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Beta-adrenergic inhibitors (aka, beta blocker)
The efficiency of atenolol for hypertension and coronary heart disease has been well documented in numerous comparative studies:
Like other antihypertensive drugs, atenolol lowers the systolic and diastolic blood pressure by 15 to 20% in a single drug treatment. In long-term treatment it has the ability to reduce cardiovascular mortality.
For chronic angina pectoris the frequency of attacks, the occurrence of silent ischemia, and the risk of an infarction are reduced. In this respect atenolol is superior to nifedipine and nitrates. For an acute myocardial infarction the extension of the infarction can be reduced if therapy is begun within the first 12 hours; complications and mortality are thus lessened. A long-term atenolol treatment after a myocardial infarction reduces the risk of re-infarction and the cardiovascular mortality. Its efficiency for Prinzmetal's angina is not as accurately documented.
Atenolol can also be considered for the therapy of supraventricular and selected cases of ventricular arrhythmias.
It can be combined with diuretics, vasodilators, ACE inhibitors, and other cardiac drugs. Mind the interactions when administering intravenously!
In comparison with propranolol, atenolol has a selective effect on ß1-receptors and it can therefore be considered (relatively) cardioselective. It does not have intrinsic sympathomimetic effects. Atenolol reduces both submaximal and maximal exercise heart rates and delays atrioventricular conduction. The betablockade also leads to a certain reduction of contractility. On the whole the oxygen requirements decrease. Atenolol can lead to a reduction of peripheral blood flow and to an increase of plasma triglycerides and total cholesterol as well as to reduced high-density lipoprotein cholesterol values.
Second and third degree heart block, manifested heart failure, cardiogenic shock.
Do not stop taking atenolol abruptly unless you are directed to do so by your doctor. Stopping atenolol abruptly may cause your condition to become worse.
Call your doctor immediately if you experience shortness of breath.
Use caution when driving, operating machinery, or performing other hazardous activities. Atenolol may cause dizziness or drowsiness. If you experience dizziness or drowsiness, avoid these activities.
Do not crush, break, or chew the tablets. Swallow them whole.
Tell your doctor and dentist that you are taking atenolol before having surgery.
Use alcohol cautiously. Alcohol may increase drowsiness and dizziness while taking this medication.
Reduces myocardial contractility; intravenous administration is permitted at the earliest 24 hours after the withdrawal of drug (danger of acute heart failure!). The same is true for class I anti-arrhythmic drugs (e.g. quinidine). The effect of atenolol on blood pressure is reduced by anti-inflammatory agents.
Pronounced fatigue and cold extremities have been observed in 10 to 20% of the treated subjects. Complaints about bradycardia, dizziness and gastrointestinal symptoms are less frequent. Despite its relative selectivity, atenolol can cause bronchospasms in asthma patients.
Amongst the many but rarely observed side-effects are sleep disturbances, depressions, paresthesiae, impotence, exanthema, psoriasis exacerbations and arthropathies. Clinically relevant changes in the blood sugar have hardly occurred. There is no clarity as to the practical significance of the above mentioned changes in the lipid metabolism.
Further information is available in the writeup for the brand name(s) of this medication
Several studies demonstrate an advantageous effect on pregnancy-associated hypertension. No known malformations. Mind bradycardias or hypoglycemia in the neonate!
Relatively high concentrations in breast milk. Metroprolol is less hazardous.
Should not be used for children.
No multiplication of adverse reactions in elderly patients.
Considerably prolonged half-life!
Dose adjustment: when plasma creatinine is above 300 µmol/l at the most 50 mg/day, when plasma creatinine is above 600 µmol/l: at the most 25-50 mg every other day.
No dose adjustment is necessary.