Atenolol

Oral
Intravenous
Class
Adrenergic receptor blockers
Subclass
Cardioselective β-blockers
Substance name
Atenolol
Brand names
Tenormin®
Common formulations
Tablet
Contained in
Atenolol / chlorthalidone (Tenoretic®)
Dosage and administration
Adults patients
Treatment
Hypertension
•
Start at: 50 mg PO daily
•
Maintenance: 50-100 mg PO daily
Titrate over 1-2 weeks.
Myocardial infarction • Acute management, hemodynamically stable
•
Loading: 5 mg IV twice at 10-minute intervals, administered over 5 minutes
•
Subsequently: 50 mg PO BID for 1 day, with the first dose given 10 minutes after the last IV dose
•
Maintenance: 100 mg PO daily, in 1-2 divided doses for 6-9 days
Avoid β-blockers in patients with decompensated HF, cardiogenic shock, acute RV infarction, or bradyarrhythmias.
Stable angina
•
Start at: 50 mg PO daily
•
Maintenance: 100 mg PO daily
•
Maximum: 200 mg per day
Titrate over 1-2 weeks.
AF • Rate control • Off-label
•
25-100 mg PO daily
SVT • Ongoing management • Off-label
•
Maintenance: 25-50 mg PO daily
•
Maximum: 100 mg per day
Thyrotoxicosis • Off-label
•
25-100 mg PO q12-24h
Ventricular arrhythmias • Non-life-threatening • Off-label
•
25-100 mg PO q12-24h
Adjunctive treatment
Adjunctive treatment for alcohol withdrawal syndrome • Off-label
•
100 mg PO daily
Administered in combination with benzodiazepines.
Prevention
Prevention of migraine attacks • Off-label
•
Start at: 50 mg PO daily
•
Maintenance: 100 mg PO daily
Other off-label uses
•
Treatment of angina pectoris
•
Treatment of essential tremor
•
Treatment of hypertension
•
Treatment of paroxysmal SVT
Indications for use
Labeled indications
Adults
•
Treatment of hypertension
•
Treatment of myocardial infarction (acute management, hemodynamically stable)
•
Treatment of stable angina
Off-label indications
Adults
•
Treatment of angina pectoris
•
Treatment of AF (rate control)
•
Treatment of essential tremor
•
Treatment of SVT (ongoing management)
•
Treatment of thyrotoxicosis
•
Treatment of ventricular arrhythmias (non-life-threatening)
•
Adjunctive treatment for alcohol withdrawal syndrome
•
Prevention of migraine attacks
Children
•
Treatment of hypertension
•
Treatment of paroxysmal SVT
Safety risks
Boxed warnings
Angina pectoris, myocardial infarction, ventricular arrhythmia
•
Do not discontinue abruptly in patients taking the drug for a prolonged period.
Contraindications
Hypersensitivity to atenolol or its components
Bronchospastic airway disease
Sinus bradycardia, second- or third-degree AV block, cardiogenic shock, or decompensated HF
Untreated pheochromocytoma
Warnings and precautions
Bradycardia, AV block
•
Use caution with nondihydropyridine CCBs, especially in patients with conduction abnormalities or LV dysfunction.
Mask symptoms of hyperthyroidism
•
Use caution in patients with thyroid disease.
Mask symptoms of hypoglycemia
•
Use caution in patients with diabetes.
Thyroid storm
•
Do not discontinue abruptly in patients with thyroid disease suspected of developing thyrotoxicosis.
Specific populations
Renal impairment
CrCl ≥ 35 mL/min
•
No dose adjustment required. Use with caution.
CrCl 15-35 mL/min
•
Use with caution. Maximal dose of 50 mg/day.
CrCl < 15 mL/min
•
Use with caution. Maximal dose of 25 mg/day.
Renal replacement therapy
Continuous renal replacement
•
Use with caution.
Intermittent hemodialysis
•
Use acceptable. No dose adjustment required. Administer 25-50 mg after each dialysis session.
Peritoneal dialysis
•
Use acceptable. No dose adjustment required.
Hepatic impairment
Any severity
•
Use acceptable. No dose adjustment required.
Pregnancy and breastfeeding
Pregnancy
All trimesters • Australia Category: C
•
Avoid use. Consider safer alternatives. Evidence of fetal harm in humans. Monitor neonates for bradycardia and hypoglycemia.
Breastfeeding
Use with caution during breastfeeding.
•
Consider alternative agents that may be safer.
Low excretion in breastmilk (5-25%).
Low levels in breastfed infants (5-25%).
May potentially cause adverse effects in breastfed infants.
Some adverse effects on lactation reported.
Adverse reactions
Very common > 10%
•
Bradycardia, cold extremities, heart failure, hypotension, depression, dizziness, ventricular arrhythmias
Common 1-10%
•
Atrial fibrillation, atrioventricular block, atrial flutter, bronchospasm, cardiac arrest, lethargy, orthostatic hypotension, pulmonary embolism, diarrhea, fatigue, nausea, somnolence, vertigo, wheezing
Uncommon < 1%
•
Cardiogenic shock, renal failure, dyspnea
Unknown frequency
•
Diaphoresis, raynaud's phenomenon, tremor, headache, hair loss, skin rash, xerophthalmia, purpura, syncope, hypertension, palpitations, tachycardia, hallucinations, ↑ serum TBIL, ↓ platelet count, ↑ serum ALT, ↑ serum AST, skin erythema, ↑ serum triglycerides, erectile dysfunction, dry mouth, ↑ blood glucose, ↓ blood glucose, chest pain, Peyronie's disease, psoriasis, psychosis, systemic lupus erythematosus, serum sickness-like reaction, myocardial infarction, visual disturbances
Interactions
Drug(s)
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