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atenolol (Rx)Brand and Other Names:Tenormin

 
 
 

Dosing & Uses

AdultPediatricGeriatric

Dosage Forms & Strengths

tablet

  • 25mg
  • 50mg
  • 100mg
more...

Hypertension

25-50 mg/day PO initially; may be increased to 100 mg/day PO

Angina Pectoris

50 mg/day PO; after 1 week, may be increased to 100 mg/day PO; some patients may require 200 mg/day

Post Myocardial Infarction

Secondary prevention

100 mg PO once daily or divided q12hr for 6-9 days after myocardial infarction (MI)

Alcohol Withdrawal Syndrome (Off-label)

50-100 mg/day PO

Supraventricular Arrhythmias (Off-label)

Prevention

50 mg/day PO, beginning up to 3 days before surgery and continued until 7 days after surgery; may be increased to 100 mg/day

Thyrotoxicosis (Off-label)

25-100 mg PO once daily or divided q12hr

Dosing Modifications

CrCl 15-35 mL/min/1.73 m²: Not to exceed 50 mg/day PO

CrCl <15 mL/min/1.73 m²: Not to exceed 25 mg/day PO

CrCl >35 mL/min/1.73 m²: Dose adjustment not necessary  

Dosage Forms & Strengths

tablet

  • 25mg
  • 50mg
  • 100mg
more...

Hypertension (Off-label)

0.5-1 mg/kg/day PO; not to exceed 2 mg/kg/day or 100 mg/day  

May be necessary to initiate dosing at 25 mg/day PO

Hypertension

25 mg/day PO initially; may be increased to 100 mg/day PO

Angina Pectoris

25 mg/day PO; after 1 week, may be increased to 100 mg/day; some patients may require 200 mg/day

Post Myocardial Infarction

Secondary prevention

100 mg PO once daily or divided q12hr for 6-9 days after MI

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Interactions

Interaction Checker

atenolol and

No Results

     
     activity indicator 
    No Interactions Found
    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

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            Adverse Effects

            >10%

            Tiredness (13%)

            1-10%

            Hypotension (10%)

            Bradycardia (8%)

            Cold extremities (0.5- 7%)

            Postural hypotension (2-4%)

            Depression (3%)

            Nausea (2-3%)

            Dreaming (2%)

            Drowsiness (2%)

            Diarrhea (1-2%)

            Fatigue (1-2%)

            Leg pain (1-2%)

            Lethargy (1-2%)

            Lightheadedness (1-2%)

            Vertigo (1-2%)

            Dyspnea (0.4-2%)

            2°/3° atrioventricular (AV) block (1%)

            Frequency Not Defined

            Hypotension, severe congestive heart failure (CHF), sick sinus syndrome

            Catatonia, disorientation, emotional lability, hallucinations, headache, impaired performance on neuropsychometric tests, psychoses, short-term memory impairment

            Purpura, rashes

            Nausea

            Thrombocytopenia

            Elevated serum hepatic enzymes and bilirubin

            Impotence, Peyronie disease

            Antinuclear antibodies (ANA), lupus syndrome

            Visual disturbances, xerophthalmia

            Raynaud phenomenon

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            Warnings

            Black Box Warnings

            Ischemic heart disease may be exacerbated after abrupt withdrawal

            Hypersensitivity to catecholamines has been observed during withdrawal

            Exacerbation of angina and, in some cases, MI may occur after abrupt discontinuance

            When long-term beta blocker therapy (particularly with ischemic heart disease) is discontinued, dosage should be gradually reduced over 1-2 weeks with careful monitoring

            If angina worsens markedly or acute coronary insufficiency develops, beta-blocker administration should be promptly reinitiated, at least temporarily (in addition to other measures appropriate for unstable angina)

            Patients should be warned against interruption or discontinuance of beta-blocker therapy without physician advice

            Because coronary artery disease (CAD) is common and may be unrecognized, beta-blocker therapy must be discontinued slowly, even in patients treated only for hypertension

            Contraindications

            2°/3° heart block in patients without pacemaker

            Cardiogenic shock

            Sinus bradycardia

            Sinus node dysfunction

            Hypersensitivity

            Uncompensated cardiac failure

            Pulmonary edema

            Cautions

            Use with caution in anesthesia or surgery (myocardial depression), bronchospastic disease, cerebrovascular insufficiency, diabetes mellitus, hyperthyroidism or thyrotoxicosis, liver disease, renal impairment, peripheral vascular disease, compromised left ventricular function, advanced age, heart failure

            May mask effects of hyperthyroidism

            Risk of hypoglycemia and bradycardia in neonates born to mothers who receive the drug at parturition or while breastfeeding, especially in premature infants and those with renal impairment

            Use with caution in patients taking calcium-channel blockers or cardiac glycosides or using inhaled anesthetics

            Avoid abrupt withdrawal; sudden discontinuance can exacerbate angina and lead to MI

            Increased risk of stroke after surgery

            In patients receiving clonidine, atenolol should be discontinued several days before withdrawal of clonidine

            May cause or exacerbate CNS depression (use with caution in patients with psychiatric illness)

            Use in pheochromocytoma (alpha blockade required before use of beta blocker)

            Consider preexisting conditions such as sick sinus syndrome before initiating therapy

            May potentiate hypoglycemia and may mask its signs and symptoms in patients with diabetes mellitus; use caution

            Monitor for worsening of heart failure symptoms in patients with compensated heart failure

            Use caution in patients with myasthenia gravis; may precipitate or aggravate symptoms or arterial insufficiency in patients with Raynaut's disease and peripheral vascular disease; use caution and monitor for progression of arterial obstruction

            Avoid beta-blockers without alpha1-adrenergic receptor blocking activity in patients with Prinzmetal variant angina; unopposed alpha1-adrenergic receptors mediate coronary vasoconstriction and can worsen anginal symptoms

            Exacerbation or induction of psoriasis reported with beta-blocker use; cause and effect not established

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            Pregnancy & Lactation

            Pregnancy category: D

            Lactation: Drug enters breast milk; neonates born to mothers who are receiving atenolol at parturition or breastfeeding may be at risk for hypoglycemia and bradycardia; use with caution

            Pregnancy Categories

            A:Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

            B:May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

            C:Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

            D:Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

            X:Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

            NA:Information not available.

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            Pharmacology

            Mechanism of Action

            Blocks response to beta-adrenergic stimulation; cardioselective for beta1 receptors at low doses, with little or no effect on beta2 receptors

            Absorption

            Bioavailability: 46-60%

            Onset: Antihypertensive response, 3 hr

            Duration: 12-24 hr (normal renal function)

            Peak plasma time: 2-4 hr

            Distribution

            Protein bound: 6-16%

            Vd: 50-75 L/kg

            Metabolism

            Metabolized to limited extent in liver

            Metabolites: No clinically active metabolites

            Elimination

            Half-life: Children, 4.6 hr; adults, 6-7 hr; neonates, <35 hr; end-stage renal disease, 15-35 hr

            Dialyzable: Yes (HD)

            Excretion: Feces (50%), urine (40-50%)

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            Administration

            IV Incompatibilities

            Y-site: Amphotericin B cholesteryl sulfate

            IV Compatibilities

            Y-site: Meperidine, meropenem, morphine sulfate

            IV Administration

            Administer by slow IV infusion at 1 mg/min, either directly undiluted or diluted with D5W or NS

            Storage

            Store intact ampoules at room temperature

            Protect from light

            Admixture in dextrose and NaCl-containing solution is stable for 48 hours

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            Images

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            Formulary

            FormularyPatient Discounts

            To view formulary information first create a list of plans. Your list will be saved and can be edited at any time.

            Adding plans allows you to:

            • View the formulary and any restrictions for each plan.
            • Manage and view all your plans together – even plans in different states.
            • Compare formulary status to other drugs in the same class.
            • Access your plan list on any device – mobile or desktop.

            The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

            Tier Description
            1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
            2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
            3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
            4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            NC NOT COVERED – Drugs that are not covered by the plan.
            Code Definition
            PA Prior Authorization
            Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
            QL Quantity Limits
            Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
            ST Step Therapy
            Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
            OR Other Restrictions
            Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
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