Class: Beta-adrenergic blocking agent
- Tablets 25 mg
- Tablets 50 mg
- Tablets 100 mg
- Tablets 25 mg
- Tablets 50 mg
- Tablets 100 mg
CO Atenolol (Canada)
Sandoz Atenolol (Canada)
Blocks beta receptors, primarily affecting heart (slows rate), vascular system (decreases BP), and, to lesser extent, lungs (reduces function).
Rapid and consistent but incomplete; approximately 50% is absorbed from the GI tract. T max is 2 to 4 h.
6% to 16% bound to plasma proteins.
Little or no metabolism by the liver.
Approximately 50% is excreted unchanged in the feces. Approximately 50% is excreted in the urine within 24 h. Half-life is approximately 6 to 7 h.
1 h (oral).
2 to 4 h (oral).
24 h (oral). Duration of action is dose related.
Special PopulationsRenal Function Impairment
Elimination is closely related to glomerular filtration rate. Significant accumulation occurs when CrCl falls below 35 mL/min per 1.73 m 2 .Elderly
Total Cl is about 50% lower than in younger subjects. Half-life is markedly longer in elderly patients.
Indications and Usage
Treatment of hypertension (used alone or in combination with other drugs), angina pectoris resulting from coronary atherosclerosis, acute MI.
Migraine prophylaxis, supraventricular arrhythmias or tachycardias, esophageal varices rebleeding, anxiety.
Hypersensitivity to beta-blockers; sinus bradycardia; greater than first-degree heart block; overt cardiac failure; cardiogenic shock.
Dosage and AdministrationAcute MI
PO 100 mg/day for 6 to 9 days or until hospital discharge.Angina Pectoris
PO May require up to 200 mg/day.Hypertension
PO 50 to 100 mg/day.Elderly
PO Initial dosage is 25 mg daily.Renal Function Impairment
PO Adjust dose in severe renal impairment.CrCl 15 to 35 mL/min per 1.73 m 2
Max dose 50 mg daily.CrCl less than 15 mL/min per 1.73 m 2
Max dose 25 mg daily.Hemodialysis
Give 25 to 50 mg after each dialysis session; marked falls in blood pressure can occur.
- May be used alone or with other antihypertensive agents.
- In angina, withdraw atenolol gradually; observe patient for exacerbation of angina, MI, and arrhythmias. Advise patients to limit physical activity.
Store at 68° to 77°F in a tightly closed container in a cool location.
Drug InteractionsAluminum salts, ampicillin, calcium salts
Plasma levels and pharmacologic effects may be decreased.Clonidine
May add to or reverse antihypertensive effects; potentially life-threatening situations may occur, especially on withdrawal.Diltiazem
Pharmacologic effects of atenolol may be increased; symptomatic bradycardia may occur.Nifedipine, verapamil
Effects of both drugs may be increased.NSAIDs
Some agents may impair antihypertensive effect.Prazosin
May increase orthostatic hypotension.Quinidine
Pharmacologic effects of atenolol may be increased.
Laboratory Test Interactions
None well documented.
Cold extremities (12%); postural hypotension (4%); bradycardia (3%); Raynaud phenomenon, sick sinus syndrome (postmarketing).
Tiredness (26%); dizziness (13%); depression (12%); fatigue (6%); dreaming, lethargy, light-headedness (3%); drowsiness, vertigo (2%); hallucinations, headaches, psychoses (postmarketing).
Lupus syndrome, psoriasiform rash or exacerbation of psoriasis, purpura, reversible alopecia (postmarketing).
Diarrhea, nausea (3%); dry mouth (postmarketing).
Impotence, Peyronie disease (postmarketing).
Dyspnea (6%); wheezing (3%).
Leg pain (3%); antinuclear antibodies, thrombocytopenia, visual disturbances (postmarketing).
In patients with angina pectoris or coronary artery disease (CAD), atenolol may cause exacerbation of angina and occurrence of MI and ventricular arrhythmias. Monitor patients closely. Because CAD is common and may be unrecognized, it may be prudent not to discontinue beta-blocker therapy abruptly in patients treated only for hypertension.
Closely monitor patients suspected of developing thyrotoxicosis from whom atenolol is to be withdrawn. Upon discontinuation, observe patients for exacerbation of angina, MI, and arrhythmias, and advise patients to limit physical activity.
Category D .
Excreted in breast milk.
Safety not established.
Dosage reduction may be necessary.
Deaths have occurred; aggressive therapy may be required.
Administer cautiously in patients with CHF controlled by digitalis and diuretics.
May mask symptoms of hypoglycemia (eg, BP changes, tachycardia).
Nonallergic bronchospastic diseases (eg, chronic bronchitis, emphysema)
In general, do not give beta-blockers to patients with bronchospastic diseases.
Peripheral vascular disease
May precipitate or aggravate symptoms of arterial insufficiency.
May mask clinical signs (eg, tachycardia) of developing or continuing hyperthyroidism. Abrupt withdrawal may exacerbate symptoms of hyperthyroidism, including thyroid storm.
Bradycardia, bronchospasm, CHF, hypoglycemia, hypotension, lethargy, respiratory depression, sinus pause, wheezing.
- Explain that full effectiveness of drug may not occur for up to 1 to 2 wk after initiation of therapy, and that dosage will be tapered slowly before stopping. Warn that sudden discontinuation can cause chest pain or heart attack.
- Teach patient how to take pulse and instruct patient to check before taking drug. Warn patient not to take drug if pulse is less than 60 bpm, and to call health care provider.
- When medication is being used for treatment of hypertension, teach patient how to take daily BP.
- Advise patient that medication may cause increased sensitivity to cold.
- Inform patients with diabetes to monitor blood glucose level carefully. It may be necessary to alter insulin dose while taking drug.
- Instruct patient to report the following symptoms to health care provider: altered mood; depression; difficulty breathing; irregular heart beat; swelling of feet, legs, and hands.
- Caution patient to avoid sudden position changes to prevent orthostatic hypotension.
- Advise patient that drug may cause drowsiness, and to use caution while driving or performing other tasks requiring mental alertness.
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