Atenolol (Page 5 of 7)

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 Therapy plus

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

0

(0%)

2

(0.9%)

Septal Defect

Development of Mitral

0

(0%)

2

(0.9%)

Regurgitation

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
*
Full dosage was 10 mg and some patients received less than 10 mg but more than 5 mg.

I.V. 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%)

During postmarketing experience with atenolol tablets, 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 tablets, like other beta blockers, has been associated with the development of antinuclear antibodies (ANA), lupus syndrome and Raynaud’s phenomenon.

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