STEMI
- 25 to 50 mg twice daily PO titrate as tolerated based on heart rate and BP up to a usual maximum dose of 100 mg/day
Pediatric Considerations And Dosing
- Limited data available in infants and children < 2 years of age.
CCP: Arrhythmias
- 0.5 to 1 mg/kg/day PO once daily
CCP: Hypertension
- 0.5 to 1 mg/kg/day PO once daily
How Supplied
Not supplied by BCEHS
Tablet, Oral:
Tenormin: 50 mg, 100 mg [contains corn starch]
Generic: 25 mg, 50 mg, 100 mg
Mechanism Of Action
Competitively antagonizes beta-adrenergic stimulation, selectively blocks beta1-receptors with little or no effect on beta2-receptors except at high doses.
Pharmacokinetics
Onset: ≤ 1 hour
Peak effect: 2-4 hours
Duration: 12-24 hours
Half-life: 6-7 hours
Adverse Effects
Cardiovascular
- Hypotension, cardiac failure, bradycardia, ventricular tachycardia, cold extremities, supraventricular tachycardia
- Bundle branch block, atrial fibrillation, heart block, atrial flutter, orthostatic hypotension, pulmonary embolism
Central nervous system:
- Fatigue, dizziness, depression
- Abnormal dreams, lethargy, vertigo, drowsiness
Gastrointestinal
- Nausea, diarrhea
Neuromuscular & skeletal
- Limb pain
Respiratory
- Bronchospasm
Warning And Precautions
- Atenolol crosses the placenta and is found in cord blood. Maternal use of atenolol may cause harm to the fetus.
- Beta blockers are not recommended as first-line agents for hypertension.
- Patients with bronchospastic disease should not receive beta-blockers.
- Consider pre-existing conditions such as sick sinus syndrome before initiating.
- Use with caution in patients with diabetes mellitus; may potentiate hypoglycemia and/or mask signs and symptoms.
- Use with caution in patients with myasthenia gravis.
- May precipitate or aggravate symptoms of arterial insufficiency in patients with PVD and Raynaud disease.
- Adequate alpha-blockade is required prior to use of any beta-blocker in patients with an untreated pheochromocytoma.
- May mask signs of hyperthyroidism (eg, tachycardia).
- Beta-blockers without alpha1-adrenergic receptor blocking activity should be avoided in patients with Prinzmetal variant angina since unopposed alpha1-adrenergic receptors mediate coronary vasoconstriction and can worsen anginal symptoms.
Drug Interactions
- Acetylcholinesterase Inhibitors
- Alfuzosin
- Alpha1-Blockers
- Alpha2-Agonists
- Amifostine
- Amiodarone
- Amphetamines
- Ampicillin
- Antipsychotic Agents (Second Generation [Atypical])
- Bacampicillin
- Barbiturates
- Benperidol
- Beta2-Agonists
- Bradycardia-Causing Agents
- Brigatinib
- Brimonidine (Topical)
- Bromperidol
- Bupivacaine
- Ceritinib
- Cholinergic Agonists
- Dexmethylphenidate
- Diazoxide
- Dipyridamole
- Disopyramide
- DOBUTamine
- Dronedarone
- DULoxetine
- EPHEDrine (Systemic)
- EPINEPHrine (Nasal)
- EPINEPHrine (Oral Inhalation)
- Epinephrine (Racemic)
- EPINEPHrine (Systemic)
- Ergot Derivatives
- Etofylline
- Fexinidazole
- Fingolimod
- Glycopyrrolate (Systemic)
- Grass Pollen Allergen Extract (5 Grass Extract)
- Herbal Products with Blood Pressure Lowering Effects
- Hypotension-Associated Agents
- Insulins
- Ivabradine
- Lacosamide
- Levodopa-Containing Products
- Lidocaine (Systemic)
- Lormetazepam
- Mepivacaine
- Methacholine
- Methoxyflurane
- Methylphenidate
- Midodrine
- Molsidomine
- Naftopidil
- Nicergoline
- Nicorandil
- NIFEdipine
- Nitroprusside
- Nonsteroidal Anti-Inflammatory Agents
- Nonsteroidal Anti-Inflammatory Agents (Topical)
- Obinutuzumab
- Ozanimod
- Pentoxifylline
- Pholcodine
- Phosphodiesterase 5 Inhibitors
- Ponesimod
- Prostacyclin Analogues
- Quinagolide
- Reserpine
- Rivastigmine
- Siponimod
- Sulfonylureas
- Tasimelteon
- Terlipressin
- Theophylline Derivatives
- Tofacitinib
- White Birch Allergen Extract