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

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: