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a cardioselective beta-adrenergic blocking agent used in the treatment of hypertension and chronic angina pectoris and the prevention and treatment of myocardial infarction and cardiac arrhythmias; administered orally or intravenously.
Miller-Keane Encyclopedia and Dictionary of Medicine, Nursing, and Allied Health, Seventh Edition. © 2003 by Saunders, an imprint of Elsevier, Inc. All rights reserved.


Antipressan (UK), Atenix (UK), Novo-Atenol (CA), Tenormin

Pharmacologic class: Beta-adrenergic blocker (selective)

Therapeutic class: Antianginal, anti-hypertensive

Pregnancy risk category D

FDA Box 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.


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.


Tablets: 25 mg, 50 mg, 100 mg

Indications and dosages


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: 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


• Cardiogenic shock

• Sinus bradycardia

• Greater than first-degree heart block

• Heart failure (unless secondary to tachyarrhythmia treatable with beta-adrenergic blockers)


Use cautiously in:

• renal failure, hepatic impairment, pulmonary disease, diabetes mellitus, thyrotoxicosis

• pregnant or breastfeeding patients

• children.


Adjust initial and subsequent dosages downward depending on clinical observations, including pulse rate and blood pressure.

Don't discontinue drug suddenly. Instead, taper dosage over 2 weeks.

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


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 anti-hypertensive 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.

McGraw-Hill Nurse's Drug Handbook, 7th Ed. Copyright © 2013 by The McGraw-Hill Companies, Inc. All rights reserved


(ə-tĕn′ə-lôl′, -lōl′)
A beta-blocker drug, C14H22N2O3, used primarily in the treatment of angina pectoris and hypertension.
The American Heritage® Medical Dictionary Copyright © 2007, 2004 by Houghton Mifflin Company. Published by Houghton Mifflin Company. All rights reserved.


Tenormin® Cardiology A β-blocker used to treat HTN, angina. See β-blocker, Myocardial infarction.
McGraw-Hill Concise Dictionary of Modern Medicine. © 2002 by The McGraw-Hill Companies, Inc.


A beta adrenoceptor blocker drug that acts mostly on the heart and has a long action. It slows the heart and corrects irregularities of rhythm. It is used to treat high blood pressure (HYPERTENSION) and ANGINA PECTORIS. The drug has been found to have a significant protective effect against heart attacks during the two years or so after non-cardiac surgery. The drug is on the WHO official list. Brand names are Tenormin, Tenoret 50 and Totamol.
Collins Dictionary of Medicine © Robert M. Youngson 2004, 2005