Pharm

Atenolol

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Atenolol, Tenormin

  • See Also
  1. Beta Blocker
  • Indications
  1. See Beta Blocker
  2. Hypertension
  3. Coronary Artery Disease (including Angina, post-Myocardial Infarction)
  4. Migraine Headache Prophylaxis
  5. Atrial Fibrillation Rate Control
  • Mechanism
  1. See Beta Adrenergic ReceptorAntagonist
  2. Selective Beta Antagonist that primarily inhibits B1 activity by blocking B1 Receptors
    1. Reduces Myocardial Contractility, Blood Pressure, myocardial oxygen demand
    2. Also Antiarrhythmic and slows ventricular response in Atrial Fibrillation
  3. Contrast with non-selective Beta Blockers (e.g. Propranolol)
    1. Non-selective Beta Blockers also act at B2 Receptors (bronchoconstriction) and B3 Receptors (block lipolysis)
  • Adverse Effects
  1. See Beta Blocker
  • Drug Interactions
  1. See Beta Blocker
  2. Apple juice or orange juice
    1. May reduce Atenolol absorption
    2. Separate dose from juice by at least 4 hours
  • Dosing
  • Adults
  1. Start: 25-50 mg orally daily
    1. Despite daily dosing, duration of activity is not a a full 24 hours
    2. Consider dividing dosing into twice daily (e.g. 50 mg twice daily)
  2. Target: 50-100 mg orally daily (may divide dose twice daily)
  3. Maximum dose: 100 mg (50 mg if GFR <35 ml/min, 25 mg if GFR <15 ml/min)
  • Efficacy
  1. Not as effective as other Beta Blockers in cardiovascular disease prevention (especially with Hypertension present)
    1. Consider Metoprolol, Bisoprolol, Carvedilol or Nadolol instead
    2. Carlberg (2004) Lancet 364:1684-9 [PubMed]
  • Safety
  1. Pregnancy Category D
  2. Avoid in Lactation
    1. Risk of Hypoglycemia in newborns
  • Metabolism
  1. Bioavailability 50%
  2. Not lipophilic
  3. Renal excretion
  • Resources
  1. Atenolol (DailyMed)
    1. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=96dd038f-b363-4e24-9c67-82b7c85c3bc4
  • References
  1. (2019) Presc Lett, Resource #350503, Comparison of Oral Beta Blockers
  2. (2020) Med Lett Drugs Ther 62(1598): 73-80
  3. Olson (2020) Clinical Pharmacology, Medmaster Miami, p. 66-7
  4. Hamilton (2020) Tarascon Pocket Pharmacopoeia