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TENORMIN INJECTION 0.5MG/ML

Active substance(s): ATENOLOL

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28046118

Package leaflet: Information for the patient

Tenormin® Injection 0.5 mg/ml
atenolol

Read all of this leaflet carefully before you start
taking this medicine because it contains important
information for you.
• Keep this leaflet. You may need to read it again.
• If you have any further questions, ask your doctor or
pharmacist.
• This medicine has been prescribed for you only. Do not
pass it on to others. It may harm them, even if their signs
of illness are the same as yours.
• If you get any side effects, talk to your doctor or
pharmacist. This includes any possible side effects not
listed in this leaflet. See section 4.

Do not have Tenormin if any of the above apply to you. If
you are not sure, talk to your doctor or pharmacist before
having Tenormin.

• Y
 ou have diabetes. Your medicine may change how you
respond to having low blood sugar. You may feel your
heart beating faster.
• You have thyrotoxicosis (a condition caused by an
overactive thyroid gland). Your medicine may hide the
symptoms of thyrotoxicosis.
• You have problems with your kidneys. You may need to
have some check‑ups during your treatment.
If you are not sure if any of the above apply to you, talk to
your doctor or pharmacist before having Tenormin.
Other medicines and Tenormin
Tell your doctor or pharmacist if you are taking, have
recently taken or might take any other medicines. This
includes medicines that you buy without a prescription and
herbal medicines. This is because Tenormin can affect the
way some other medicines work and some medicines can
have an effect on Tenormin.
In particular, tell your doctor if you are taking any of the
following medicines:
• Clonidine (for high blood pressure or migraine). If you
are taking clonidine and Tenormin together, do not stop
taking clonidine unless your doctor tells you to do so. If
you have to stop taking clonidine, your doctor will give
you careful instructions about how to do it.
• Verapamil, diltiazem and nifedipine (for high blood
pressure or chest pain).
• Disopyramide, quinidine or amiodarone (for an uneven
heart beat).
• Digoxin (for heart problems).
• Adrenaline, also known as epinephrine (a medicine that
stimulates the heart).
• Ibuprofen or indometacin (for pain and inflammation).
• Insulin or medicines that you take by mouth for diabetes.
• Medicines to treat nose or sinus congestion or other cold
remedies (including those you can buy in the pharmacy).
Operations
If you go into hospital to have an operation, tell the
anaesthetist or medical staff that you are having Tenormin.
This is because you can get low blood pressure (hypotension)
if you are given certain anaesthetics while you are having
Tenormin.
Pregnancy, breast-feeding and fertility
If you are pregnant or breast-feeding, think you may be
pregnant or are planning to have a baby, ask your doctor or
pharmacist for advice before taking this medicine.
Driving and using machines
• Your medicine is not likely to affect you being able to drive
or use any tools or machines. However, it is best to wait
to see how your medicine affects you before trying these
activities.
• If you feel dizzy or tired when having this medicine, do
not drive or use any tools or machines.

Warnings and precautions
Talk to your doctor or pharmacist before having Tenormin if:
• You have asthma, wheezing or any other similar
breathing problems, or you get allergic reactions,
for example to insect stings. If you have ever had
asthma or wheezing, do not take this medicine
without first checking with your doctor.
• You have a type of chest pain (angina) called
Prinzmetal's angina.
• You have poor blood circulation or controlled heart failure.
• You have first‑degree heart block.

3. How to have Tenormin
This medicine will be given to you by a doctor or nurse. It
will be given to you as an injection.
The dose depends on your illness, and how bad it is, your
age and weight and how well your kidneys are working.
Use in children
This medicine must not be given to children.
If you have more Tenormin than you should
If you think you have been given too much of this medicine,
talk to your doctor or nurse straight away.

What is in this leaflet
1. What Tenormin is and what it is used for
2. What you need to know before you have Tenormin
3. How to have Tenormin
4. Possible side effects
5. How to store Tenormin
6. Contents of the pack and other information
1. What Tenormin is and what it is used for
Tenormin contains a medicine called atenolol. This belongs
to a group of medicines called beta‑blockers. Tenormin is
used to:
• Treat uneven heart beats (arrhythmias).
• Protect the heart in the early treatment after a heart
attack (myocardial infarction).
It works by making your heart beat more slowly and with
less force.
2. What you need to know before you have Tenormin
Do not have Tenormin:
• If you are allergic to atenolol or any of the other ingredients
in your medicine (see Section 6: Further information).
• If you have ever had any of the following heart problems:
-- heart failure which is not under control (this usually
makes you breathless and causes your ankles to swell)
-- second- or third‑degree heart block (a condition which
may be treated by a pacemaker)
-- very slow or very uneven heart beats, very low blood
pressure or very poor circulation.
• If you have a tumour called phaeochromocytoma that
is not being treated. This is usually near your kidney
and can cause high blood pressure. If you are being
treated for phaeochromocytoma, your doctor will give you
another medicine, called an alpha-blocker, to take as well
as your Tenormin.
• If you have been told that you have higher than normal
levels of acid in your blood (metabolic acidosis).

MEDICAL INFORMATION LEAFLET

TENORMIN ® INJECTION 0.5 mg/ml
atenolol

1. Name of the medicinal product
‘Tenormin’ Injection 0.5 mg/ml
2. Qualitative and quantitative composition
Atenolol 0.5 mg/ml (5 mg in 10 ml).
For the full list of excipients, see section 6.1.
3 Pharmaceutical form
Solution for injection or infusion.
Type I clear glass ampoules containing a clear, colourless, sterile solution.
4 Clinical particulars
4.1 Therapeutic indications
Management of arrhythmias and for the early intervention treatment of acute
myocardial infarction.
4.2 Posology and method of administration
Posology
The dose must always be adjusted to individual requirements of the patients,
with the lowest possible starting dosage. The following are guidelines:
Adults
Cardiac arrhythmias
A suitable initial dose of Tenormin is 2.5 mg (5 ml) injected intravenously
over a 2.5 minute period (i.e.1 mg/minute). This may be repeated at 5 minute
intervals until a response is observed up to a maximum dosage of 10 mg. If
Tenormin is given by infusion, 0.15 mg/kg bodyweight may be administered
over a 20 minute period. If required, the injection or infusion may be repeated
every 12 hours.
Having controlled the arrhythmias with intravenous Tenormin, a suitable oral
maintenance dosage is 50 to 100 mg daily (see prescribing information for
Tenormin and Tenormin LS tablets).
Myocardial infarction
For patients suitable for treatment with intravenous beta-blockade and presenting
within 12 hours of the onset of chest pain, Tenormin 5–10 mg should be given
by slow intravenous injection (1 mg/minute) followed by Tenormin 50 mg orally
about 15 minutes later, provided no untoward effects have occurred from the
intravenous dose. This should be followed by a further 50 mg orally 12 hours
after the intravenous dose, and then 12 hours later by 100 mg orally, once
daily. If bradycardia and/or hypotension requiring treatment, or any other
untoward effects occur, Tenormin should be discontinued.
Older population
Dosage requirements may be reduced, especially in patients with impaired
renal function.
Paediatric population
There is no paediatric experience with Tenormin and for this reason it is not
recommended for use in children.
Renal failure
Since Tenormin is excreted via the kidneys, dosage should be adjusted in cases
of severe impairment of renal function.
No significant accumulation of Tenormin occurs in patients who have
a creatinine clearance greater than 35 ml/min/1.73 m2 (normal range is
100–150 ml/min/1.73 m2).
For patients with a creatinine clearance of 15–35 ml/min/1.73 m2 (equivalent to
serum creatinine of 300–600 micromol/litre), the oral dose should be 50 mg daily
and intravenous dose should be 10 mg once every two days.
For patients with a creatinine clearance of less than 15 ml/min/1.73 m2
(equivalent to serum creatinine of greater than 600 micromol/litre), the oral
dose should be 25 mg daily or 50 mg on alternate days and the intravenous
dose should be 10 mg once every four days.
Patients on haemodialysis should be given 50 mg orally after each dialysis;
this should be done under hospital supervision as marked falls in blood
pressure can occur.
Method of administration
Administered by the intravenous route.
4.3 Contraindications
Tenormin, as with other beta-blockers, should not be used in patients with any
of the following:
• hypersensitivity to the active substance, or to any of the excipients listed in
section 6.1
• cardiogenic shock
• uncontrolled heart failure
• sick sinus syndrome
• second- or third‑degree heart block
• untreated phaeochromocytoma
• metabolic acidosis
• bradycardia (<45 bpm)
• hypotension
• severe peripheral arterial circulatory disturbances.
4.4 Special warnings and precautions for use
Tenormin as with other beta-blockers:
• Should not be withdrawn abruptly. The dosage should be withdrawn gradually
over a period of 7–14 days, to facilitate a reduction in beta-blocker dosage.
Patients should be followed during withdrawal, especially those with ischaemic
heart disease.
• When a patient is scheduled for surgery, and a decision is made to discontinue
beta-blocker therapy, this should be done at least 24 hours prior to the procedure.
The risk-benefit assessment of stopping beta-blockade should be made for
each patient. If treatment is continued, an anaesthetic with little negative
inotropic activity should be selected to minimise the risk of myocardial depression.
The patient may be protected against vagal reactions by intravenous
administration of atropine.

• A
 lthough contraindicated in uncontrolled heart failure (see section 4.3),
may be used in patients whose signs of heart failure have been controlled.
Caution must be exercised in patients whose cardiac reserve is poor.
• May increase the number and duration of angina attacks in patients with
Prinzmetal’s angina due to unopposed alpha-receptor mediated coronary
artery vasoconstriction. Tenormin is a beta1-selective beta-blocker;
consequently, its use may be considered although utmost caution must be
exercised.
• Although contraindicated in severe peripheral arterial circulatory disturbances
(see section 4.3), may also aggravate less severe peripheral arterial
circulatory disturbances.
• Due to its negative effect on conduction time, caution must be exercised if
it is given to patients with first‑degree heart block.
• May mask the symptoms of hypoglycaemia, in particular, tachycardia.
• May mask the signs of thyrotoxicosis.
• Will reduce heart rate as a result of its pharmacological action. In the
rare instances when a treated patient develops symptoms which may
be attributable to a slow heart rate and the pulse rate drops to less than
50–55bpm at rest, the dose should be reduced.
• May cause a more severe reaction to a variety of allergens when given
to patients with a history of anaphylactic reaction to such allergens.
Such patients may be unresponsive to the usual doses of adrenaline
(epinephrine) used to treat the allergic reactions.
• May cause a hypersensitivity reaction including angioedema and urticaria.
• Should be used with caution in the elderly, starting with a lesser dose
(see section 4.2).
Since Tenormin is excreted via the kidneys, dosage should be reduced in
patients with a creatinine clearance of below 35ml/min/1.73 m2.
Although cardioselective (beta1) beta-blockers may have less effect on lung
function than non-selective beta-blockers, as with all beta-blockers, these
should be avoided in patients with reversible obstructive airways disease,
unless there are compelling clinical reasons for their use. Where such reasons
exist, Tenormin may be used with caution. Occasionally, some increase in
airways resistance may occur in asthmatic patients however, and this may
usually be reversed by commonly used dosage of bronchodilators such
as salbutamol or isoprenaline. The label and patient information leaflet for
this product state the following warning: “If you have ever had asthma or
wheezing, you should not take this medicine unless you have discussed these
symptoms with the prescribing doctor”.
As with other beta-blockers, in patients with a phaeochromocytoma, an
alpha-blocker should be given concomitantly.
4.5 Interaction with other medicinal products and other forms of
interaction
Combined use of beta-blockers and calcium channel blockers with negative
inotropic effects, e.g. verapamil and diltiazem, can lead to an exaggeration of
these effects particularly in patients with impaired ventricular function and/or
sinoatrial or atrioventricular conduction abnormalities. This may result in
severe hypotension, bradycardia and cardiac failure. Neither the beta-blocker
nor the calcium channel blocker should be administered intravenously within
48 hours of discontinuing the other.
Concomitant therapy with dihydropyridines, e.g. nifedipine, may increase the risk
of hypotension, and cardiac failure may occur in patients with latent cardiac
insufficiency.
Digitalis glycosides, in association with beta-blockers, may increase atrioventricular
conduction time.
Beta-blockers may exacerbate the rebound hypertension which can follow the
withdrawal of clonidine. If the two drugs are co-administered, the beta-blocker
should be withdrawn several days before discontinuing clonidine. If replacing
clonidine by beta-blocker therapy, the introduction of beta-blockers should be
delayed for several days after clonidine administration has stopped.
(See also prescribing information for clonidine.)
Class I anti-arrhythmic drugs (e.g. disopyramide) and amiodarone may have a
potentiating effect on atrial-conduction time and induce negative inotropic effect.
Concomitant use of sympathomimetic agents, e.g. adrenaline (epinephrine),
may counteract the effect of beta-blockers.
Concomitant use with insulin and oral antidiabetic drugs may lead to the
intensification of the blood sugar lowering effects of these drugs. Symptoms of
hypoglycaemia, particularly tachycardia, may be masked (see section 4.4).
Concomitant use of prostaglandin synthetase-inhibiting drugs e.g. ibuprofen
and indometacin may decrease the hypotensive effects of beta-blockers.
Caution must be exercised when using anaesthetic agents with Tenormin. The
anaesthetist should be informed and the choice of anaesthetic should be an
agent with as little negative inotropic activity as possible. Use of beta-blockers
with anaesthetic drugs may result in attenuation of the reflex tachycardia
and increase the risk of hypotension. Anaesthetic agents causing myocardial
depression are best avoided.
4.6 Fertility, pregnancy and lactation
Caution should be exercised when Tenormin is administered during pregnancy
or to a woman who is breast-feeding.
Pregnancy
Tenormin crosses the placental barrier and appears in the cord blood. No
studies have been performed on the use of Tenormin in the first trimester and
the possibility of foetal injury cannot be excluded. Tenormin has been used
under close supervision for the treatment of hypertension in the third trimester.
Administration of Tenormin to pregnant women in the management of mild to
moderate hypertension has been associated with intra-uterine growth retardation.
The use of Tenormin in women who are, or may become, pregnant requires
that the anticipated benefit be weighed against the possible risks, particularly
in the first and second trimesters, since beta-blockers, in general, have
been associated with a decrease in placental perfusion which may result in
intra-uterine deaths, immature and premature deliveries.

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If you forget to have Tenormin
If you think you have not had a dose at the right time, talk
to your doctor or nurse straight away.

Reporting of side effects
If you get any side effects, talk to your doctor or pharmacist.
This includes any possible side effects not listed in this leaflet.
You can also report side effects directly via the Yellow Card
Scheme. Website: www.mhra.gov.uk/yellowcard. By reporting
side effects you can help provide more information on the
safety of this medicine.

If you stop having Tenormin
Your doctor or nurse will let you know when to stop having
this medicine.
4. Possible side effects

5. How to store Tenormin

Like all medicines, this medicine can cause side effects,
although not everybody gets them.

• T
 he doctor and hospital pharmacist are responsible for
storing, using and disposing of Tenormin correctly.
• Keep this medicine out of sight and reach of children.
• Do not use this medicine after the expiry date which is
stated on the ampoule label and carton. The expiry date
refers to the last day of that month.
• Do not store above 25°C. Store your medicine in the
original package. Keep the ampoules in the carton.

Allergic reactions:
If you have an allergic reaction, see a doctor straight away.
The signs may include raised lumps on your skin (weals) or
swelling of your face, lips, mouth, tongue or throat.
Other possible side effects:
Common (may affect up to 1 in 10 people)
• You may notice that your pulse rate becomes slower
while you are having the injection. This is normal, but if
you are concerned please tell your doctor about it.
• Cold hands and feet.
• Diarrhoea.
• Feeling sick (nausea).
• Feeling tired.

6. Contents of the pack and other information
What Tenormin contains
The active substance is atenolol. Tenormin contains
5 mg (milligrams) of atenolol in 10 ml (millilitres) of injection.
The other ingredients are citric acid, sodium chloride,
sodium hydroxide and water for injection.

Uncommon (may affect up to 1 in 100 people)
• Disturbed sleep.

What Tenormin looks like and contents of the pack
Tenormin Injection 0.5 mg/ml is a clear, colourless solution
in a clear glass ampoule. It comes in a pack containing
10 ampoules. Each ampoule contains 10 ml of solution.

Rare (may affect up to 1 in 1,000 people)
• Heart block (which may cause an abnormal heart beat,
dizziness, tiredness or fainting).
• Numbness and spasm in your fingers which is followed
by warmth and pain (Raynaud’s disease).
• Mood changes.
• Nightmares.
• Feeling confused.
• Changes in personality (psychoses).
• Hallucinations.
• Headache.
• Dizziness, particularly when standing up.
• Tingling of your hands.
• Being unable to get an erection (impotence).
• Dry mouth.
• Dry eyes.
• Disturbances of vision.
• Thinning of your hair.
• Skin rash.
• Reduced numbers of platelets in your blood (this may
make you bruise more easily).
• Purplish marks on your skin.
• Jaundice (causing yellowing of your skin or the whites of
your eyes).

Marketing Authorisation Holder and Manufacturer
The Marketing Authorisation for Tenormin Injection 0.5 mg/ml
is held by AstraZeneca UK Limited, 600 Capability Green,
Luton, LU1 3LU, UK.
Tenormin Injection 0.5 mg/ml is manufactured by
AstraZeneca UK Limited, Silk Road Business Park,
Macclesfield, Cheshire, SK10 2NA, UK.

To listen to or request a copy of this
leaflet in Braille, large print or audio
please call, free of charge:
0800 198 5000 (UK only)
Please be ready to give the following
information:
Product name Tenormin
Injection
0.5 mg/ml
Reference number 17901/0050
This is a service provided by the Royal
National Institute of Blind People.

Very rare (may affect up to 1 in 10,000 people)
• Changes to some of the cells or other parts of your blood.
Your doctor may take blood samples every so often to
check whether Tenormin has had any effect on your blood.
Not known (frequency cannot be estimated from the
available data)
• Lupus-like syndrome (a disease where the immune system
produces antibodies that attacks mainly skin and joints).

Leaflet prepared: October 2015.
© AstraZeneca 2015.
Tenormin is a trade mark of the AstraZeneca group of
companies.

Conditions that may get worse
If you have any of the following conditions, they may get
worse when you start to take your medicine. This happens
rarely affecting less than 1 in 1,000 people.
• Psoriasis (a skin condition).
• Being short of breath or having swollen ankles (if you have
heart failure).
• Asthma or breathing problems.
• Poor circulation.

CV 15 0070

Breast-feeding
There is significant accumulation of Tenormin in breast milk.

5 Pharmacological properties
5.1 Pharmacodynamic properties
Pharmacotherapeutic group: Beta-blocking agents, plain, selective,
ATC code: CO7A B03.
Mechanism of action
Atenolol is a beta-blocker which is beta1-selective, (i.e. acts preferentially
on beta1-adrenergic receptors in the heart). Selectivity decreases with
increasing dose.
Atenolol is without intrinsic sympathomimetic and membrane-stabilising
activities and as with other beta-blockers, has negative inotropic effects
(and is therefore contraindicated in uncontrolled heart failure).
As with other beta-blockers, the mode of action of atenolol in the treatment of
hypertension is unclear.
It is probably the action of atenolol in reducing cardiac rate and contractility
which makes it effective in eliminating or reducing the symptoms of patients
with angina.
Clinical efficacy and safety
It is unlikely that any additional ancillary properties possessed by S (-) atenolol,
in comparison with the racemic mixture, will give rise to different therapeutic
effects.
Tenormin is effective and well-tolerated in most ethnic populations although
the response may be less in black patients.
The narrow dose range and early patient response to Tenormin ensure that
the effect of the drug in individual patients is quickly demonstrated. Tenormin
is compatible with diuretics, other hypotensive agents and antianginals
(see section 4.5). Since it acts preferentially on beta-adrenergic receptors in the
heart, Tenormin may, with care be used successfully in the treatment of patients
with respiratory disease who cannot tolerate non-selective beta-adrenoceptor
blocking drugs.
Early intervention with Tenormin in acute myocardial infarction reduces infarct
size and decreases morbidity and mortality. Fewer patients with a threatened
infarction progress to frank infarction; the incidence of ventricular arrhythmias
is decreased and marked pain relief may result in reduced need of opiate
analgesics. Early mortality is decreased. Tenormin is an additional treatment
to standard coronary care.
5.2 Pharmacokinetic properties
Absorption
Following intravenous administration, the blood levels of atenolol decay
tri-exponentially with an elimination half‑life of about 6 hours. Throughout
the intravenous dose range of 5 to 10 mg the blood level profile obeys
linear pharmacokinetics and beta-adrenoceptor blockade is still measurable
24 hours after a 10 mg intravenous dose.
Absorption of atenolol following oral dosing is consistent but incomplete
(approximately 40–50%) with peak plasma concentrations occurring 2–4 hours
after dosing. The atenolol blood levels are consistent and subject to little
variability. There is no significant hepatic metabolism of atenolol and more
than 90% of that absorbed reaches the systemic circulation unaltered.
Distribution
Atenolol penetrates tissues poorly due to its low lipid solubility and
its concentration in brain tissue is low. Plasma protein binding is low
(approximately 3%).
Elimination
The plasma half‑life is about 6 hours but this may rise in severe renal impairment
since the kidney is the major route of elimination.
5.3 Preclinical safety data
Atenolol is a drug on which extensive clinical experience has been obtained.
Relevant information for the prescriber is provided elsewhere in the
Prescribing Information.
6 Pharmaceutical particulars
6.1 List of excipients
Citric acid
Sodium chloride
Sodium hydroxide
Water for Injection

Neonates born to mothers who are receiving Tenormin at parturition or
breast-feeding may be at risk of hypoglycaemia and bradycardia.
4.7 Effects on ability to drive and use machines
Tenormin has no or negligible influence on the ability to drive and use machines.
However, it should be taken into account that occasionally dizziness or fatigue
may occur.
4.8 Undesirable effects
Tenormin is well tolerated. In clinical studies, the undesired events reported
are usually attributable to the pharmacological actions of atenolol.
The following undesired events, listed by body system, have been reported
with the following frequencies: very common (≥1/10), common (≥1/100 to <1/10),
uncommon (≥1/1,000 to <1/100), rare (≥1/10,000 to <1/1,000), very rare (<1/10,000)
including isolated reports, not known (cannot be estimated from the available data).
System Organ Class
Blood and lymphatic
system disorders
Psychiatric disorders

Nervous system
disorders
Eye disorders
Cardiac disorders

Frequency Undesirable Effect
Rare
Purpura, thrombocytopenia
Uncommon Sleep disturbances of the type noted
with other beta-blockers
Rare
Mood changes, nightmares, confusion,
psychoses and hallucinations
Rare
Dizziness, headache, paraesthesia
Rare
Common
Rare

Dry eyes, visual disturbances
Bradycardia
Heart failure deterioration, precipitation
of heart block
Vascular disorders
Common Cold extremities
Rare
Postural hypotension which may be
associated with syncope, intermittent
claudication may be increased if
already present, in susceptible
patients Raynaud's phenomenon
Respiratory, thoracic and Rare
Bronchospasm may occur in patients
mediastinal disorders
with bronchial asthma or a history of
asthmatic complaints
Gastrointestinal disorders Common Gastrointestinal disturbances
Rare
Dry mouth
Hepato-biliary disorders Uncommon Elevations of transaminase levels
Rare
Hepatic toxicity including intrahepatic
cholestasis
Skin and subcutaneous Rare
Alopecia, psoriasiform skin reactions,
tissue disorders
exacerbation of psoriasis, skin rashes
Not known Hypersensitivity reactions, including
angioedema and urticaria
Not known Lupus-like syndrome
Musculoskeletal and
connective tissue
disorders
Reproductive system and Rare
Impotence
breast disorders
Common Fatigue
General disorders and
administration site
conditions
Investigations
Very rare An increase in ANA (Antinuclear
Antibodies) has been observed,
however the clinical relevance of this
is not clear

Discontinuance of the drug should be considered if, according to clinical
judgement, the well‑being of the patient is adversely affected by any of the
above reactions.
Reporting of suspected adverse reactions
Reporting suspected adverse reactions after authorisation of the medicinal
product is important. It allows continued monitoring of the benefit/risk
balance of the medicinal product. Healthcare professionals are asked to
report any suspected adverse reactions via the Yellow Card Scheme:
website:www.mhra.gov.uk/yellowcard.

6.2 Incompatibilities
None known.
6.3 Shelf‑life
36 months.
6.4 Special precautions for storage
Do not store above 25°C. Keep the container in the outer carton.

4.9 Overdose
The symptoms of overdosage may include bradycardia, hypotension, acute
cardiac insufficiency and bronchospasm.

6.5 Nature and contents of container
Glass ampoules.
10 ml ampoules are packed in boxes of 10.

General treatment should include: close supervision, treatment in an intensive
care ward; the use of gastric lavage; activated charcoal and a laxative to
prevent absorption of any drug still present in the gastrointestinal tract; the
use of plasma or plasma substitutes to treat hypotension and shock. The use
of haemodialysis or haemoperfusion may be considered.

6.6 Special precautions for disposal and other handling
Use as instructed by the prescriber.
Tenormin Injection is compatible with sodium chloride intravenous infusion
(0.9 %w/v) and Glucose Intravenous Infusion BP (5 % w/v).
7 Marketing Authorisation holder
AstraZeneca UK Limited,
600 Capability Green,
Luton, LU1 3LU, UK.
Leaflet Prepared: October 2015
Trade marks on this leaflet are the property of the AstraZeneca group.
© AstraZeneca 2015

Excessive bradycardia can be countered with atropine 1–2 mg intravenously
and/or a cardiac pacemaker. If necessary, this may be followed by a bolus dose
of glucagon 10 mg intravenously. If required, this may be repeated or followed by
an intravenous infusion of glucagon 1–10 mg/hour depending on response. If no
response to glucagon occurs or if glucagon is unavailable, a beta-adrenoceptor
stimulant such as dobutamine 2.5 to 10 micrograms/kg/minute by intravenous
infusion may be given. Dobutamine, because of its positive inotropic effect could
also be used to treat hypotension and acute cardiac insufficiency. It is likely that
these doses would be inadequate to reverse the cardiac effects of beta-blocker
blockade if a large overdose has been taken. The dose of dobutamine should
therefore be increased if necessary to achieve the required response according
to the clinical condition of the patient.

CV 15 0070

Bronchospasm can usually be reversed by bronchodilators.

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Source: Medicines and Healthcare Products Regulatory Agency

Disclaimer: Every effort has been made to ensure that the information provided here is accurate, up-to-date and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. This information has been compiled for use by healthcare practitioners and consumers in the United States. The absence of a warning for a given drug or combination thereof in no way should be construed to indicate that the drug or combination is safe, effective or appropriate for any given patient. If you have questions about the substances you are taking, check with your doctor, nurse or pharmacist.

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