atenolol: clinical use

Prescribing considerations

• Avoid abrupt withdrawal, particularly in ischaemic heart disease.
• Review renal function because atenolol is predominantly renally eliminated and can accumulate in severe impairment.
• Use caution with controlled heart failure, poor cardiac reserve, first-degree heart block, Prinzmetal angina and peripheral arterial disease.
• Avoid in reversible obstructive airways disease unless compelling clinical reasons exist; document risk assessment and monitor closely.
• Atenolol may mask tachycardia from hypoglycaemia and clinical signs of thyrotoxicosis.
• Review perioperative beta blockade with the anaesthetic team rather than stopping automatically.

Contraindications and cautions

• Hypersensitivity to atenolol or formulation excipients.
• Cardiogenic shock or uncontrolled heart failure.
• Sick sinus syndrome or second- or third-degree heart block.
• Clinically significant bradycardia or hypotension.
• Untreated phaeochromocytoma or metabolic acidosis.
• Severe peripheral arterial circulatory disturbance.

Monitoring

• Blood pressure, resting heart rate and symptoms of bradycardia or hypotension.
• Renal function, particularly in older adults or known renal impairment.
• Heart-failure symptoms and cardiac conduction where clinically indicated.
• Blood glucose and recognition of hypoglycaemia in people with diabetes.
• Respiratory symptoms in anyone with asthma, wheeze or obstructive airways disease.
• Fetal growth and neonatal heart rate or glucose when used during pregnancy, as directed by specialist teams.

Clinical pharmacology

Atenolol is a relatively beta-1-selective antagonist without significant intrinsic sympathomimetic or membrane-stabilising activity. Oral absorption is incomplete; hepatic metabolism is minimal, protein binding is low, and elimination is mainly renal. Its half-life is prolonged in severe renal impairment.

Formulation and product differences

• Selected products include film-coated tablets, oral solutions and a solution for intravenous injection or infusion.
• Oral solutions differ in flavour, excipients, storage after opening and food instructions; check product-specific information.
• One selected oral solution is intended for people unable to swallow tablets.
• Liquid formulations contain excipients such as sorbitol, propylene glycol and preservatives; amounts and clinical implications differ by product.
• The injectable formulation is intended for monitored hospital treatment of arrhythmias or early acute myocardial infarction.

Oral solution

Route: Oral

Strengths: 5 mg/mL, 25 mg/5 mL

Tablet

Route: Oral

Strengths: 25 mg, 50 mg, 100 mg