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# **ATT (Atenolol)**
## Overview
Atenolol is a cardioselective beta-1 adrenergic receptor blocker (beta-blocker). It reduces heart rate, myocardial contractility, and blood pressure.
## Primary Indications
* Hypertension
* Angina Pectoris
* Myocardial Infarction (secondary prophylaxis)
## Adult Dosing
* **Hypertension:** Start at 25-50 mg once daily. Usual dose range: 50-100 mg once daily. Maximum dose: 100 mg once daily.
* **Angina Pectoris:** Start at 50 mg once daily. Usual dose range: 50-100 mg once daily. Maximum dose: 100 mg once daily.
* **Myocardial Infarction (secondary prophylaxis):** After acute phase (typically 7 days post-MI), 100 mg once daily or 50 mg twice daily.
## Pediatric Dosing
Dosing in pediatric patients is not well-established and should be individualized under specialist supervision. Some sources suggest starting doses of 0.5 mg/kg/day divided into two doses, with a maximum of 2 mg/kg/day or 50 mg/day.
## Dose Adjustments
* **Renal Impairment:** Dose adjustment is necessary based on creatinine clearance (CrCl).
* CrCl 15-35 mL/min: Give usual dose every other day.
* CrCl < 15 mL/min: Give half the usual dose every other day.
* Hemodialysis patients: Give 50 mg after each dialysis session.
## Contraindications
* Hypersensitivity to atenolol or any component of the formulation.
* Sinus bradycardia, greater than first-degree heart block, cardiogenic shock, decompensated cardiac failure.
## Adverse Effects
* **Common:** Bradycardia, hypotension, fatigue, dizziness, cold extremities.
* **Less Common:** Depression, shortness of breath, nausea, diarrhea.
* **Serious:** Severe bradycardia, heart block, bronchospasm, masking of hypoglycemia symptoms.
## Key Drug Interactions
* **Calcium Channel Blockers (e.g., verapamil, diltiazem):** Additive effects on AV conduction and negative inotropic effects, increasing risk of hypotension and heart block.
* **Catecholamine-depleting drugs (e.g., reserpine):** May potentiate the hypotensive effect.
* **Insulin and oral hypoglycemic agents:** May mask symptoms of hypoglycemia.
* **NSAIDs:** May decrease antihypertensive effect.
* **Digoxin:** Increased risk of bradycardia and AV block.
## Monitoring
* Blood pressure (standing and supine).
* Heart rate.
* Signs of heart failure.
* Blood glucose levels in diabetic patients.
* Renal function.
## Clinical Pearls
* Atenolol is a cardioselective beta-blocker, meaning it primarily blocks beta-1 receptors in the heart. However, at higher doses, it can also block beta-2 receptors, leading to potential bronchospasm in susceptible individuals.
* Abrupt withdrawal should be avoided, especially in patients with coronary artery disease, as it can precipitate angina, myocardial infarction, or arrhythmias. Taper dose gradually over 1-2 weeks.
* Can mask signs and symptoms of hypoglycemia (e.g., tachycardia), but sweating may still be present.
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**Disclaimer:** This information is for educational purposes only and does not substitute for professional medical advice. Always consult with a qualified healthcare provider to ensure the appropriateness of any medication. Verify the most current prescribing information before initiating or modifying treatment.
