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# 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 (stable)
* Myocardial infarction (secondary prevention)
## Adult Dosing
* **Hypertension:** Initially 25-50 mg once daily. Maintenance dose 50-100 mg once daily. Maximum 100 mg daily.
* **Angina Pectoris:** Initially 50 mg once daily. Maintenance dose 100 mg once daily (given as 50 mg twice daily or 100 mg once daily). Maximum 100 mg daily.
* **Myocardial Infarction (Secondary Prevention):** Oral therapy initiated 5-7 days after stabilization of myocardial infarction. 50 mg twice daily for 7 days. If oral therapy is not tolerated, intravenous administration may be considered.
## Pediatric Dosing
Dosing in pediatric patients is not well established and should be determined by a specialist based on individual patient factors.
## Dose Adjustments
* **Renal Impairment:**
* CrCl 15-35 mL/min: 50 mg once daily.
* CrCl < 15 mL/min: 25 mg once daily or 50 mg every other day.
* Hemodialysis: 50 mg after each dialysis.
## Contraindications
* Hypersensitivity to atenolol or other beta-blockers.
* Sinus bradycardia, heart block greater than first degree, cardiogenic shock, overt cardiac failure.
* Severe peripheral arterial circulation disturbances.
## Adverse Effects
Common: Fatigue, bradycardia, hypotension, dizziness, cold extremities, gastrointestinal disturbances.
Serious: Worsening heart failure, bronchospasm, masking of hypoglycemia symptoms, severe bradycardia, AV block.
## Key Drug Interactions
* **Calcium Channel Blockers (e.g., verapamil, diltiazem):** Increased risk of bradycardia, AV block, and heart failure.
* **Antiarrhythmics (Class I):** Additive myocardial depressant effects.
* **Other Antihypertensives:** Additive hypotensive effects.
* **Insulin/Oral Hypoglycemics:** May mask symptoms of hypoglycemia.
* **NSAIDs:** May decrease antihypertensive effect.
## Monitoring
* Blood pressure and heart rate.
* Signs and symptoms of heart failure.
* Renal function (especially in patients with impaired renal function).
* Blood glucose levels in diabetic patients.
## Clinical Pearls
* Atenolol is renally eliminated, requiring dose adjustment in renal impairment.
* Abrupt discontinuation can lead to exacerbation of angina or precipitate myocardial infarction. Taper dose gradually over 1-2 weeks.
* Caution in patients with asthma or COPD due to potential for bronchospasm, although cardioselectivity may mitigate this risk compared to non-selective beta-blockers.
* May mask symptoms of hyperthyroidism.
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*This information is intended for healthcare professionals. Always consult the official prescribing information and relevant clinical guidelines for complete and up-to-date details.*
