Atenolol Dosage

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Usual Adult Dose for Hypertension

Initial dose: 50 mg orally once a day. The full effect of this dose will usually be seen within 1 to 2 weeks. If an optimal response is not achieved, the dosage should be increased to 100 mg orally once a day.

Usual Adult Dose for Angina Pectoris Prophylaxis

Initial dose: 50 mg orally once a day. If an optimal response is not achieved within one week, the dosage should be increased to 100 mg orally once a day. Some patients may require a dosage of 200 mg once a day for optimal effect.

Twenty-four hour control with once daily dosing is achieved by giving doses larger than necessary to achieve an immediate maximum effect. The maximum early effect on exercise tolerance occurs with doses of 50 to 100 mg, but at these doses the effect at 24 hours is attenuated, averaging about 50% to 75% of that observed with once a day oral doses of 200 mg.

Usual Adult Dose for Angina Pectoris

Initial dose: 50 mg orally once a day. If an optimal response is not achieved within one week, the dosage should be increased to 100 mg orally once a day. Some patients may require a dosage of 200 mg once a day for optimal effect.

Twenty-four hour control with once daily dosing is achieved by giving doses larger than necessary to achieve an immediate maximum effect. The maximum early effect on exercise tolerance occurs with doses of 50 to 100 mg, but at these doses the effect at 24 hours is attenuated, averaging about 50% to 75% of that observed with once a day oral doses of 200 mg.

Usual Adult Dose for Myocardial Infarction

IV: 5 mg over 5 minutes followed by another 5 mg injection 10 minutes later.
Oral: In patients who tolerate the full IV dose (10 mg), atenolol tablets 50 mg should be initiated 10 minutes after the last IV dose followed by another 50 mg dose 12 hours later. Thereafter, either 100 mg once a day or 50 mg twice a day for 6 to 9 days.

Usual Adult Dose for Anxiety

Initial dose: 50 mg orally once a day.
Maintenance dose: In most cases data have shown no benefit and an increased risk of fatigue with daily doses greater than 100 mg.

Usual Adult Dose for Esophageal Variceal Hemorrhage Prophylaxis

Initial dose: 50 mg orally once a day.
Maintenance dose: In most cases data have shown no benefit and an increased risk of fatigue with daily doses greater than 100 mg.

Usual Adult Dose for Migraine Prophylaxis

Initial dose: 50 mg orally once a day.
Maintenance dose: In most cases data have shown no benefit and an increased risk of fatigue with daily doses greater than 100 mg.

Usual Adult Dose for Alcohol Withdrawal

Initial dose: 50 mg orally once a day.
Maintenance dose: Initial oral doses may be titrated upward as needed and tolerated approximately every 7 days. The maximum recommended daily dose is 200 mg.

Usual Adult Dose for Supraventricular Tachycardia

Initial dose: 50 mg orally once a day.
Maintenance dose: Initial oral doses may be titrated upward as needed and tolerated approximately every 7 days. The maximum recommended daily dose is 200 mg.

Usual Adult Dose for Ventricular Tachycardia

Initial dose: 50 mg orally once a day.
Maintenance dose: Initial oral doses may be titrated upward as needed and tolerated approximately every 7 days. The maximum recommended daily dose is 200 mg.

Renal Dose Adjustments

CrCl less than 15 mL/min: Maximum dose: 25 mg orally once a day.

CrCl 15 to 35 mL/min: Maximum dose: 50 mg orally once a day.

Liver Dose Adjustments

Data not available

Dose Adjustments

Data from other beta blocker trials suggest that if there is any question concerning the use of IV beta blocker or clinical estimate that there is a contraindication, the IV beta blocker may be eliminated and patients fulfilling the safety criteria may be given atenolol tablets 50 mg twice daily or 100 mg once a day for at least 7 days (if the IV dosing is excluded).

During the second and third trimesters of pregnancy a dose adjustment may be required in order to maintain an adequate therapeutic effect because of a significant increase in atenolol renal clearance and a shorter half-life. A generalized dosage recommendation for pregnancy is not possible due to the variability in bioavailability.

Renally impaired or elderly patients being treated for hypertension may require a lower starting dose of atenolol, usually 25 mg once daily. If this lower dose is used, assessment of efficacy should be made carefully. This should include measurement of blood pressure just prior to the next dose ("trough" blood pressure) to ensure that the treatment effect is present for a full 24 hours. Although a similar dosage reduction may be considered for renally impaired or elderly patients being treated for indications other than hypertension, data are not available for these patient populations.

Precautions

Patients with coronary artery disease receiving atenolol should be advised to avoid abrupt discontinuation of the drug, as severe exacerbation of angina and occurrence of myocardial infarction and ventricular arrhythmias have occurred. The last two complications may occur with or without preceding exacerbation of the angina pectoris. As with other beta-blockers, when discontinuation of atenolol is planned, the patients should be carefully monitored and advised to limit physical activity to a minimum. If the angina worsens or acute coronary insufficiency develops, it is advised that atenolol be promptly reinstituted, at least temporarily. Because coronary artery disease is common and may be unrecognized, it may be prudent not to discontinue atenolol treatment abruptly even in patients treated only for hypertension.

Atenolol is contraindicated in patients with sinus bradycardia, second- or third-degree atrioventricular heart block, cardiogenic shock, untreated pheochromocytoma, and overt congestive heart failure.

Atenolol should be used with caution in patients with heart failure, a history of heart failure, bronchospastic disease, diabetes and hypoglycemia.

Beta-adrenergic blockade may mask certain clinical signs (e.g., tachycardia) of hyperthyroidism. Abrupt discontinuation of beta-blockade might precipitate a thyroid storm; therefore, patients suspected of developing thyrotoxicosis from whom atenolol treatment is to be withdrawn should be closely monitored.

Withdrawal of beta-blocker therapy prior to major surgery is controversial, as the impaired ability of the heart to respond to reflex adrenergic stimuli may augment the risks of general anesthesia and surgical procedures.

Atenolol therapy may aggravate peripheral arterial circulatory disorders.

Atenolol therapy should be used with caution in patients with impaired renal function.

If bradycardia or hypotension requiring treatment or any other untoward effects occur, atenolol should be discontinued.

Safety and effectiveness in pediatric patients have not been established.

Dialysis

Atenolol is moderately hemodialyzable (20% to 50%). Patients should be given 25 to 50 mg after each hemodialysis.

Elimination is not enhanced via peritoneal dialysis. A supplemental dose is not needed with peritoneal dialysis.

Other Comments

Increasing the dosage beyond 100 mg a day is unlikely to produce any further benefit when treating hypertension.

Atenolol may be used alone or concomitantly with other antihypertensive agents including thiazide-type diuretics, hydralazine, prazosin, and alpha-methyldopa.

Compared with Caucasian patients, Black patients have a reduced blood pressure response to monotherapy with beta-blockers; however, the reduced response is largely eliminated if combination therapy that includes an adequate dose of a diuretic is instituted.

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