Atenolol Side Effects
Some side effects of atenolol may not be reported. Always consult your doctor or healthcare specialist for medical advice. You may also report side effects to the FDA.
For the Consumer
Applies to atenolol: oral tablet
Get emergency medical help if you have any of these signs of an allergic reaction while taking atenolol: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.
Call your doctor at once if you have any of these serious side effects:
slow or uneven heartbeats;
feeling light-headed, fainting;
feeling short of breath, even with mild exertion;
swelling of your ankles or feet;
nausea, stomach pain, low fever, loss of appetite, dark urine, clay-colored stools, jaundice (yellowing of the skin or eyes);
cold feeling in your hands and feet.
Less serious side effects of atenolol may include:
decreased sex drive, impotence, or difficulty having an orgasm;
sleep problems (insomnia);
tired feeling; or
This is not a complete list of side effects and others may occur. Tell your doctor about any unusual or bothersome side effect.
For Healthcare Professionals
Applies to atenolol: compounding powder, injectable solution, oral tablet
Cardiovascular side effects occur in less than 3% of patients and include bradycardia, hypotension, precipitation of heart failure, and cold extremities. Less than 1% of patients report flushing symptoms. These side effects may require discontinuation of therapy or dosage reduction. The use of atenolol may be associated with reduced HDL cholesterol and increased total cholesterol. These changes may be deleterious in some patients with heart disease.
Profound hypotension following atenolol administration for malignant hypertension has been reported.
Nervous system side effects such as complaints of sleep disturbances, depression, and headache occur in up to 4% of patients. Nervous system side effects are less common than with some beta-blockers due to the more hydrophilic properties of atenolol. A single case of organic anxiety syndrome has been associated with rapid withdrawal of atenolol therapy.
Neurologic side effects are less common with atenolol than with some other beta-blockers because it is less lipophilic and, therefore, less able to penetrate the central nervous system. At least three cases of acute central nervous system disturbances have been attributed to atenolol therapy. In one case, the ratio of the serum to CSF atenolol levels was 2:1, which is much lower than previously reported ratios of 14:,1 indicating that there was significant CSF penetration.
Gastrointestinal side effects have included diarrhea and nausea in 2% and 4% of patients, respectively. Retroperitoneal fibrosis has rarely been associated with atenolol.
A 68-year-old woman with hypertension developed vomiting, abdominal pain, and progressive renal failure associated with extensive retroperitoneal fibrosis and ureteral obstruction during atenolol therapy. While the patient was also taking oral iron preparations, metoclopramide, and ibuprofen, the authors of this case report implicate atenolol due to previous associations of the retroperitoneal fibrosis with other beta-blockers.
Hypersensitivity reactions are rare.
Hepatic dysfunction has rarely been associated with atenolol.
A single case of reversible liver dysfunction and a single case of cholecystitis have been associated with atenolol. The mechanism of toxicity is not known, and is considered to be idiosyncratic.
A 71-year-old woman with unstable angina developed multiple erythematous, subcutaneous nodules over the metacarpal-phalanx and interphalanx joints of both hands. The patient also developed an increase of CD8+ T lymphocytes (cytotoxic suppressor lymphocytes) and the presence of antinuclear antibodies. The lesions resolved by 90 days after atenolol was withdrawn. Subsequent use of atenolol lead to a similar sequelae.
Dermatologic side effects are rare. A case of septal panniculitis is reported, thought to be due to an immunologic mechanism.
Endocrine side effects including slightly decreased T3 concentrations among patients with hyperthyroidism have been reported, although T4 concentrations were not affected.
Breast pain, swelling, and tenderness developed in a 54-year-old woman after starting therapy with atenolol 25 mg daily. Symptoms resolved following discontinuation of therapy.
In one study, postmenopausal women reported a reduction in libido after receiving atenolol 50 to 100 mg daily.
Genitourinary side effects have included decreased libido and at least one case of breast pain, swelling, and tenderness.
The mechanism by which atenolol induces weight gain is unknown. Some investigators have reported a 4% to 9% reduction in total energy expenditure and a 25% reduction in thermogenic response to food during beta-blocker treatment.
Metabolic side effects have included weight gain.
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