Atenolol

Tell your doctor about any allergies you have, and about all the medications you take, whether prescription or over-the-counter, vitamins, illegal or recreational drugs, and dietary or herbal supplements, as they can affect how Atenolol works, and vice-versa.

Check with a pharmacist if you combine Atenolol with cough or cold remedies. Do not take atenolol if you are allergic to it. Inactive ingredients may cause allergic reactions.

Make sure your doctor knows if you have heart rhythm problems; breathing issues such as asthma, emphysema, and chronic bronchitis; kidney disease; blood circulation problems; or serious allergies.

Atenolol may mask signs of low blood sugar such as a fast heartbeat (often associated with hypoglycemia), and may make it harder to control blood sugar levels.

>10%

Tiredness (13%)

1-10%

Hypotension (10%)

Bradycardia (8%)

Cold extremities (0.5- 7%)

Postural hypotension (2-4%)

Depression (3%)

Nausea (2-3%)

Dreaming (2%)

Drowsiness (2%)

Diarrhea (1-2%)

Fatigue (1-2%)

Leg pain (1-2%)

Lethargy (1-2%)

Lightheadedness (1-2%)

Vertigo (1-2%)

Dyspnea (0.4-2%)

2°/3° atrioventricular (AV) block (1%)

Frequency Not Defined

Hypotension, severe congestive heart failure (CHF), sick sinus syndrome

Catatonia, disorientation, emotional lability, hallucinations, headache, impaired performance on neuropsychometric tests, psychoses, short-term memory impairment

Purpura, rashes

Nausea

Thrombocytopenia

Elevated serum hepatic enzymes and bilirubin

Impotence, Peyronie disease

Antinuclear antibodies (ANA), lupus syndrome

Visual disturbances, xerophthalmia

Raynaud phenomenon

Pregnancy category: D

Lactation: Drug enters breast milk; neonates born to mothers who are receiving atenolol at parturition or breastfeeding may be at risk for hypoglycemia and bradycardia; use with caution

Pregnancy Categories

A:Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

B:May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

C:Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

D:Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

X:Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

NA:Information not available.

Atenolol may be found in some form under the following brand names:

• Senormin

• Tenoretic

• Tenormin

Tell your doctor about all the medicines you take including prescription and non-prescription medicines, vitamins, and herbal supplements. Especially tell your doctor if you take: 

• calcium channel blockers such as diltiazem (Cardizem, Dilacor, Tiazac, others) and verapamil (Calan, Isoptin, Verelan)
• clonidine (Catapres) 
• nonsteroidal anti-inflammatory drugs (NSAIDs) such as indomethacin (Indocin)
• reserpine (Serpalan, Serpasil, Serpatabs)

Your doctor may need to change the doses of your medications or monitor you carefully for side effects.

Medicines can interact with certain foods. In some cases, this may be harmful and your doctor may advise you to avoid certain foods. In the case of atenolol there are no specific foods that you must exclude from your diet when receiving. If your doctor prescribes a low-salt or low-sodium diet, follow these directions carefully.

Tell your doctor if you are breastfeeding or plan to breastfeed. 

Atenolol is excreted in human breast milk. Slow heart rate has been reported in breast-fed infants. Premature infants, or infants with impaired kidney function, may be more likely to develop adverse effects.

General

• Individualize dosage according to patient response.111

• β1-Adrenergic blocking selectivity diminishes as dosage is increased.111 120

• If long-term therapy is discontinued, reduce dosage gradually over a period of about 2 weeks.111 120

BP Monitoring and Treatment Goals

• Carefully monitor BP during initial titration or subsequent upward adjustment in dosage.500 501

• When available, use evidence-based dosing information (i.e., dosages shown in randomized controlled trials to reduce complications of hypertension) to determine target dosages; target dosages usually can be achieved within 2–4 weeks but may take up to several months.501

• Goal is to achieve and maintain optimal control of BP; individualize specific target BP based on consideration of multiple factors, including patient age and comorbidities, and currently available evidence from clinical studies.500 501

Administration

Administer orally; also has been administered by IV injection, however, a parenteral preparation no longer commercially available in US.111 120 401

Oral Administration

Once-daily dosing usually is sufficient in the management of hypertension.c

Dosage

Pediatric Patients

Some experts recommend an initial dosage of 0.5–1 mg/kg daily given as a single dose or in 2 divided doses.258 Increase dosage as necessary up to a maximum dosage of 2 mg/kg (up to 100 mg) daily given as a single dose or in 2 divided doses.258

Adults

JNC 8 expert panel recommends initial dosage of 25–50 mg once daily and target dosage of 100 mg once daily based on dosages used in randomized controlled studies.501

Manufacturer recommends initial dosage of 50 mg once daily, alone or in combination with a diuretic; full hypotensive effect usually seen within 1–2 weeks.600 If necessary, may increase dosage to 100 mg once daily.600

Some experts state usual dosage range is 25–100 mg daily.500

If intolerable adverse effects occur, consider dosage reduction; if adverse effects worsen or fail to resolve, may need to discontinue and switch to another antihypertensive drug class.501

Initially, 50 mg of atenolol and 25 mg of chlorthalidone once daily.118 If response is not optimal, 100 mg of atenolol and 25 mg of chlorthalidone once daily.118

Manufacturer states fixed-combination preparation is not recommended for initial therapy; administer each drug separately, then use the fixed combination if the optimum maintenance dosage corresponds to the ratio of drugs in the combination preparation.118 c

May add another antihypertensive agent when necessary (gradually using half of the usual initial dosage to avoid an excessive decrease in BP).118

Initially, 50 mg once daily.111

If optimum response is not achieved within 1 week, increase to 100 mg once daily.111

Some patients may require 200 mg once daily for optimum effect.111

To reduce risk of cardiovascular mortality during the early phase of acute MI, treatment with atenolol has been initiated with IV doses;113 120 169 however, a parenteral preparation no longer commercially available in US.

50 mg twice daily or 100 mg once daily for at least 7 days.111 120

If not initiated acutely (see MI: Early Treatment, under Dosage and Administration), initiate long-term therapy within a few days of an acute MI.169

Optimum duration remains to be clearly established,111 120 but studies suggest optimum benefit with at least 1–3 years of therapy after infarction (if not contraindicated).111 113 120 122 132 134

Indefinite continuation of therapy (unless contraindicated) has been recommended.169 173

Some experts recommend an initial dose of 25–50 mg daily and usual maintenance dosage of 25–100 mg daily for ongoing therapy.300 301

Dosage has not been established; in clinical studies 100 mg daily was usual effective dosage.228

Prescribing Limits

Pediatric Patients

Maximum 2 mg/kg (up to 100 mg) daily.258

Adults

Increasing beyond 100 mg daily usually does not result in further improvement in BP control.600

Special Populations

Hepatic Impairment

Minimal hepatic metabolism; no dosage adjustment recommended.111 120

Renal Impairment

Modify doses and/or frequency of administration in response to the degree of renal impairment.c

Initial dosage of 25 mg daily may be necessary.111

Measure BP just prior to the dose to ensure persistence of adequate BP reduction.111

Patients with Clcr 15–35 mL/minute per 1.73 m2: Maximum 50 daily.111

Patients with Clcr<15 mL/minute per 1.73 m2: Maximum 25 mg daily or 50 mg every other day.111 120

Hemodialysis patients: May administer 25 or 50 mg after each dialysis.111 Marked reductions in BP may occur; give under careful supervision.111

Geriatric Patients

Modification of dosage may be necessary because of age-related decreases in renal function.111

Initially, 25 mg daily may be necessary.111

Measure BP just prior to a dose to ensure persistence of adequate BP reduction.111

Initially, 50 mg daily and use lowest possible dosage.111 If dosage must be increased, consider administering in 2 divided doses daily to decrease peak blood levels.111 A β2-adrenergic agonist bronchodilator should be available.111 (See Bronchospastic Disease under Cautions.)

• Tell all of your health care providers that you take this medicine. This includes your doctors, nurses, pharmacists, and dentists.
• Avoid driving and doing other tasks or actions that call for you to be alert until you see how atenolol affects you.
• To lower the chance of feeling dizzy or passing out, rise slowly if you have been sitting or lying down. Be careful going up and down stairs.
• Have blood work checked as you have been told by the doctor. Talk with the doctor.
• Check blood pressure and heart rate as the doctor has told you. Talk with the doctor.
• Talk with your doctor before you drink alcohol.
• This medicine may hide the signs of low blood sugar. Talk with the doctor.
• If you have high blood sugar (diabetes), you will need to watch your blood sugar closely.
• Talk with your doctor before using OTC products that may raise blood pressure. These include cough or cold drugs, diet pills, stimulants, ibuprofen or like products, and some natural products or aids.
• This medicine may make it harder to tell if you have signs of an overactive thyroid like fast heartbeat. If you have an overactive thyroid and stop taking this medicine all of a sudden, it may get worse and could be life-threatening. Talk with your doctor.
• If you have had a very bad allergic reaction, talk with your doctor. You may have a chance of an even worse reaction if you come into contact with what caused your allergy. If you use epinephrine to treat very bad allergic reactions, talk with your doctor. Epinephrine may not work as well while you are taking atenolol.
• This medicine may cause harm to the unborn baby if you take it while you are pregnant. If you are pregnant or you get pregnant while taking this medicine, call your doctor right away.
• Tell your doctor if you are breast-feeding. You will need to talk about any risks to your baby.

All drugs may cause side effects. However, many people have no side effects or only have minor side effects. Call your doctor or get medical help if any of these side effects or any other side effects bother you or do not go away:

• Dizziness.
• Feeling tired or weak.

These are not all of the side effects that may occur. If you have questions about side effects, call your doctor. Call your doctor for medical advice about side effects.

You may report side effects to the FDA at 1-800-FDA-1088. You may also report side effects at http://www.fda.gov/medwatch.

• Store at room temperature.
• Protect from light.
• Store in a dry place. Do not store in a bathroom.
• Keep all drugs in a safe place. Keep all drugs out of the reach of children and pets.
• Check with your pharmacist about how to throw out unused drugs.

Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product

Suspension, Oral:

Atenolol+SyrSpend SF PH4: 1 mg/mL (120 mL)

Tablet, Oral:

Tenormin: 25 mg, 50 mg

Tenormin: 50 mg [DSC] [scored]

Tenormin: 100 mg

Generic: 25 mg, 50 mg, 100 mg

• Atenolol+SyrSpend SF PH4
• Tenormin

Total clearance is about 50% lower than in younger subjects. Half-life is markedly longer in elderly patients.

Atrial fibrillation (rate control)

Based on the American Heart Association/American College of Cardiology/Heart Rhythm Society (AHA/ACC/HRS) guidelines for the management of patients with atrial fibrillation, the use of beta blockers, including atenolol, for ventricular rate control in patients with paroxysmal, persistent, or permanent AF is effective and recommended for this condition.

Non-ST-elevation acute coronary syndrome

Based on the AHA/ACC guidelines for the management of non-ST-elevation ACS (NSTE-ACS), oral beta-blockers initiated within the first 24 hours, unless the patient has signs of heart failure, evidence of a low-output state, an increased risk for cardiogenic shock, or other contraindications, is effective and recommended for this condition. However, recommendations do not specify any particular beta-blocking agent for optimal treatment of NSTE-ACS. Thus, clinicians must use practical experience to determine proper therapy in managing patients.

Pediatric hypertension

Guidelines for the management of pediatric hypertension generally recommend the same drug classes that are indicated for management of adult hypertension. Particular consideration should be given to medications for which published pediatric experience is available, including appropriate dosing ranges. Similar to adults, prescribers should assess for concomitant disease states that would present a compelling indication for use of a particular drug. As a beta-blocker, atenolol would be a preferred agent for children with concomitant hypertension and migraine headaches. Other patient-specific factors, such as the potential for a patient to become pregnant while on therapy, can narrow selection. Atenolol is among the therapeutic options for pediatric hypertension identified by the National High Blood Pressure Education Program, based on published case series in children.

Supraventricular tachycardia (AV nodal reentrant tachycardia [AVNRT], AV reentrant tachycardia [AVRT], atrial flutter, focal atrial tachycardia [AT])

Based on the American College of Cardiology/American Heart Association/Heart Rhythm Society guidelines for the management of patients with supraventricular arrhythmias, the use of an oral beta blocker, including atenolol, is an effective and recommended treatment option for the ongoing management of a variety of symptomatic supraventricular tachycardias (AVNRT, AVRT, focal AT) without pre-excitation in patients who are not candidates for, or prefer not to undergo catheter ablation. Oral beta-blockers, including atenolol, may also be useful for the ongoing management (acute rate control) in hemodynamically stable patients with atrial flutter.

Additional Off-Label Uses

Acute ethanol withdrawal (in combination with a benzodiazepine); Ventricular arrhythmias

There are no dosage adjustments provided in the manufacturer’s labeling; however, atenolol undergoes minimal hepatic metabolism.

Atenolol (Tenormin) is a beta-blocker that affects the heart and circulation (blood flow through arteries and veins).

Atenolol is used to treat angina (chest pain) and hypertension (high blood pressure).

Atenolol is also used to lower the risk of death after a heart attack.

You should not use atenolol if you are allergic to it, or if you have:

• a serious heart condition such as "AV block" (second or third degree);

• very slow heartbeats; or

• heart failure.

To make sure atenolol is safe for you, tell your doctor if you have:

• congestive heart failure;

• coronary artery disease (hardened arteries);

• asthma, bronchitis, emphysema;

• diabetes;

• overactive thyroid;

• liver or kidney disease;

• pheochromocytoma (tumor of the adrenal gland);

• peripheral vascular disease such as Raynaud's syndrome; or

• allergies (or if you are undergoing allergy treatments or skin-testing).

Using atenolol during pregnancy could harm the unborn baby. Tell your doctor if you are pregnant or if you become pregnant while using this medicine.

Atenolol can pass into breast milk and may harm a nursing baby. Tell your doctor if you are breast-feeding a baby.

Atenolol is not approved for use by anyone younger than 18 years old.

Atenolol works on heart-specific receptors to lower blood pressure and slow heart rate; however, this selective effect on the heart may be lost with dosages greater than 50mg/day which increases the risk that atenolol may adversely affect breathing.

Use with caution Excreted into human milk: Yes Comments: -Clinically significant bradycardia has occurred; monitor breastfed infants, especially newborns and with high maternal doses, for signs of beta blockade.

This drug is excreted into human breast milk at a ratio of 1.5 to 6.8 when compared to the plasma concentration. Signs of beta blockade, such as bradycardia, hypotension, and hypoglycemia, have been observed in breastfed infants. Neonates younger than 3 months of age, infants with impaired renal function, and high maternal doses, are at increased risk due to high renal excretion of this drug and its potential for accumulation in the breastmilk. The risk in older infants appears to be lower.

You should not use atenolol if you are allergic to it, or if you have:

• a serious heart condition such as "AV block" (second or third degree);

• very slow heartbeats; or

• heart failure.

To make sure atenolol is safe for you, tell your doctor if you have:

• congestive heart failure;

• coronary artery disease (hardened arteries);

• asthma, bronchitis, emphysema;

• diabetes;

• overactive thyroid;

• liver or kidney disease;

• pheochromocytoma (tumor of the adrenal gland);

• peripheral vascular disease such as Raynaud's syndrome; or

• allergies (or if you are undergoing allergy treatments or skin-testing).

Using atenolol during pregnancy could harm the unborn baby. Tell your doctor if you are pregnant or if you become pregnant while using this medicine.

Atenolol can pass into breast milk and may harm a nursing baby. Tell your doctor if you are breast-feeding a baby.

Atenolol is not approved for use by anyone younger than 18 years old.

Get emergency medical help if you have signs of an allergic reaction: hives; difficult breathing; swelling of your face, lips, tongue, or throat.

Call your doctor at once if you have:

• new or worsening chest pain;

• slow or uneven heartbeats;

• a light-headed feeling, like you might pass out;

• shortness of breath (even with mild exertion), swelling, rapid weight gain; or

• a cold feeling in your hands and feet.

Common side effects may include:

• dizziness;

• feeling tired; or

• depressed mood.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.