ATENOLOL

Indications & Dose:

Hypertension

• BY MOUTH

Adult: 25–50 mg daily, higher doses are rarely necessary

Angina

• BY MOUTH

Adult: 100 mg daily in 1–2 divided doses continued

Arrhythmias

• BY MOUTH

Adult: 50–100 mg daily

• BY INTRAVENOUS INJECTION

Adult: 2.5 mg every 5 minutes (max. per dose 10 mg), repeated if necessary, given at a rate of 1 mg/minute

• BY INTRAVENOUS INFUSION

Adult: 150 micrograms/kg every 12 hours if required, to be given over 20 minutes

Migraine prophylaxis

• BY MOUTH

Adult: 50–200 mg daily in divided doses

Early intervention within 12 hours of myocardial infarctio

•  INITIALLY BY INTRAVENOUS INJECTION

Adult: Initially 5 mg, to be given over 5 minutes, followed by (by mouth) 50 mg after 15 minutes,then (by mouth) 50 mg after 12 hours, then (by mouth) 100 mg daily

Contraindications:

Cardiogenic  shock, 2nd or 3rd degree heart block, sinus bradycardia, overt cardiac failure

Side Effects:

CNS: Ataxia, depression, dizziness, drowsiness, fatigue, hallucinations, insomnia, lethargy, memory loss, mental changes, strange dreams

CV: Bradycardia, CHF, cold extremities, postural hypotension, profound hypotension, 2nd or 3rd degree heart block, withdrawal angina, rebound hypertension

EENT : Dry burning eyes, sore throat, visual disturbances

GI: Diarrhea, dry mouth, ischemic colitis, mesenteric arterial thrombosis, nausea, vomiting

GU: Impotence, sexual dysfunction

METAB: Hyperglycemia, hyperlipidemia (increase TG, total cholesterol, LDL; decrease HDQ, masked hypoglycemic response (sweating excepted)

RESP: Bronchospasm, dyspnea, wheezing

SKIN: Alopecia, pruritus, rash

Cautions:

Precautions:

Anesthesia/surgery (myocardial depression), avoid abrupt withdrawal, bronchospasmic airways, congestive heart failure, diabetes mellitus, hyperthyroidism/ thyrotoxicosis (atenolol, unlike propranolol does not decrease T3 levels), concurrent clonidine (discontinue atenolol several days prior to withdrawal of clonidine), peripheral vascular disease, renal disease.

Pregnancy & breast-feeding: Use with caution.

Old age: May be given in reduced dose.

Interaction:

Drugs

Adenosine: Bradycardia aggravated

Alpha-1 adrenergic blockers: Potential enhanced first dose response (marked initial drop in blood pressure, particularly on standing [especially prazocin])

Amoxicillin, Ampicillin: Reduced atenolol bioBrands Available with Cost

Antacids: Reduced atenolol absorption

Calcium channel blockers: See dihydropyridine and verapamil

Clonidine: Exacerbation of rebound hypertension upon discontinuation of clonidine

Digoxin: Additive prolongation of atrioventricular (AV) conduction time.

Dihydropyridines: Additive hemodynamic effects; increased serum concentration of atenolol

Dipyridamole: Bradycardia aggravated

Disopyramide: Additive decreases in cardiac output

Lidocaine: Increased ser lidocaine concentrations possible

Neostigmine: Bradycardia aggravate

NSAIDs: Reduced antihypertensive effects of atenolol

Physostigmine: Bradycardia aggravated

Prazosin: First-dose response to prazosin may be enhanced by blockade

Tacrine: Bradycardia aggravated

Theophylline: Antagonistic pharmacodynamic effects

Verapamil: Enhanced effects of both drugs, particularly AV node conduction slowing; reduced atenolol clearance

Warnings:

Adverse Effects:

Lactations:

Special Precautions:

Counselling:

Side Effects Or Adverse Reactions:

Patient And Carer Advice: