a·ten·o·lol ( -t n -lôl , -l l)n. A beta-blocking agent used primarily in the treatment of angina pectoris and hypertension. |
atenolol
atenolol (
ten´lôl),drug class: antihypertensive, selective β1 blocker;
action: produces fall in blood pressure without reflex tachycardia or significant reduction in heart rate;
uses: acute myocardial infarction, mild to moderate hypertension, prophylaxis of angina pectoris.
atenolol Warning - High-alert drug!
Antipressan (UK), Apo-Atenolol (CA), Atenix (UK), Novo-Atenol (CA), Tenormin
Pharmacologic class: Beta-adrenergic blocker (selective)
Therapeutic class: Antianginal, antihypertensive
Pregnancy risk category D
FDA Boxed Warning
• Caution patients with coronary artery disease (CAD) not to discontinue drug abruptly, because this may cause severe angina exacerbation, myocardial infarction, and ventricular arrhythmias. (The last two complications may occur with or without preceding angina exacerbation.) With planned drug discontinuation, observe patients carefully and advise them to minimize physical activity; if angina worsens or acute coronary insufficiency develops, drug should be reinstituted promptly, at least temporarily. Because CAD is common and may go unrecognized, abrupt withdrawal may pose a risk even in patients treated only for hypertension.
Action
Selectively blocks beta1-adrenergic (myocardial) receptors; decreases cardiac output, peripheral resistance, and myocardial oxygen consumption. Also depresses renin secretion without affecting beta2-adrenergic (pulmonary, vascular, uterine) receptors.
Availability
Injection: 5 mg/10 ml
Tablets: 25 mg, 50 mg, 100 mg
⊘Indications and dosages
➣ Hypertension
Adults: Initially, 50 mg P.O. once daily, increased to 100 mg after 7 to 14 days if needed
➣ Angina pectoris
Adults: Initially, 50 mg P.O. once daily, increased to 100 mg after 7 days if needed. Some patients may require up to 200 mg daily.
➣ Acute myocardial infarction
Adults: Initially, 5 mg I.V. over 5 minutes, followed by 5 mg I.V. 10 minutes later; 10 minutes after last I.V. dose, give 50-mg tablet P.O., then give 50 mg P.O. in 12 hours. Maintenance dosage is 100 mg P.O. daily or 50 mg b.i.d. for 6 to 9 days.
Dosage adjustment
• Renal impairment
• Elderly patients
Contraindications
• Cardiogenic shock
• Sinus bradycardia
• Greater than first-degree heart block
• Heart failure (unless secondary to tachyarrhythmia treatable with beta-adrenergic blockers)
Precautions
Use cautiously in:
• renal failure, hepatic impairment, pulmonary disease, diabetes mellitus, thyrotoxicosis
• pregnant or breastfeeding patients
• children.
Administration
☞ If apical pulse is below 60 beats/minute, withhold dose and call prescriber.
• Mix I.V. dose with dextrose or sodium chloride injection solution.
• For I.V. use, administer slowly (no faster than 1 mg/minute).
• Use I.V. solution within 48 hours of mixing.
☞ Don't discontinue drug suddenly. Instead, taper dosage over 2 weeks.
| Route | Onset | Peak | Duration |
| P.O. | 1 hr | 2 hr | 24 hr |
| I.V. | 5 min | 5 min | 12 hr |
Adverse reactions
CNS: fatigue, lethargy, vertigo, drowsiness, dizziness, depression, disorientation, short-term memory loss
CV: hypertension, intermittent claudication, cold arms and legs, orthostatic hypotension, bradycardia, arrhythmias, heart failure, cardiogenic shock, myocardial reinfarction
EENT: blurred vision, dry eyes, eye irritation, conjunctivitis, stuffy nose, rhinitis, pharyngitis, laryngospasm
GI: nausea, vomiting, diarrhea, constipation, gastric pain, flatulence, anorexia, ischemic colitis, retroperitoneal fibrosis, acute pancreatitis, mesenteric arterial thrombosis
GU: impotence, decreased libido, dysuria, nocturia, Peyronie's disease, renal failure
Hematologic: agranulocytosis
Hepatic: hepatomegaly
Metabolic: hypoglycemia
Musculoskeletal: muscle cramps, back and joint pain
Respiratory: dyspnea, wheezing, respiratory distress, bronchospasm, bronchial obstruction, pulmonary emboli
Other: decreased exercise tolerance, allergic reaction, fever, development of antinuclear antibodies, hypersensitivity reaction
Interactions
Drug-drug. Amiodarone, cardiac glycosides, diltiazem, verapamil: increased myocardial depression, causing excessive bradycardia and heart block
Amphetamines, cocaine, ephedrine, norepinephrine, phenylephrine, pseudoephedrine: excessive hypertension, bradycardia
Ampicillin, calcium salts: decreased antihypertensive and antianginal effects
Aspirin, bismuth subsalicylate, magnesium salicylate, nonsteroidal anti-inflammatory drugs: decreased antihypertensive effect
Clonidine: life-threatening blood pressure increase after clonidine withdrawal or simultaneous withdrawal of both drugs
Dobutamine, dopamine: decrease in beneficial beta-cardiovascular effects
Lidocaine: increased lidocaine levels, greater risk of toxicity
MAO inhibitors: bradycardia
Prazosin: increased risk of orthostatic hypotension
Reserpine: increased hypotension, marked bradycardia
Theophylline: decreased theophylline elimination
Drug-diagnostic tests. Alanine aminotransferase, alkaline phosphatase, aspartate aminotransferase, antinuclear antibody titer, blood urea nitrogen, creatinine, lactate dehydrogenase, platelets, potassium, uric acid: increased levels
Glucose: increased or decreased level
Insulin tolerance test: false result
Drug-behaviors. Alcohol use: increased hypotension
Patient monitoring
• Watch for signs and symptoms of hypersensitivity reaction.
• Monitor vital signs (especially blood pressure), ECG, and exercise tolerance.
• Check closely for hypotension in hemodialysis patients.
• Monitor blood glucose level regularly if patient is diabetic; drug may mask signs and symptoms of hypoglycemia.
Patient teaching
☞ Instruct patient to immediately report signs and symptoms of allergic response, breathing problems, and chest pain.
• Advise patient to take drug at same time every day.
☞ Inform patient that he may experience serious reactions if he stops taking drug suddenly. Advise him to consult prescriber before discontinuing.
• Caution patient to avoid driving and other hazardous activities until he knows how drug affects concentration and alertness.
• Tell patient that drug may cause a temporary blood pressure decrease if he stands or sits up suddenly. Instruct him to rise slowly and carefully.
• Inform women that drug shouldn't be taken during pregnancy. Urge them to report planned or suspected pregnancy.
• Tell men that drug may cause erectile dysfunction. Advise them to discuss this issue with prescriber.
• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs, tests, and behaviors mentioned above.
atenolol
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