Atenolol - a selective Beta-1 receptor blocker

Atenolol selectively blocks beta-1 receptors while having little to no impact on beta-2 receptors.

It is used to treat the following conditions:

  • To treat hemodynamically stable individuals with acute myocardial infarction in order to lower cardiovascular mortality.

    • The ACC/ AHA recommend initiating beta-blocking drugs within the first 24 hours except in the following situations:
      • contraindications to beta-blocking drugs exist
      • evidence of a low output state
      • clinical features of heart failure
      • increased risk of cardiogenic shock
  • For the chronic management of Angina pectoris

  • For the management of hypertension (Beta-blockers are not considered as first-line therapy)

  • As Off-Label Use in the following conditions:

    • For rate control in Atrial fibrillation

    • Supraventricular tachycardia

      • AV nodal reentrant tachycardia

      • AV re-entrant tachycardia

      • Atrial flutter

      • Focal atrial tachycardia

    • Thyrotoxicosis

    • Ventricular Arrhythmias

 

Dose in the treatment of Angina pectoris:

  • One daily oral dose of 50 mg
  • To 100 mg once daily, the dosage can be raised.
  • Some people may receive oral doses of up to 200 mg once daily.

Dose for the treatment of rate control in Atrial fibrillation as off-label use:

  • 25 - 100 mg once a day.

Dose as an alternative agent in the treatment of Hypertension:

  • One daily oral dose of 50 mg
  • Every week or two, the dosage should be increased until it reaches the typical daily maximum of 100 mg.

Dose in the treatment of ST-elevation Myocardial infarction or Non-ST-elevation Acute coronary syndrome:

  • 50 - 100 mg orally in 1 or 2 divided doses.
  • After a myocardial infarction, it should start within 24 hours and persist permanently.

Dose in the treatment of Supraventricular tachycardia as off-label use:

  • 25 - 50 mg orally once a day to a maximum maintenance dose of 100 mg/day.

Dose in the treatment of Thyrotoxicosis as off-label use:

  • 25 - 100 mg orally once or two times a day.

Dose in the treatment of Ventricular arrhythmias as off-label use:

  • 25 - 100 mg/day orally

 

Dose in the treatment of Arrhythmias:

  • Infants, Children, and Adolescents:
    • Long QT syndrome:
      • 0.5 - 1 mg/kg/day orally once a day or in two divided doses.
    • Supraventricular tachycardia:
      • 0.3 - 1 mg/kg/day orally once a day or in two divided doses.

Dose in the treatment of infantile Hemangioma:

  • Infants and Children less than 2 years:
    • 1 mg/kg/dose orally once a day for 6 months.

Dose in the treatment of Hypertension:

  • Children and Adolescents:
    • 0.5 - 1 mg/kg/day orally either once a day or divided into doses two times a day
    • The dose should be titrated to the usual dosage range of 0.5 - 1.5 mg/kg/day.
    • The maximum daily dose is 2 mg/kg/day (not exceeding 100 mg/day).

Dose in the treatment of Thyrotoxicosis: 

  • Children and Adolescents:
    • 1 - 2 mg/kg orally once a day
    • The dose may be increased to two times a day if needed
    • The maximum dose should not exceed 100 mg/dose.

Pregnancy Risk Factor D

  • Atenolol can have harmful consequences on the foetus, including hypoglycemia, bradycardia, and lower birth weight since it passes the placental barrier when taken by the mother.
  • The use of alternative medications rather than atenolol is preferable despite the fact that beta-blockers can be used to treat hypertension during pregnancy.

Atenolol use during breastfeeding:

  • Breast milk contains atenolol.
  • Breastfeeding infants may experience hypoglycemia and Bradycardia.
  • Lactating mothers should be cautious when using it.

Atenolol Dose in Renal Disease:

  • CrCl of more than 35 mL/minute/1.73 m² :
    • Adjustment in the dose is not necessary.
  • CrCl 15 - 35 mL/minute/1.73 m² :
    • The daily intake shouldn't be higher than 50 mg.
  • CrCl of less than 15 mL/minute/1.73 m²:
    • The daily intake shouldn't be higher than 25 mg.
  • Hemodialysis:
    • It is moderately dialyzable (20% - 50%)
    • After dialysis, give the dose or give an additional dose of 25–50 mg.
  • Peritoneal dialysis:
    • After peritoneal dialysis, the extra dose is not required.

Atenolol Dose in Liver Disease:

  •  Atenolol undergoes minimal hepatic metabolism.
  • The manufacturer does not recommend any dose adjustment in patients with liver disease.

Common Side Effects of Atenolol Include:

  • Cardiovascular:
    • Hypotension
    • Cardiac failure
    • Bradycardia
    • Ventricular tachycardia
    • Cold extremities
    • Supraventricular tachycardia
  • Central nervous system:
    • Fatigue
    • Dizziness
    • Depression

Less Common Side Effects of Atenolol Include:

  • Cardiovascular:
    • Bundle branch block
    • Atrial fibrillation
    • Heart block
    • Atrial flutter
    • Orthostatic hypotension
    • Pulmonary embolism
  • Central nervous system:
    • Abnormal dreams
    • Lethargy
    • Vertigo
    • Drowsiness
  • Gastrointestinal:
    • Nausea
    • Diarrhea
  • Neuromuscular & skeletal:
    • Limb pain
  • Respiratory:
    • Bronchospasm

Contraindication to Atenolol Include:

  • Severe allergic reactions to atenolol and any component of the formulations
  • Inotropic support and intravenous vasopressors are required for decompensated cardiac failure
  • Allergy bronchial asthma
  • Second- or third-degree block of AV,
  • Sick sinus syndrome
  • Bradycardia severe
  • Cardiogenic shock
  • Advanced liver impairment
  • Hypotension severe
  • Primary obstructive valve heart disease
  • Patients suffering from severe Alzheimer disease, addiction, or drug abuse should be closely monitored.
  • Cor pulmonale
  • Severe peripheral arterial disease
  • Pheochromocytoma without alpha-blockade
  • Metabolic acidosis

Warnings and Precautions

  • Anaphylactic reactions
    •  It should not be used by those who have a known allergy to beta-blockers.
    • Patients who experience a drug hypersensitivity reaction should be advised to stop using it and treated accordingly.
    • Furthermore, people who have had an allergic reaction to a beta-blocker may not respond well to epinephrine.
  • Bronchospastic disease
    • Beta-blockers should not be prescribed to patients with asthma or any other disorder that affects the reactive airways.
  • Conductive abnormality
    • Patients suffering from heart disease and sick sinus syndrome should not take the drug.
  • Diabetes:
    • It can increase hypoglycemia, mask its clinical symptoms like anxiety, sweating, and tachycardia.
    • Patients with heart failure who are diabetics may have hypoglycemia.
  • Heart failure:
    • Patients with heart failure have not been shown to benefit from Atenolol.
    • You should use it with caution. The patient should be closely monitored for signs of heart failure.
  • Myasthenia gravis:
    • Patients with myasthenia Gravis should use it with caution.
  • Raynaud and peripheral vascular disease (PVD).
    • Patients with peripheral arterial disease should use caution.
  • Untreated Pheochromocytoma
    • Beta-blockers should be prescribed to patients with pheochromocytoma after taking alpha-blockers.
  • Angina Prinzmetal version:
    • Prinzmetal variant of angina patients should be avoided.
    • Coronary vasoconstriction can be caused by alpha1-adrenergic cells. 
    • Avoid beta-blockers that do not block alpha1 receptor activity as they can cause anginal symptoms.
  • Psoriasis:
    • It can worsen the symptoms of psoriasis.
  • Renal impairment
    • Patients with kidney disease should use it with caution.
    • Dose adjustment is necessary.
  • Thyroid disease:
    • It can mask hyperthyroidism symptoms. Patients with hyperthyroidism may experience a thyroid crisis or storm if beta-blockers abruptly stop.

Atenolol: Drug Interaction

Note: Drug Interaction Categories:

  • Risk Factor C: Monitor When Using Combination
  • Risk Factor D: Consider Treatment Modification
  • Risk Factor X: Avoid Concomitant Use

Risk Factor C (Monitor therapy).

Acetylcholinesterase inhibitors Beta-Blockers may increase the bradycardic effects.
Alfuzosin Might increase the hypotensive effects of Blood Pressure Lowering Agents.
Alpha1-Blockers Beta-Blockers can increase the orthostatic hypotensive effects of Alpha1Blockers. Ophthalmic products are less likely to be a risk than systemic ones.
Amiodarone Beta-Blockers may increase bradycardic effects. Possible to cause cardiac arrest. Amiodarone could increase serum Beta-Blockers.
Amphetamines May lessen the effects of antihypertensive medications in treating hypertension.
Ampicillin Atenolol's bioavailability and potency can be decreased.
Antipsychotic Agents, Second Generation (Atypical) Antipsychotic drugs can have a greater hypotensive effect when blood pressure-lowering medications are used (Second Gen [Atypical]).
Bacampicillin Atenolol's bioavailability and potency can be decreased.
Barbiturates May intensify blood pressure lowering medications' hypotensive effects.
Benperidol May intensify blood pressure lowering medications' hypotensive effects.
Beta2-Agonists Beta2-Agonists can have their bronchodilatory effects lessened by beta-blockers (Beta1 selective). Nonselective beta-blockers and greater doses of beta1-selective beta-blockers are of particular concern.
Bradycardia-Causing Agents May intensify the bradycardia-causing agents' bradycardic effects.
Bretylium May increase the bradycardic effects of Bradycardia Causing Agents. Patients receiving AV blocking drugs may experience a reduction in atrioventricular (AV), blockage due to Bretylium.
Brigatinib May decrease the antihypertensive effects of Antihypertensive Drugs. Brigatinib could increase the bradycardic effects of Antihypertensive Drugs.
Brimonidine (Topical) Might increase the hypotensive effects of Blood Pressure Lowering Agents.
Bupivacaine Beta-Blockers can increase serum Bupivacaine concentrations.
Calcium Channel Blockers (Nondihydropyridine) BetaBlockers may increase the hypotensive effects. Also, signs of heart disease and Bradycardia have been reported. Calcium Channel Blockers (Nondihydropyridine), may increase serum Beta-Blockers. Exceptions: Bepridil.
Cardiac Glycosides Beta-Blockers can increase the bradycardic effects of Cardiac Glycosides.
Cholinergic Agonists Beta-Blockers could increase the toxic/adverse effects of Cholinergic Agonists. Particular concerns are the possibility of cardiac conduction abnormalities or bronchoconstriction. Administration: Use these agents with caution and monitor for conduction problems. Due to the possibility of additive bronchoconstriction, avoid methacholine and any beta-blocker.
Dexmethylphenidate Antihypertensive agents may have a less therapeutic effect.
Diazoxide May intensify blood pressure lowering medications' hypotensive effects.
Dipyridamole The consequences of bradycardia could be amplified by beta-blockers.
Disopyramide Beta-Blockers may increase the bradycardic effects. Disopyramide may have a negative inotropic effect that Beta-Blockers can enhance.
DULoxetine DULoxetine may increase hypotensive effects by lowering blood pressure.
EPINEPHrine (Nasal) The therapeutic effects of EPINEPHRINE can be diminished by beta-blockers (Beta1 selective).
EPINEPHrine (Oral Inhalation) The therapeutic effects of EPINEPHRINE can be diminished by beta-blockers (Beta1 selective).
Epinephrine (Racemic) The therapeutic effects of EPINEPHRINE can be diminished by beta-blockers (Beta1 selective).
EPINEPHrine Systemic The therapeutic effects of EPINEPHRINE Systemic may be diminished by beta-blockers (Beta1 selective).
Glycopyrrolate (Systemic) May raise serum amounts of atenolol
Herbs (Hypertensive Properties) May decrease the antihypertensive effects of Antihypertensive Drugs.
Herbs (Hypotensive properties) Might increase the hypotensive effects of Blood Pressure Lowering Agents.
Hypotension-Associated Agents Blood Pressure Lowering Agents may enhance the hypotensive effect of Hypotension-Associated Agents.
Insulins Beta-Blockers can increase the hypoglycemic effects of Insulins.
Ivabradine Bradycardia-Causing agents may increase the bradycardic effects of Ivabradine.
Lacosamide Bradycardia-Causing Agents can increase the AV-blocking effects of Lacosamide.
Levodopa-Containing Products Blood Pressure Lowering Agents can increase the hypotensive effects of Levodopa -Containing Products.
Lidocaine (Systemic) Beta-Blockers can increase serum levels of Lidocaine (Systemic).
Lidocaine (Topical) Beta-Blockers can increase serum Lidocaine (Topical) concentrations
Lormetazepam Might increase the hypotensive effects of Blood Pressure Lowering Agents.
Mepivacaine Beta-Blockers can increase serum levels of Mepivacaine.
Methoxyflurane May increase the hypotensive effects of Beta-Blockers.
Methylphenidate May decrease the antihypertensive effects of Antihypertensive Drugs.
Midodrine May increase the bradycardic effects of Bradycardia Causing Agents.
Molsidomine Might increase the hypotensive effects of Blood Pressure Lowering Agents.
Naftopidil Might increase the hypotensive effects of Blood Pressure Lowering Agents.
Nicergoline Might increase the hypotensive effects of Blood Pressure Lowering Agents.
Nicorandil Might increase the hypotensive effects of Blood Pressure Lowering Agents.
NIFEdipine May increase the hypotensive effects of Beta-Blockers. NIFEdipine could increase the negative inotropic effects of Beta-Blockers.
Nitroprusside The hypotensive effects of Nitroprusside may be enhanced by blood pressure lowering agents.
Nonsteroidal Anti-Inflammatory Drugs BetaBlockers may have a lower antihypertensive impact.
Opioids (Anilidopiperidine) Beta-Blockers may increase the bradycardic effects. Anilidopiperidine and other opioids may increase the hypotensive effects of Beta-Blockers.
Pentoxifylline May intensify blood pressure lowering medications' hypotensive effects.
Pholcodine By reducing blood pressure, pholocdine may exacerbate hypotension.
Phosphodiesterase 5 Inhibitors May intensify blood pressure lowering medications' hypotensive effects.
Prostacyclin Analogues May intensify blood pressure lowering medications' hypotensive effects.
Quinagolide May intensify blood pressure lowering medications' hypotensive effects.
Regorafenib The consequences of bradycardia could be amplified by beta-blockers.
Reserpine May intensify beta-blockers' hypotensive effects.
Ruxolitinib Bradycardia-Causing Agents' bradycardic effects might be amplified. Management: The Canadian product labels for roxolitinib advise against using any medication that can cause bradycardia.
Sulfonylureas Beta-Blockers can increase the hypoglycemic effects of sulfonylureas. Nonselective beta blockers may be more dangerous than cardioselective betablockers. As an initial sign of hypoglycemia, all beta-blockers seem to be able to mask tachycardia. Ophthalmic beta blockers are likely to be associated with a lower risk than systemic drugs.
Terlipressin Bradycardia Causing Agents may have more bradycardic effects.
Theophylline Derivatives Theophylline Derivates can have their bronchodilatory effects lessened by beta-blockers (Beta1 selective). Monitoring: Keep an eye out for any diminished theophylline effectiveness when taking a beta-blocker at the same time. Beta-1 selective drugs may lose their selectivity at larger doses, although they are less likely to antagonise beta-phylline than nonselective drugs.
Tofacitinib May increase the bradycardic effects of Bradycardia Causing Agents.
Yohimbine May decrease the antihypertensive effects of Antihypertensive Drugs.

Risk Factor D (Consider therapy modifications)

 
Alpha2-Agonists Beta-Blockers may have an AV-blocking effect that is greater. It is possible to increase the risk of sinus node dysfunction. Beta-Blockers can increase the rebound hypertensive effect Alpha2Agonists. This can happen if the Alpha2-Agonist abruptly withdraws. Treatment: Monitor your heart rate closely while you are taking clonidine and beta blockers. When possible, stop taking beta blockers a few days before you begin clonidine withdrawal. Also, monitor your blood pressure carefully. We do not have any recommendations for alpha2-agonists. Apraclonidine is an exception.
Amifostine The hypotensive effects of amifostine may be strengthened by blood pressure reducing medications. Treatment: Patients receiving chemotherapy should stop taking blood pressure medications at least 24 hours before receiving amifostine. If taking blood pressure medicine cannot be stopped, amifostine should be avoided.
Ceritinib Bradycardia-inducing substances may intensify the bradycardic effects of ceritinib. Management: If the combination is not possible, keep a close eye out for bradycardia symptoms in patients, and closely monitor blood pressure and heart rate throughout treatment. Various monographs will go through the exceptions.
Dronedarone Beta-blockers may intensify the consequences of bradycardia. Dronedarone may elevate serum levels of beta-blockers. This is most likely accurate only for substances that use CYP2D6 for metabolism. Treatment: It is advised to start taking beta-blockers at lower doses. The patient's ability to tolerate the combination should be confirmed by the results of the ECG.
Ergot Derivatives The vasoconstrictive effects of ergot derivatives can be enhanced by beta-blockers. The exception is Nicergoline.
Fingolimod Fingolimod may intensify beta-blockers' bradycardic effects. Avoid using fingolimod and beta-blockers concurrently, if at all feasible. Overnight ECG abnormalities in patients who need coadministration should be watched for. Bradycardia should be kept an eye on in patients.
Grass Pollen Allergen Extract (5 Grass Extract) Beta-Blockers could increase the toxic/adverse effects of Grass Pollen Extract (5 Grass) More specifically, Beta-Blockers may inhibit the ability to effectively treat severe allergic reactions to Grass Pollen Allergen Extract (5 Grass Extract) with epinephrine. Other effects of epinephrine might not be affected or even increased by Beta-Blockers.
Obinutuzumab This may increase the hypotensive effects of Blood Pressure Lowering Agents. Management: You may temporarily withhold blood pressure lowering medication beginning 12 hours before obinutuzumab injection and continuing for 1 hour after infusion.
Siponimod Bradycardia-Causing Drugs can increase Siponimod's bradycardic effects. Management: Siponimod should not be taken with bradycardia-causing drugs.

Risk Factor X (Avoid Combination)

 
Bromperidol Bromperidol's hypotensive effects may be enhanced by Blood Pressure Lowering agents. Bromperidol could decrease the hypotensive effects of Blood Pressure Lowering agents.
Floctafenine Beta-Blockers may have an adverse/toxic effect that can be increased.
Methacholine Beta-Blockers can increase the toxic/adverse effects of Methacholine.
Rivastigmine Beta-Blockers may increase the bradycardic effects.

Monitoring Parameters:

  • Patients receiving acute cardiac treatment:
    • Monitor Blood pressure and ECG.
  • Patients receiving atenolol for hypertension, monitor:
    • Blood pressure
    • Heart rate
    • Plasma glucose
  • Target Blood Pressure in patients with confirmed hypertension and known CVD or 10-year ASCVD risk of greater than 10%:
    • Less than 130/80 mm Hg is recommended.
  • Target Blood pressure in patients with confirmed hypertension without markers of increased ASCVD risk:
    • Less than 130/80 mm Hg may be reasonable. 

How to administer Atenolol?

It may be administered orally without regard to meals.

Mechanism of action of Atenolol:

It preferentially blocks Beta-1 receptors, inhibiting adrenergic activation, with little to no action on Beta-2 receptors until used in high concentrations.

It has beenThe beginning of actionThe peak effect lasts for less than an hour, and is visible in between 2 and 4 hours after oral administration. Normal renal function patients have a Beta-blocking effect lasting 12-24 hours. The antihypertensive effect is 24 hours. Half the drug is absorbed by oral administration, and half is absorbed quickly.absorbed. It is not blood-brain-barrier-crossing and minimally protein-bound.

The half-life elimination varies with age:

  • Newborns less than 24 hours of age (who are born to mothers receiving atenolol):
    • 16 hours (up to 35 hours)
  • Children and Adolescents 5 -16 years of age:
    • 4.6 hours (ranging from 3.5 - 7 hours)
  • Adults:
    • Normal renal function: 6 - 7 hours
    • End-stage renal disease (ESRD): 15 - 35 hours

The time to peak plasma concentration after oral intake is 2 - 4 hours. Half of it is excreted in the feces while the other half in urine as unchanged drug.  

International Brands of Atenolol:

  • Ablok
  • Alonet
  • Altol
  • Angipress
  • Angiten
  • Antipressan
  • Apo-Atenol
  • Atarox
  • Atcord
  • Atecard
  • Atecor
  • AteHexal
  • Atehexal
  • Atenal
  • Atendol
  • Atenex
  • Ateni
  • Atenil
  • Ateno
  • Atenobene
  • Atenocor
  • Atenodan
  • Atenodeks
  • Atenol
  • Atenolin
  • Atenolol Pharmavit
  • Atenolol von ct
  • Atestad
  • Atinol
  • Atoken
  • Atonium
  • Atormin
  • B-Vasc
  • Betablok
  • Betacar
  • Betacard
  • Betaday
  • Betaten
  • Betatop Ge
  • Beten
  • Betenol
  • Biofilen
  • Bloket
  • Blokium
  • Blotex
  • Cardioten
  • Catenol
  • Corotenol
  • Durabeta
  • Enolol
  • Etnol
  • Felo-Bits
  • Hiblok
  • Hipros
  • Hypernol
  • Internol
  • Internolol
  • Lorten
  • Lotenal
  • Myocord
  • Normalol
  • Normaten
  • Normiten
  • Normoten
  • Nortelol
  • Noten
  • Oraday
  • Ormidol
  • Plenacor
  • Prenolol
  • Pretenol
  • Prinorm
  • Procor
  • Rotelol
  • Serten
  • Stermin
  • Tenamed
  • Tendiol
  • Tenoblock
  • Tenocard
  • Tenocor
  • Tenol
  • Tenoloc
  • Tenolol
  • Tenopress
  • Tenoprin
  • Tenoren
  • Tenormin
  • Tenormin ICN
  • Tenormine
  • Tenorvas
  • Tensig
  • Tensinor
  • Tensotin
  • Ternolol
  • Totamol
  • Trantalol
  • Trebanol
  • Tredol
  • Urosin
  • Vascoten
  • Velorin
  • Wesipin

Atenolol Brands in Pakistan:

Atenolol [Tabs 5 mg]

Trobel Zinta Pharmaceuticals Industries

Atenolol [Tabs 10 Mg]

Trobel Zinta Pharmaceuticals Industries

Atenolol [Tabs 25 Mg]

Atelor Pharmedic (Pvt) Ltd.
Atenopharm Epharm Laboratories
Atenoscot Scotmann Pharmaceuticals
Atlin Bosch Pharmaceuticals (Pvt) Ltd.
Atomin Semos Pharmaceuticals (Pvt) Ltd.
Betafix Johnson & Johnson Pakistan (Pvt) Ltd
Blokium Highnoon Laboratories Ltd.
Cardaxen Platinum Pharmaceuticals (Pvt.) Ltd.
Cardi Benson Pharamceuticals.
Cardiolite Continental Chemical Company (Pvt) Ltd.
Cardiwin Wns Field Pharmaceuticals
Careeb Shaheen Pharmaceuticals
Caten Atco Laboratories Limited
Controbeat Pfizer Laboratories Ltd.
Diolit Medicaids Pakistan (Pvt) Ltd.
Ezilife Davis Pharmaceutical Laboratories
Harten Pharmatec Pakistan (Pvt) Ltd.
Jingle Scotmann Pharmaceuticals
K-Nol Akson Pharmaceuticals (Pvt) Ltd.
Kvik Webros Pharmaceuticals
Normitab Nabiqasim Industries (Pvt) Ltd.
Qunoten Novartis Pharma (Pak) Ltd
Tenormin Ici Pakistan Ltd.
Totamol Bio Pharma

Atenolol [Tabs 50 Mg]

Adonax Evron (Pvt) Ltd.
Anglolol Euro Pharma International
Atecard Medizan Labs (Pvt) Ltd
Atelor Pharmedic (Pvt) Ltd.
Atenblock Everest Pharmaceuticals
Ateno-Heart Friends Pharma (Pvt) Ltd
Atenocard Mediate Pharmaceuticals (Pvt) Ltd
Atenolol Ideal Pharmaceutical Industries
Atenolol Batala Pharmaceuticals.
Atenopharm Epharm Laboratories
Atenorm Ferozsons Laboratoies Ltd.
Atenosaf Saaaf Pharmaceuticals
Atenoscot Scotmann Pharmaceuticals
Atl Mega Pharmaceuticals (Pvt) Ltd
Atlin Bosch Pharmaceuticals (Pvt) Ltd.
Atn Flow Pharmaceuticals (Pvt) Ltd.
Atril Star Laboratories (Pvt) Ltd.
Atromin Noa Hemis Pharmaceuticals
B-Loc Nova Med Pharmaceuticals
Bekolol Hygeia Pharmaceuticals
Betafix Johnson & Johnson Pakistan (Pvt) Ltd
Blocker Dosaco Laboratories
Blokium Highnoon Laboratories Ltd.
Cardat Jawa Pharmaceuticals(Pvt) Ltd.
Cardaxen Platinum Pharmaceuticals (Pvt.) Ltd.
Cardexol Syntex Pharmaceuticals
Cardi Benson Pharamceuticals.
Cardilol Ipram International
Cardiolite Continental Chemical Company (Pvt) Ltd.
Cardiwin Wns Field Pharmaceuticals
Careeb Shaheen Pharmaceuticals
Caricard Bryon Pharmaceuticals (Pvt) Ltd.
Carilif Friends Pharma (Pvt) Ltd
Cartac English Pharmaceuticals Industries
Cartac English Pharmaceuticals Industries
Caten Atco Laboratories Limited
Co-Pulse Werrick Pharmaceuticals
Controbeat Pfizer Laboratories Ltd.
Coxalol Searle Pakistan (Pvt.) Ltd.
Diolit Medicaids Pakistan (Pvt) Ltd.
Eourmin Unexo Labs (Pvt) Ltd.
Eplacard-50 Epla Laboratories (Pvt) Ltd.
Ethinolol Ethical Laboratories (Pvt) Ltd.
Eurocard Euro Pharma International
Ezilife Davis Pharmaceutical Laboratories
Harten Pharmatec Pakistan (Pvt) Ltd.
Hetolol Healers Laboratories
Hypernol Geofman Pharmaceuticals
Iqanol Karachi Chemical Industries
Jeotol Pulse Pharmaceuticals
Jingle Scotmann Pharmaceuticals
K-Nol-50 Akson Pharmaceuticals (Pvt) Ltd.
Kantrol Helicon Pharmaceutek Pakistan (Pvt) Ltd.
Konduct Fynk Pharmaceuticals
Kvik Webros Pharmaceuticals
Maklol Makson Pharmaceuticals
Medi-Heart Medicon Pharmaceuticals Industries (Pvt) Ltd
Minocard Pearl Pharmaceuticals
Nomin Efroze Chemical Industries (Pvt) Ltd.
Normitab Nabiqasim Industries (Pvt) Ltd.
Nortenalol A.J. & Company.
Plinol Pliva Pakistan (Pvt) Limited
Pulsbit-50 Epoch Pharmaceutical
Pulse Werrick Pharmaceuticals
Qunoten Novartis Pharma (Pak) Ltd
Rocard Rock Pharmaceuticals
Safecard Irza Pharma (Pvt) Ltd.
Sydlol Saydon Pharmaceutical Industries (Pvt) Ltd.
Tenif Gray`S Pharmaceuticals
Tenormin Ici Pakistan Ltd.
Tinocard-50 Caylex Pharmaceuticals (Pvt) Ltd.
Totamol Bio Pharma
Tynotin Selmore Agencies
Wilnormin Wilshire Laboratories (Pvt) Ltd.
Wnsol Welmark Pharmaceuticals
Zafnol Zafa Pharmaceutical Laboratories (Pvt) Ltd.

Atenolol [Tabs 100 Mg]

Adonax Evron (Pvt) Ltd.
Alt Xenon Pharmaceuticals (Pvt) Ltd.
Anglolol Euro Pharma International
Atecard Medizan Labs (Pvt) Ltd
Atelor Pharmedic (Pvt) Ltd.
Atenblock Everest Pharmaceuticals
Ateno-Heart Friends Pharma (Pvt) Ltd
Atenolol Pliva Pakistan (Pvt) Limited
Atenolol Zafa Pharmaceutical Laboratories (Pvt) Ltd.
Atenolol Ideal Pharmaceutical Industries
Atenopharm Epharm Laboratories
Atenorm Ferozsons Laboratoies Ltd.
Atenosaf Saaaf Pharmaceuticals
Atenoscot Scotmann Pharmaceuticals
Atl Mega Pharmaceuticals (Pvt) Ltd
Atlin Bosch Pharmaceuticals (Pvt) Ltd.
Atn Flow Pharmaceuticals (Pvt) Ltd.
Atril Star Laboratories (Pvt) Ltd.
Atromin Noa Hemis Pharmaceuticals
B-Loc Nova Med Pharmaceuticals
Bekolol Hygeia Pharmaceuticals
Blocker Dosaco Laboratories
Blokium Highnoon Laboratories Ltd.
Cardat Jawa Pharmaceuticals(Pvt) Ltd.
Cardaxen Platinum Pharmaceuticals (Pvt.) Ltd.
Cardi Benson Pharamceuticals.
Cardilol Ipram International
Cardiolite Continental Chemical Company (Pvt) Ltd.
Cardiwin Wns Field Pharmaceuticals
Caricard Bryon Pharmaceuticals (Pvt) Ltd.
Cartac English Pharmaceuticals Industries
Cartac English Pharmaceuticals Industries
Caten Atco Laboratories Limited
Controbeat Pfizer Laboratories Ltd.
Coxalol Searle Pakistan (Pvt.) Ltd.
Diolit Medicaids Pakistan (Pvt) Ltd.
Eourmin Unexo Labs (Pvt) Ltd.
Eplacard-100 Epla Laboratories (Pvt) Ltd.
Ethinolol Ethical Laboratories (Pvt) Ltd.
Eurocard Euro Pharma International
Ezilife Davis Pharmaceutical Laboratories
Harten Pharmatec Pakistan (Pvt) Ltd.
Hypernol Geofman Pharmaceuticals
Iqanol Karachi Chemical Industries
Jingle Scotmann Pharmaceuticals
K-Nol Plus Akson Pharmaceuticals (Pvt) Ltd.
Konduct Fynk Pharmaceuticals
Kvik Webros Pharmaceuticals
Medi-Heart Medicon Pharmaceuticals Industries (Pvt) Ltd
Minocard Pearl Pharmaceuticals
Nomin Efroze Chemical Industries (Pvt) Ltd.
Normitab Nabiqasim Industries (Pvt) Ltd.
Nortenalol A.J. & Company.
Plinol Pliva Pakistan (Pvt) Limited
Pulse Werrick Pharmaceuticals
Qunoten Novartis Pharma (Pak) Ltd
Rocard Rock Pharmaceuticals
Safecard Irza Pharma (Pvt) Ltd.
Sydlol Saydon Pharmaceutical Industries (Pvt) Ltd.
Tenif Gray`S Pharmaceuticals
Tenormin Ici Pakistan Ltd.
Tinocard-100 Caylex Pharmaceuticals (Pvt) Ltd.
Totamol Bio Pharma
Tynotin Selmore Agencies
Wilnormin Wilshire Laboratories (Pvt) Ltd.