Tenormin

IV Incompatibilities

Y-site: Amphotericin B cholesteryl sulfate

IV Compatibilities

Y-site: Meperidine, meropenem, morphine sulfate

IV Administration

Administer by slow IV infusion at 1 mg/min, either directly undiluted or diluted with D5W or NS

Storage

Store intact ampoules at room temperature

Protect from light

Admixture in dextrose and NaCl-containing solution is stable for 48 hours

Appropriate studies have not been performed on the relationship of age to the effects of atenolol in the pediatric population. Safety and efficacy have not been established .

Tenormin is a prescription medication used to treat high blood pressure (hypertension), to prevent angina (chest pain), and to improve survival after a heart attack. Tenormin belongs to a group of drugs called beta blockers, which relax blood vessels and reduce heart rate.

This medication comes in tablet form and is taken once or twice a day, with or without food. Tenormin is also available in an injectable form to be given directly into a vein (IV) by a healthcare professional.

Common side effects include tiredness, nausea, and dizziness. Do not drive or operate heavy machinery until you know how Tenormin affects you.

Tenormin is a prescription medicine used alone or in combination with other medicines to treat high blood pressure. It also is used to prevent angina (chest pain) and improve survival after a heart attack.

This medication may be prescribed for other uses. Ask your doctor or pharmacist for more information.

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.

Before taking Tenormin,

• tell your doctor and pharmacist if you are allergic to Tenormin or any other medications.
• tell your doctor if you have or have ever had asthma or other lung disease; diabetes; severe allergies; an overactive thyroid gland (hyperthyroidism); pheochromocytoma; heart failure; a slow heart rate; circulation problems; or heart or kidney disease.
• tell your doctor if you are pregnant, plan to become pregnant, or are breast-feeding. If you become pregnant while taking Tenormin, call your doctor immediately.
• if you are having surgery, including dental surgery, tell the doctor or dentist that you are taking Tenormin.
• you should know that if you have allergic reactions to different substances, your reactions may be worse while you are using Tenormin, and your allergic reactions may not respond to the usual doses of injectable epinephrine.

Tenormin can cause dizziness or drowsiness. Do not drive or operate heavy machinery until you know how Tenormin affects you.

Tenormin should not be taken/contraindicated if you:

• have sinus bradycardia, heart block greater than first degree, cardiogenic shock, and overt cardiac failure. These conditions are diagnosed by your doctor.
• have an allergy to Tenormin 

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 Tenormin 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 pregnant or plan to become pregnant. 

The FDA categorizes medications based on safety for use during pregnancy. Five categories - A, B, C, D, and X, are used to classify the possible risks to an unborn baby when a medication is taken during pregnancy.

Tenormin falls into category D. It has been shown that use of Tenormin in pregnant women caused some babies to be born with problems. Tenormin can cause fetal harm when administered to a pregnant woman. Tenormin crosses the placental barrier and appears in cord blood. Tenormin use in pregnant women resulted in children born small in size with low sugar and slow heart rate.  Caution should be exercised Tenormin is used during pregnancy or to a woman who is breast feeding. However, in some serious situations, the benefit of using this medication may be greater than the risk of harm to the baby.

Take the missed dose as soon as you remember. Skip the missed dose if it is almost time for your next scheduled dose. Do not take extra medicine to make up the missed dose.

β1-Selective adrenergic blocking agent (β-blocker).111 118 120 c

• Inhibits response to adrenergic stimuli by competitively blocking β1-adrenergic receptors within the myocardium.c Blocks β2-adrenergic receptors within bronchial and vascular smooth muscle only in high doses (e.g., >100 mg daily).c

• Decreases resting and exercise-stimulated heart rate and reflex orthostatic tachycardia by about 25–35%.c Slows AV nodal conduction.c

• No intrinsic sympathomimetic activity and little or no membrane-stabilizing effect on the heart.c

• Reduces BP by decreasing cardiac output, suppressing renin release, and/or decreasing sympathetic outflow from the CNS.c

• In patients with angina pectoris, blocks catecholamine-induced increases in heart rate, myocardial contractility, and BP, resulting in decreased myocardial oxygen consumption.111 120 c

• Possibly increases oxygen requirements in patients with heart failure due to increased left ventricular fiber length and end diastolic pressure.111

• Increases airway resistance (at doses >100 mg) in patients with asthma and/or COPD.c

• Produces little or no changes in serum insulin concentrations, time to recovery from insulin-induced hypoglycemia, or free fatty acid response to hypoglycemia.c

Excipients in commercially available drug preparations may have clinically important effects in some individuals; consult specific product labeling for details.

Please refer to the ASHP Drug Shortages Resource Center for information on shortages of one or more of these preparations.

* available from one or more manufacturer, distributor, and/or repackager by generic (nonproprietary) name

* available from one or more manufacturer, distributor, and/or repackager by generic (nonproprietary) name

In addition to the use of this medicine, treatment for your high blood pressure may include weight control and changes in the types of foods you eat, especially foods high in sodium. Your doctor will tell you which of these are most important for you. You should check with your doctor before changing your diet .

Many patients who have high blood pressure will not notice any signs of the problem. In fact, many may feel normal. It is very important that you take your medicine exactly as directed and that you keep your appointments with your doctor even if you feel well .

Remember that this medicine will not cure your high blood pressure, but it does help control it. You must continue to take it as directed if you expect to lower your blood pressure and keep it down. You may have to take high blood pressure medicine for the rest of your life. If high blood pressure is not treated, it can cause serious problems such as heart failure, blood vessel disease, stroke, or kidney disease .

Do not interrupt or stop taking this medicine without first checking with your doctor. Your doctor may want you to gradually reduce the amount you are taking before stopping it completely. Some conditions may become worse when the medicine is stopped suddenly, which can be dangerous .

Dosing

The dose of this medicine will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of this medicine. If your dose is different, do not change it unless your doctor tells you to do so.

The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.

• For oral dosage form (tablets):
  • For acute heart attack:
    • Adults—50 milligrams (mg) ten minutes after the last intravenous (IV) dose followed by another 50 mg twelve hours later. Then, 100 mg once a day or 50 mg two times a day for another 6 to 9 days or until discharge from the hospital.
    • Children—Use and dose must be determined by your doctor .
  • For chest pain:
    • Adults—At first, 50 milligrams (mg) once a day. Your doctor may increase your dose if needed.
    • Children—Use and dose must be determined by your doctor .
  • For high blood pressure:
    • Adults—At first, 50 milligrams (mg) once a day. Your doctor may increase your dose if needed.
    • Children—Use and dose must be determined by your doctor .

Missed Dose

If you miss a dose of this medicine, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not double doses.

Storage

Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light. Keep from freezing.

Keep out of the reach of children.

Do not keep outdated medicine or medicine no longer needed.

Ask your healthcare professional how you should dispose of any medicine you do not use.

Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor immediately if any of the following side effects occur:

• 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

• 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

• 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

• 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

Get emergency help immediately if any of the following symptoms of overdose occur:

• 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 side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

• Discouragement
• feeling sad or empty
• irritability
• lack of appetite
• loss of interest or pleasure
• trouble concentrating
• trouble sleeping

• Diarrhea
• dream activity
• feeling of constant movement of self or surroundings
• sensation of spinning
• sleepiness

• 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

Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.

Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.

NDC 0310-0101-10

100 tablets

Tenormin®

(atenolol)

100 mg tablets

Rx only

Manufactured for:

AstraZeneca Pharmaceuticals LP

Wilmington, DE 19850

By: IPR Pharmaceuticals, Inc.

Canóvanas, PR 00729

Product of Italy

AstraZeneca

Tell your doctor about all your current medicines and any you start or stop using, especially:

• digoxin, digitalis;

• indomethacin;

• any other beta-blocker--bisoprolol, carvedilol, labetalol, metoprolol, nebivolol, propranolol, sotalol, timolol, and others; or

• heart or blood pressure medication--amiodarone, clonidine, diltiazem, disopyramide, nicardipine, nifedipine, reserpine, verapamil, and others.

This list is not complete. Other drugs may interact with atenolol, including prescription and over-the-counter medicines, vitamins, and herbal products. Not all possible interactions are listed in this medication guide.