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**Drug:** Atenolol
## Overview
Atenolol is a selective beta-1 adrenergic receptor blocker (cardioselective beta-blocker).
## Primary Indications
* Hypertension
* Angina Pectoris (Prophylaxis)
* Myocardial Infarction (Post-MI management)
## Adult Dosing
* **Hypertension:** Initiate at 25-50 mg once daily. Maintenance dose typically 50-100 mg once daily. Maximum: 100 mg daily.
* **Angina Pectoris:** Initiate at 50 mg once daily. Maintenance dose typically 50-100 mg once daily. Maximum: 100 mg daily.
* **Post-Myocardial Infarction:** 50 mg twice daily for 7 days, then 100 mg once daily for 6-12 months.
## Pediatric Dosing
Limited data available. Pediatric dosing is not well-established and should be guided by specialist recommendations and clinical judgment.
## Dose Adjustments
* **Renal Impairment:**
* CrCl 15-35 mL/min: Administer usual dose every other day.
* CrCl < 15 mL/min: Administer usual dose every other day or 25 mg daily.
## Contraindications
* Sinus bradycardia
* Heart block greater than first degree
* Cardiogenic shock
* Decompensated cardiac failure
* Severe peripheral arterial circulation problems
## Adverse Effects
Common: Bradycardia, fatigue, dizziness, cold extremities, hypotension.
Serious: Bronchospasm (especially in asthmatics), heart failure, heart block, masking of hypoglycemia symptoms.
## Key Drug Interactions
* **Calcium Channel Blockers (e.g., verapamil, diltiazem):** Additive negative chronotropic and inotropic effects, increased risk of hypotension and heart block.
* **Digoxin:** Increased risk of bradycardia and heart block.
* **Catecholamine-depleting drugs (e.g., reserpine):** Increased risk of hypotension and severe bradycardia.
* **NSAIDs:** May decrease antihypertensive effect.
* **Insulin/Oral Hypoglycemics:** May mask symptoms of hypoglycemia.
## Monitoring
* Blood pressure and heart rate regularly.
* Signs of heart failure (e.g., edema, shortness of breath).
* Renal function (especially in patients with impaired renal function).
* Blood glucose levels in diabetic patients.
## Clinical Pearls
* Atenolol is cardioselective, but this selectivity is lost at higher doses.
* Abrupt discontinuation can lead to exacerbation of angina and precipitation of myocardial infarction. Taper dose gradually over 1-2 weeks.
* Use with caution in patients with asthma or COPD due to potential for bronchospasm.
* Masking of hypoglycemia symptoms is a significant concern in diabetic patients.
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**Disclaimer:** This information is for educational purposes only and does not substitute for professional medical advice. Always consult the current prescribing information and a qualified healthcare provider for any medication-related questions or decisions.
