Atenolol (Page 3 of 4)

PRECAUTIONS

General

Patients already on a beta-blocker must be evaluated carefully before atenolol is administered. Initial and subsequent atenolol dosages can be adjusted downward depending on clinical observations including pulse and blood pressure. Atenolol may aggravate peripheral arterial circulatory disorders.
Impaired Renal Function
The drug should be used with caution in patients with impaired renal function. (See DOSAGE AND ADMINISTRATION.)

Drug Interactions

Catecholamine-depleting drugs (e.g., reserpine) may have an additive effect when given with beta-blocking agents. Patients treated with atenolol plus a catecholamine depletor should therefore be closely observed for evidence of hypotension and/or marked bradycardia which may produce vertigo, syncope, or postural hypotension.
Calcium channel blockers may also have an additive effect when given with atenolol (see WARNINGS).
Disopyramide is a Type I antiarrhythmic drug with potent negative inotropic and chronotropic effects. Disopyramide has been associated with severe bradycardia, asystole and heart failure when administered with beta-blockers.
Amiodarone is an antiarrhythmic agent with negative chronotropic properties that may be additive to those seen with beta-blockers.
Beta-blockers may exacerbate the rebound hypertension which can follow the withdrawal of clonidine. If the two drugs are coadministered, the beta-blocker should be withdrawn several days before the gradual withdrawal of clonidine. If replacing clonidine by beta-blocker therapy, the introduction of beta-blockers should be delayed for several days after clonidine administration has stopped.
Concomitant use of prostaglandin synthase inhibiting drugs, e.g., indomethacin, may decrease the hypotensive effects of beta-blockers.
Information on concurrent usage of atenolol and aspirin is limited. Data from several studies, i.e., TIMI-II, ISIS-2, currently do not suggest any clinical interaction between aspirin and beta-blockers in the acute myocardial infarction setting.
While taking beta-blockers, patients with a history of anaphylactic reaction to a variety of allergens may have a more severe reaction on repeated challenge, either accidental, diagnostic or therapeutic. Such patients may be unresponsive to the usual doses of epinephrine used to treat the allergic reaction.
Both digitalis glycosides and beta-blockers slow atrioventricular conduction and decrease heart rate. Concomitant use can increase the risk of bradycardia.

Carcinogenesis, Mutagenesis, Impairment of Fertility

Two long-term (maximum dosing duration of 18 or 24 months) rat studies and one long-term (maximum dosing duration of 18 months) mouse study, each employing dose levels as high as 300 mg/kg/day or 150 times the maximum recommended human antihypertensive dose,* did not indicate a carcinogenic potential of atenolol. A third (24 month) rat study, employing doses of 500 and 1,500 mg/kg/day (250 and 750 times the maximum recommended human antihypertensive dose*) resulted in increased incidences of benign adrenal medullary tumors in males and females, mammary fibroadenomas in females, and anterior pituitary adenomas and thyroid parafollicular cell carcinomas in males. No evidence of a mutagenic potential of atenolol was uncovered in the dominant lethal test (mouse), in vivo cytogenetics test (Chinese hamster) or Ames test (S typhimurium).
Fertility of male or female rats (evaluated at dose levels as high as 200 mg/kg/day or 100 times the maximum recommended human dose*) was unaffected by atenolol administration.
Animal Toxicology
Chronic studies employing oral atenolol performed in animals have revealed the occurrence of vacuolation of epithelial cells of Brunner’s glands in the duodenum of both male and female dogs at all tested dose levels of atenolol (starting at 15 mg/kg/day or 7.5 times the maximum recommended human antihypertensive dose*) and increased incidence of atrial degeneration of hearts of male rats at 300 but not 150 mg atenolol/kg/day (150 and 75 times the maximum recommended human antihypertensive dose,* respectively).
*Based on the maximum dose of 100 mg/day in a 50 kg patient.

Usage in Pregnancy

Pregnancy Category D
See WARNINGS — Pregnancy and Fetal Injury.

Nursing Mothers

Atenolol is excreted in human breast milk at a ratio of 1.5 to 6.8 when compared to the concentration in plasma. Caution should be exercised when atenolol is administered to a nursing woman. Clinically significant bradycardia has been reported in breast-fed infants. Premature infants, or infants with impaired renal function, may be more likely to develop adverse effects.
Neonates born to mothers who are receiving atenolol at parturition or breastfeeding may be at risk for hypoglycemia and bradycardia. Caution should be exercised when atenolol is administered during pregnancy or to a woman who is breastfeeding (see WARNINGS, Pregnancy and Fetal Injury).

Pediatric Use

Safety and effectiveness in pediatric patients have not been established.

Geriatric Use

Hypertension and Angina Pectoris Due to Coronary Atherosclerosis
Clinical studies of atenolol did not include sufficient number of patients aged 65 and over to determine whether they respond differently from younger subjects. Other reported clinical experience has not identified differences in responses between the elderly and younger patients. In general, dose selection for an elderly patient should be cautious, usually starting at the low end of the dosing range, reflecting the greater frequency of decreased hepatic, renal, or cardiac function, and of concomitant disease or other drug therapy.
Acute Myocardial Infarction
Of the 8,037 patients with suspected acute myocardial infarction randomized to atenolol in the ISIS-1 trial (See CLINICAL PHARMACOLOGY), 33% (2,644) were 65 years of age and older. It was not possible to identify significant differences in efficacy and safety between older and younger patients; however, elderly patients with systolic blood pressure <120 mmHg seemed less likely to benefit (see INDICATIONS AND USAGE).
In general, dose selection for an elderly patient should be cautious, usually starting at the low end of the dosing range, reflecting greater frequency of decreased hepatic, renal, or cardiac function, and of concomitant disease or other drug therapy. Evaluation of patients with hypertension or myocardial infarction should always include assessment of renal function.

ADVERSE REACTIONS

Most adverse effects have been mild and transient.The frequency estimates in the following table were derived from controlled studies in hypertensive patients in which adverse reactions were either volunteered by the patient (U.S. studies) or elicited, e.g., by checklist (foreign studies). The reported frequency of elicited adverse effects was higher for both atenolol and placebo-treated patients than when these reactions were volunteered. Where frequency of adverse effects of atenolol and placebo is similar, causal relationship to atenolol is uncertain.

Volunteered(U.S. Studies)

Total — Volunteered and Elicited (Foreign+U.S. Studies)

Atenolol(n=164)%

Placebo(n=206)%

Atenolol(n=399) %

Placebo(n=407) %

CARDIOVASCULAR

Bradycardia

3

0

3

0

Cold Extremities

0

0.5

12

5

Postural Hypotension

2

1

4

5

Leg Pain

0

0.5

3

1

CENTRAL NERVOUS SYSTEM/NEUROMUSCULAR

Dizziness

4

1

13

6

Vertigo

2

0.5

2

0.2

Lightheadedness

1

0

3

0.7

Tiredness

0.6

0.5

26

13

Fatigue

3

1

6

5

Lethargy

1

0

3

0.7

Drowsiness

0.6

0

2

0.5

Depression

0.6

0.5

12

9

Dreaming

0

0

3

1

GASTROINTESTINAL

Diarrhea

2

0

3

2

Nausea

4

1

3

1

RESPIRATORY (see WARNINGS)

Wheeziness

0

0

3

3

Dyspnea

0.6

1

6

4

Acute Myocardial Infarction
In a series of investigations in the treatment of acute myocardial infarction, bradycardia and hypotension occurred more commonly, as expected for any beta-blocker, in atenolol-treated patients than in control patients. However, these usually responded to atropine and/or to withholding further dosage of atenolol. The incidence of heart failure was not increased by atenolol. Inotropic agents were infrequently used. The reported frequency of these and other events occurring during these investigations is given in the following table.In a study of 477 patients, the following adverse events were reported during either intravenous and/or oral atenolol administration:

Conventional TherapyPlus Atenolol(n=244)

Conventional Therapy Alone(n=233)

Bradycardia

43

(18%)

24

(10%)

Hypotension

60

(25%)

34

(15%)

Bronchospasm

3

(1.2%)

2

(0.9%)

Heart Failure

46

(19%)

56

(24%)

Heart Block

11

(4.5%)

10

(4.3%)

BBB + Major Axis Deviation

16

(6.6%)

28

(12%)

Supraventricular Tachycardia

28

(11.5%)

45

(19%)

Atrial Fibrillation

12

(5%)

29

(11%)

Atrial Flutter

4

(1.6%)

7

(3%)

Ventricular Tachycardia

39

(16%)

52

(22%)

Cardiac Reinfarction

0

(0%)

6

(2.6%)

Total Cardiac Arrests

4

(1.6%)

16

(6.9%)

Nonfatal Cardiac Arrests

4

(1.6%)

12

(5.1%)

Deaths

7

(2.9%)

16

(6.9%)

Cardiogenic Shock

1

(0.4%)

4

(1.7%)

Development of Ventricular Septal Defect

0

(0%)

2

(0.9%)

Development of Mitral Regurgitation

0

(0%)

2

(0.9%)

Renal Failure

1

(0.4%)

0

(0%)

Pulmonary Emboli

3

(1.2%)

0

(0%)

In the subsequent International Study of Infarct Survival (ISIS-1) including over 16,000 patients of whom 8,037 were randomized to receive atenolol treatment, the dosage of intravenous and subsequent oral atenolol was either discontinued or reduced for the following reasons:

Reasons for Reduced Dosage

IV Atenolol Reduced Dose(< 5 mg)*

Oral Partial Dose

Hypotension/Bradycardia

105

(1.3%)

1168

(14.5%)

Cardiogenic Shock

4

(.04%)

35

(.44%)

Reinfarction

0

(0%)

5

(.06%)

Cardiac Arrest

5

(.06%)

28

(.34%)

Heart Block (> first degree)

5

(.06%)

143

(1.7%)

Cardiac Failure

1

(.01%)

233

(2.9%)

Arrhythmias

3

(.04%)

22

(.27%)

Bronchospasm

1

(.01%)

50

(.62%)

*Full dosage was 10 mg and some patients received less than 10 mg but more than 5 mg.
During postmarketing experience with atenolol, the following have been reported in temporal relationship to the use of the drug: elevated liver enzymes and/or bilirubin, hallucinations, headache, impotence, Peyronie’s disease, postural hypotension which may be associated with syncope, psoriasiform rash or exacerbation of psoriasis, psychoses, purpura, reversible alopecia, thrombocytopenia, visual disturbance, sick sinus syndrome, and dry mouth. Atenolol, like other beta-blockers, has been associated with the development of antinuclear antibodies (ANA), lupus syndrome, and Raynaud’s phenomenon.
POTENTIAL ADVERSE EFFECTS
In addition, a variety of adverse effects have been reported with other beta-adrenergic blocking agents, and may be considered potential adverse effects of atenolol.
Hematologic: Agranulocytosis.
Allergic: Fever, combined with aching and sore throat, laryngospasm, and respiratory distress.
Central Nervous System: Reversible mental depression progressing to catatonia; an acute reversible syndrome characterized by disorientation of time and place; short-term memory loss; emotional lability with slightly clouded sensorium; and, decreased performance on neuropsychometrics.
Gastrointestinal: Mesenteric arterial thrombosis, ischemic colitis.
Other: Erythematous rash.
Miscellaneous: There have been reports of skin rashes and/or dry eyes associated with the use of beta-adrenergic blocking drugs. The reported incidence is small, and in most cases, the symptoms have cleared when treatment was withdrawn. Discontinuance of the drug should be considered if any such reaction is not otherwise explicable. Patients should be closely monitored following cessation of therapy. (See DOSAGE AND ADMINISTRATION.)
The oculomucocutaneous syndrome associated with the beta-blocker practolol has not been reported with atenolol. Furthermore, a number of patients who had previously demonstrated established practolol reactions were transferred to atenolol therapy with subsequent resolution or quiescence of the reaction.

All MedLibrary.org resources are included in as near-original form as possible, meaning that the information from the original provider has been rendered here with only typographical or stylistic modifications and not with any substantive alterations of content, meaning or intent.

This site is provided for educational and informational purposes only, in accordance with our Terms of Use, and is not intended as a substitute for the advice of a medical doctor, nurse, nurse practitioner or other qualified health professional.

Privacy Policy | Copyright © 2022. All Rights Reserved.