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# Atenolol
## Overview
Atenolol is a selective beta-1 adrenergic receptor antagonist (beta-blocker). It works by decreasing heart rate, blood pressure, and myocardial contractility.
## Primary Indications
* Hypertension
* Angina Pectoris (Prophylaxis)
* Myocardial Infarction (Secondary Prevention)
## Adult Dosing
* **Hypertension:**
* Initial: 50 mg once daily.
* Maintenance: 50-100 mg once daily.
* Maximum: 100 mg once daily.
* **Angina:**
* Initial: 50 mg once daily.
* Maintenance: 100 mg once daily (given as 50 mg twice daily or 100 mg once daily).
* Maximum: 100 mg once daily.
* **Acute Myocardial Infarction (Oral continuation after IV therapy):**
* 100 mg once daily, started as soon as patient is hemodynamically stable, usually within 24 hours of event.
## Pediatric Dosing
Dosing in pediatric patients is not well established and should be determined by a physician experienced in pediatric cardiology.
## Dose Adjustments
* **Renal Impairment:**
* CrCl > 35 mL/min: No adjustment needed.
* CrCl 15-35 mL/min: 50 mg once daily.
* CrCl < 15 mL/min: 25 mg once daily or 50 mg every other day.
## Contraindications
* Sinus bradycardia
* Heart block greater than first degree
* Cardiogenic shock
* Decompensated cardiac failure
* Hypersensitivity to atenolol or any component of the formulation
## Adverse Effects
* **Common:** Bradycardia, hypotension, fatigue, dizziness, cold extremities, shortness of breath.
* **Less Common:** Nausea, diarrhea, depression, erectile dysfunction.
* **Rare but Serious:** Heart failure exacerbation, bronchospasm, severe bradycardia, heart block.
## Key Drug Interactions
* **Calcium Channel Blockers (e.g., verapamil, diltiazem):** Increased risk of bradycardia, AV block, and heart failure.
* **Other Antihypertensives:** Additive hypotensive effects.
* **Catecholamine-depleting drugs (e.g., reserpine, MAO inhibitors):** May cause excessive reduction of sympathetic activity.
* **Insulin or Oral Hypoglycemics:** May mask symptoms of hypoglycemia.
## Monitoring
* Blood pressure
* Heart rate
* Signs and symptoms of heart failure
* Renal function (especially in patients with impaired renal function)
* Blood glucose (in diabetic patients)
## Clinical Pearls
* Atenolol is a cardioselective beta-blocker, meaning it primarily affects beta-1 receptors in the heart. However, at higher doses, selectivity is lost, and it can affect beta-2 receptors, potentially causing bronchospasm.
* Abrupt discontinuation can lead to angina exacerbation, myocardial infarction, or arrhythmias, particularly in patients with underlying coronary artery disease. Taper dose gradually over 1-2 weeks.
* It is generally not the preferred beta-blocker for patients with post-myocardial infarction management due to its shorter half-life and less evidence compared to carvedilol or metoprolol succinate.
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**Disclaimer:** This information is intended for educational purposes only and does not constitute medical advice. Always consult with a qualified healthcare provider and refer to the most current prescribing information for definitive guidance.
