Atenolol; Uses, Dosage, Side Effects, Interactions, Pregnancy

Atenolol is a selective β₁ receptor antagonist, cardioselective beta-adrenergic blocker possessing properties and potency similar to propranolol, but without a negative inotropic effect. The drug belonging to the group of beta blockers (sometimes written β-blockers), a class of drugs used primarily in cardiovascular diseases.

Mechanism of Action of Atenolol

Like metoprolol, atenolol competes with sympathomimetic neurotransmitters such as catecholamines for binding at beta(1)-adrenergic receptors in the heart and vascular smooth muscle, inhibiting sympathetic stimulation. This results in a reduction in resting heart rate, cardiac output, systolic and diastolic blood pressure, and reflex orthostatic hypotension. Higher doses of atenolol also competitively block beta(2)-adrenergic responses in the bronchial and vascular smooth muscles. Although it is similar to metoprolol, atenolol differs from pindolol and propranolol in that it does not have intrinsic sympathomimetic properties or membrane-stabilizing activity. Atenolol is used alone or with chlorthalidone in the management of hypertension and edema.

Indications of Atenolol

• Long-term management of patients with angina
• Control high blood pressure.
• Relieve chest pain (angina pectoris stable or unstable).
• Control an irregular heartbeat.
• Protect the heart in the early treatment after a heart attack.
• Angina pectoris
• Heart failure, unspecified
• High blood pressure (Hypertension)
• Myocardial infarction (MI)
• Secondary prevention myocardial infarction
• Ventricular tachyarrhythmias
• Supraventricular tachyarrhythmias
• Long QT syndrome,
• Acute myocardial infarction,
• Ventricular tachycardia,
• Symptoms of alcohol withdrawal.
• Anxiety
• Alcohol Withdrawal
• Angina Pectoris Prophylaxis
• Esophageal Variceal Hemorrhage Prophylaxis
• Heart Attack
• Mitral Valve Prolapse

Contra-Indications of Atenolol

• Depression
• Complete Heart Block
• Second Degree Atrioventricular Heart Block
• Sinus Bradycardia
• Occasional Numbness
• Prickling
• or Tingling of Fingers and Toes
• Asthma
• Severe Chronic Obstructed Lung Disease
• Severe Renal Impairment
• Psoriasis
• Blood Circulation Failure due to Serious Heart Condition
• Abnormal Liver Function Tests
• Pregnancy
• Anaphylactic Shock due to Allergy Shots
• Acutely Decompensated HF Requiring Parenteral Inotropic Therapy

Dosage of Atenolol

Strengths: 25 mg; 50 mg; 100 mg; & 0.5 mg/mL

Angina pectoris

• The initial dose for hypertension is 50 mg, given as one tablet a day, with the full effect seen in one to two weeks.
• For angina, the initial dose is 50 mg, given as one tablet a day. But if an optimal response is not achieved in one week, the dosage is increased to 100 mg, given as one tablet a day.

Hypertension

• Initial dose: 50 mg orally once a day
• Maintenance dose: 50 to 100 mg orally once a day
• Maximum dose: 100 mg per day

Angina Pectoris Prophylaxis

• Initial dose: 50 mg orally once a day
• Increase to 100 mg orally once a day after 1 week if optimal response not achieved
• Maintenance dose: 50 to 200 mg orally once a day
• Maximum dose: 200 mg per day

Angina Pectoris

• Initial dose: 50 mg orally once a day
• Increase to 100 mg orally once a day after 1 week if optimal response not achieved
• Maintenance dose: 50 to 200 mg orally once a day
• Maximum dose: 200 mg per day

Myocardial Infarction

• 50 mg orally twice a day or 100 mg orally once a day

Side Effects of Atenolol

The most common

• A dry cough
• Depression
• Dizziness and light-headedness due to low blood pressure
• Fatigue, especially in the early stages
• Mouth dryness in the early stages
• The most common (a burning feeling in the chest, behind the breastbone or gullet)
• Abdominal or stomach pain
• Constipation
• High blood pressure
• Nausea, vomiting,
• painful or swollen gums
• numbness or heavy feeling in the jaw
• dull, aching pain in the hip, groin, or thigh
• stomach pain,
• a headache,
• reversible hair loss or thinning, and
• fever.

Common

• chills or fever
• a headache, severe and throbbing
• joint or back pain
• muscle aching or cramping
• muscle pains or stiffness
• chest pressure or squeezing pain in the chest
• excessive sweating
• sudden drowsiness or need to sleep
• coughing up blood
• liver problems–nausea, upper stomach pain, itching, tired feeling, loss of appetite, dark urine, clay-colored stools, jaundice (yellowing of the skin or eyes)
• decreased amount of urine

Rare

• Anxiety
• change in vision
• chest pain or tightness
• confusion
• a cough
• Agitation
• arm, back, or jaw pain
• blurred vision
• chest pain or discomfort
• convulsions
• extra heartbeats
• hallucinations
• a headache
• irritability
• lightheadedness
• cold and clammy skin
• fast and shallow breathing
• swelling of your feet, legs, or hands purple spot on your skin caused by internal bleeding
• fast or abnormal heart rate or palpitations
• loss of appetite
• lower back, side, or stomach pain
• mental depression
• muscle pain or cramps
• Swelling of your feet or ankles
• Shortness of breath
• Nausea, fever, dark urine, loss of appetite
• Depression

Drug Interactions of Atenolol

Atenolol may interact with following drugs, supplements, & may change the efficacy of drugs

• aminophylline
• asthma medications (e.g., theophylline)
• diabetes medications (e.g., glyburide)
• calcium channel blocker medicines (e.g., diltiazem, nifedipine, verapamil)
• diltiazem
• medications for abnormal heart rhythms (e.g., disopyramide)
• nitroglycerin
• nonsteroidal anti-inflammatory medications (NSAIDs; e.g., indomethacin, naproxen)
• oral diabetes medications (e.g., metformin, pioglitazone)
• pentoxifylline
• monoamine oxidase (MAO) inhibitors (e.g., phenelzine, selegiline, )
• other beta-blockers (e.g., propranolol, metoprolol)
• oxtriphylline
• verapamil
• SSRI antidepressants including fluoxetine, paroxetine, fluvoxamine,
• Other drugs to treat high blood pressure (e.g., clonidine, hydralazine, methyldopa, haloperidol,)
• other heart medications (e.g., quinidine),  theophylline, thioridazine, thyroid hormones (e.g., levothyroxine),
• warfarin.

Pregnancy & Lactation of Atenolol

FDA Pregnancy Category D

Pregnancy

There have not been adequate studies on the use of atenolol by pregnant women; however, studies have shown that atenolol does cross the placenta. This medication should not be used during pregnancy unless the benefits outweigh the risks. If you become pregnant while taking this medication, contact your doctor immediately.

Breastfeeding

This medication passes into breast milk. If you are a breastfeeding mother and are taking atenolol, it may affect your baby. Talk to your doctor about whether you should continue breastfeeding.

Children

The safety and effectiveness of using this medication have not been established for children.

References

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