Atenolol Side Effects

Not all side effects for atenolol may be reported. You should always consult a doctor or healthcare professional for medical advice. Side effects can be reported to the FDA here.

For the Consumer

Applies to atenolol: oral tablet

Other dosage forms:

In addition to its needed effects, some unwanted effects may be caused by atenolol. In the event that any of these side effects do occur, they may require medical attention.

You should check with your doctor immediately if any of these side effects occur when taking atenolol:

More common
  • Blurred vision
  • cold hands or feet
  • confusion
  • difficult or labored breathing
  • dizziness, faintness, or lightheadedness when getting up from a lying or sitting position suddenly
  • shortness of breath
  • sweating
  • tightness in chest
  • unusual tiredness or weakness
  • wheezing
Less common
  • Anxiety
  • chest pain or discomfort
  • chills
  • cold sweats
  • cough
  • dizziness or lightheadedness
  • fainting
  • fast heartbeat
  • leg pain
  • noisy breathing
  • slow or irregular heartbeat
  • sudden shortness of breath or troubled breathing
Rare
  • Bloody urine
  • decreased frequency or amount of urine
  • increased blood pressure
  • increased thirst
  • loss of appetite
  • lower back or side pain
  • nausea
  • swelling of face, fingers, or lower legs
  • vomiting
  • weight gain
Incidence not determined
  • Black, tarry stools
  • bleeding gums
  • blood in urine or stools
  • blurred or loss of vision
  • bone or joint pain
  • disturbed color perception
  • double vision
  • feeling that others are watching you or controlling your behavior
  • feeling that others can hear your thoughts
  • feeling, seeing, or hearing things that are not there
  • fever
  • halos around lights
  • night blindness
  • overbright appearance of lights
  • paleness or cold feeling in fingertips and toes
  • pinpoint red or purple spots on skin
  • severe mood or mental changes
  • skin irritation or rash, including rash that looks like psoriasis
  • skin rash, hives, or itching
  • sore throat
  • swollen or painful glands
  • tingling or pain in fingers or toes when exposed to cold
  • tunnel vision
  • unusual behavior
  • unusual bleeding or bruising

If any of the following symptoms of overdose occur while taking atenolol, get emergency help immediately:

Symptoms of overdose
  • Anxiety
  • coma
  • cool, pale skin
  • depression
  • dilated neck veins
  • extreme fatigue
  • headache
  • increased hunger
  • irregular breathing
  • nervousness
  • nightmares
  • seizures
  • shakiness
  • slurred speech
  • unusual drowsiness, dullness, tiredness, weakness, or feeling of sluggishness

Some of the side effects that can occur with atenolol may not need medical attention. As your body adjusts to the medicine during treatment these side effects may go away. Your health care professional may also be able to tell you about ways to reduce or prevent some of these side effects. If any of the following side effects continue, are bothersome or if you have any questions about them, check with your health care professional:

More common
  • Discouragement
  • feeling sad or empty
  • irritability
  • lack of appetite
  • loss of interest or pleasure
  • trouble concentrating
  • trouble sleeping
Less common
  • Diarrhea
  • dream activity
  • feeling of constant movement of self or surroundings
  • sensation of spinning
  • sleepiness
Incidence not determined
  • Decreased interest in sexual intercourse
  • dry mouth
  • inability to have or keep an erection
  • loss in sexual ability, desire, drive, or performance
  • loss of hair, temporary
  • pain of penis on erection

For Healthcare Professionals

Applies to atenolol: compounding powder, injectable solution, oral tablet

Cardiovascular

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.[Ref]

Profound hypotension following atenolol administration for malignant hypertension has been reported.[Ref]

Nervous system

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.[Ref]

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.[Ref]

Gastrointestinal

Gastrointestinal side effects have included diarrhea and nausea in 2% and 4% of patients, respectively. Retroperitoneal fibrosis has rarely been associated with atenolol.[Ref]

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.[Ref]

Hypersensitivity

Hypersensitivity reactions are rare.[Ref]

Hepatic

Hepatic dysfunction has rarely been associated with atenolol.[Ref]

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.[Ref]

Dermatologic

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.[Ref]

Dermatologic side effects are rare. A case of septal panniculitis is reported, thought to be due to an immunologic mechanism.[Ref]

Endocrine

Endocrine side effects including slightly decreased T3 concentrations among patients with hyperthyroidism have been reported, although T4 concentrations were not affected.[Ref]

Genitourinary

Genitourinary side effects have included decreased libido and at least one case of breast pain, swelling, and tenderness.[Ref]

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.[Ref]

Metabolic

Metabolic side effects have included weight gain.[Ref]

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.[Ref]

References

1. Totterman K, Groop L, Groop PH, et al "Effect of beta-blocking drugs on beta-cell function and insulin sensitivity in hypertensive non-diabetic patients." Eur J Clin Pharmacol 26 (1984): 13-7

2. Cosenzi A, Sacerdote A, Bocin E, Molino R, Mangiarotti M, Bellini G "Metabolic effects of atenolol and doxazosin in healthy volunteers during prolonged physical exercise." J Cardiovasc Pharmacol 25 (1995): 142-6

3. Giang DW, Isaeff DM "Atenolol overdosage in a patient with progressive renal failure." West J Med 145 (1986): 101-3

4. Rossner S, Weiner L "Atenolol and metoprolol: comparison of effects on blood pressure and serum lipoproteins, and side effects." Eur J Clin Pharmacol 24 (1983): 573-7

5. Brown HC, Carruthers SG, Johnston GD, et al "Clinical pharmacologic observations on atenolol, a beta-adrenoceptor blocker." Clin Pharmacol Ther 20 (1976): 524-34

6. Valimaki M, Maass L, Harno K, Nikkila EA "Lipoprotein lipids and apoproteins during beta-blocker administration: comparison of penbutolol and atenolol." Eur J Clin Pharmacol 30 (1986): 17-20

7. Wadsworth AN, Murdoch D, Brogden RN "Atenolol: a reappraisal of its pharmacological properties and therapeutic use in cardiovascular disorders." Drugs 42 (1991): 468-510

8. Disler LJ, Joffe BI, Seftel HC "Massive hypertriglyceridemia associated with atenolol." Am J Med 85 (1988): 586-7

9. Howes LG, Lykos D, Rennie GC "Effects of antihypertensive drugs on coronary artery disease risk: a meta-analysis." Clin Exp Pharmacol Physiol 23 (1996): 555-8

10. Abrahamsen AM, Digranes O, Gisholt K "Comparison of the side-effects of pindolol and atenolol in the treatment of hypertension." J Intern Med 228 (1990): 219-22

11. Kholeif M, Isles C "Profound hypotension after atenolol in severe hypertension." Br Med J 298 (1989): 161-2

12. Frishman WH "Atenolol and timolol, two new systemic beta-adrenoceptor antagonists." N Engl J Med 306 (1982): 1456-62

13. Perry HM, Hall WD, Benz JR, Bartels DW, Kostis JB, Townsend RR, Due DL, Peng A, Sirgo M "Efficacy and safety of atenolol, enalapril, and isradipine in elderly hypertensive women." Am J Med 96 (1994): 77-86

14. Gordon NF, Scott CB, Duncan JJ "Effects of atenolol versus enalapril on cardiovascular fitness and serum lipids in physically active hypertensive men." Am J Cardiol 79 (1997): 1065-9

15. Deckert J, Przuntek H, Gleiter CH "Organic anxiety syndrome after withdrawal of atenolol." Am J Psychiatry 151 (1994): 1840

16. Viadero JJ, Wong SH, White WB "Acute psychotic behavior associated with atenolol." Am J Psychiatry 140 (1983): 1382

17. Arber N "Delirium induced by atenolol." Br Med J 297 (1988): 1048

18. Patterson JF "Pseudoakathisia associated with atenolol." J Clin Psychopharmacol 6 (1986): 390

19. Hubbard JR, Levenson JL, Patrick GA "Psychiatric side effects associated with the ten most commonly dispensed prescription drugs: a review." J Fam Pract 33 (1991): 177-86

20. Morrissette DL, Skinner MH, Hoffman BB, Levine RE, Davidson JM "Effects of antihypertensive drugs atenolol and nifedipine on sexual function in older men: a placebo-controlled, crossover study." Arch Sex Behav 22 (1993): 99-109

21. Doherty CC, McGeown MG, Donaldson RA "Retroperitoneal fibrosis after treatment with atenolol." Br Med J 2 (1978): 1786

22. Schwartz MS, Frank MS, Yanoff A, Morecki R "Atenolol-associated cholestasis." Am J Gastroenterol 84 (1989): 1084-6

23. Gawkrodger DJ, Beveridge GW "Psoriasiform reaction to atenolol." Clin Exp Dermatol 9 (1984): 92-4

24. Wolf R, Ophir J, Elman M, Krakowski A "Atenolol-induced cutaneous vasculitis." Cutis 43 (1989): 231-3

25. Yusuf SW, Mishra RM "Hepatic dysfunction associated with atenolol." Lancet 346 (1995): 192

26. Henderson CA, Shamy HK "Atenolol-induced pseudolymphoma." Clin Exp Dermatol 15 (1990): 119-20

27. Fragasso G, Ciboddo G, Pagnotta P, Chierchia SL "Septal panniculitis induced by atenolol - A case report." Angiology 49 (1998): 499-502

28. Surks MI, Sievert R "Drugs and thyroid function." N Engl J Med 333 (1995): 1688-94

29. Lee ST "Hyperprolactinemia, galactorrhea, and atenolol." Ann Intern Med 116 (1992): 522

30. Kelleher JA "Atenolol-induced breast pain in a woman with hypertension." Ann Pharmacother 40 (2006): 990-2

31. Fogari R, Preti P, Zoppi A, et al. "Effect of valsartan and atenolol on sexual behavior in hypertensive postmenopausal women." Am J Hypertens 17 (2004): 77-81

32. Taylor FR "Weight change associated with the use of migraine-preventive medications." Clin Ther 30 (2008): 1069-80

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