Apo-Atenolol , Tenormin
Classifications: beta-adrenergic antagonist; antihypertensive agent; Therapeutic: antihypertensive
Pregnancy Category: D
25 mg, 50 mg, 100 mg tablets; 5 mg/10 mL vial
Atenolol selectively blocks beta1-adrenergic receptors located chiefly in cardiac muscle. Mechanisms for antihypertensive action include central effect leading
to decreased sympathetic outflow to periphery, reduction in renin activity with consequent suppression of the renin-angiotensin-aldosterone
system, and competitive inhibition of catecholamine binding at beta-adrenergic receptor sites.
Reduces rate and force of cardiac contractions (negative inotropic action); cardiac output is reduced, as well as systolic
and diastolic BP. Atenolol decreases peripheral vascular resistance both at rest and with exercise.
Management of hypertension as a single agent or concomitantly with other antihypertensive agents, especially a diuretic,
and in treatment of stable angina pectoris, MI.
Antiarrhythmic, mitral valve prolapse, adjunct in treatment of pheochromocytoma and of thyrotoxicosis; and for vascular
Sinus bradycardia, greater than first-degree AV heart block, uncompensated heart failure, cardiogenic shock, peripheral
vascular disease, Raynaud's disease, hypotension; abrupt discontinuation, pulmonary edema, acute bronchospasm; pregnancy
(category D), lactation.
Hypertensive patients with CHF controlled by digitalis and diuretics, vasospastic angina (Prinzmetal's angina); asthma,
bronchitis, emphysema, and COPD; major depression; diabetes mellitus; impaired renal function, dialysis; myasthenia gravis;
pheochromocytoma, hyperthyroidism, thyrotoxicosis; older adults.
Route & Dosage
Adult: PO 2550 mg/d, may increase to 100 mg/d
Child: PO 0.81.5 mg/kg/d (max: 2 mg/kg/d)
Adult: PO 10 min after second IV dose, start 50 mg/d IV 5 mg q5min times 2 doses, then switch to PO
Clcr 1535 mL/min: max dose of 50 mg/d; <15 mL/min: max dose of 25 mg/d
- Crush tablets, if necessary, before administration and give with fluid of patient's choice.
PREPARE: Direct: Use undiluted or diluted in 1050 mL of NS, D5W, D5/NS, D5/0.45NS, or 0.45NaCl.
ADMINISTER: Direct: Give over 5 min. Do not exceed 1 mg/min.
INCOMPATIBILITIES Y-site: Amphotericin B cholesteryl complex
- Store in tightly closed, light-resistant container at 15°30° C (59°86° F) unless otherwise
Adverse Effects (≥1%)CNS:
Dizziness, vertigo, light-headedness, syncope, fatigue
or weakness, lethargy, drowsiness, insomnia
, mental changes, depression
. CV: Bradycardia, hypotension, CHF,
cold extremities, leg pains, dysrhythmias. GI:
Nausea, vomiting, diarrhea. Respiratory:
Pulmonary edema, dyspnea, bronchospasm. Other:
May mask symptoms of hypoglycemia; decreased sexual ability.
Interactions Drug: Atropine
and other anticholinergics
may increase atenolol absorption from GI tract; nsaids
may decrease hypotensive effects; may mask symptoms of a hypoglycemic reaction induced by insulin, sulfonylureas
; may increase lidocaine
levels and toxicity; pharmacologic and toxic effects of both atenolol and verapamil
are increased. Prazosin, terazocin
may increase severe hypotensive response to first dose of atenolol.
50% of PO dose absorbed. Peak:
24 h PO; 5 min IV. Duration:
24 h. Distribution:
Does not readily cross bloodbrain barrier. Metabolism:
No hepatic metabolism. Elimination:
4050% in urine; 5060% in feces. Half-Life:
Assessment & Drug Effects
- Neonates born to mothers who are receiving atenolol at parturition or breast-feeding may be at risk for hypoglycemia.
- Check apical pulse before giving oral drug, especially in patients receiving digitalis (both drugs slow AV conduction).
If below 60 bpm (or other ordered parameter), withhold dose and consult physician.
- Monitor apical pulse, BP, respirations, and peripheral circulation throughout dosage adjustment period. Consult physician
for acceptable parameters.
Patient & Family Education
- Adhere rigidly to dose regimen. Sudden discontinuation of drug can exacerbate angina and precipitate tachycardia or MI in
patients with coronary artery disease, and thyroid storm in patients with hyperthyroidism.
- Make position changes slowly and in stages, particularly from recumbent to upright posture.