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# Atenolol
## Overview
Atenolol is a selective beta-1 adrenergic receptor antagonist (beta-blocker).
## Primary Indications
* Hypertension
* Angina pectoris
* Myocardial infarction (secondary prevention)
## Adult Dosing
* **Hypertension:** 25-50 mg once daily. Maximum 100 mg daily.
* **Angina Pectoris:** 50 mg once daily. May increase to 100 mg once daily.
* **Myocardial Infarction:** Initial dose is typically 5 mg IV every 2 minutes for 3 doses, followed by oral therapy of 50 mg once daily beginning 12 hours after the last IV dose. Continue for at least 7 days.
## Pediatric Dosing
Dosing is not well established in pediatric patients. Use with caution and at the discretion of a specialist.
## Dose Adjustments
* **Renal Impairment:** Dose adjustment is necessary based on creatinine clearance (CrCl).
* 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 once daily after dialysis.
## Contraindications
* Heart failure
* Cardiogenic shock
* Second- or third-degree atrioventricular (AV) block (unless a permanent pacemaker is in place)
* Sinus bradycardia
* Hypersensitivity to atenolol or other beta-blockers
## Adverse Effects
* Bradycardia
* Hypotension
* Fatigue
* Dizziness
* Cold extremities
* Bronchospasm (in susceptible individuals)
* Exacerbation of heart failure
* Masking of hypoglycemia symptoms
## Key Drug Interactions
* **Calcium channel blockers (e.g., verapamil, diltiazem):** Additive negative chronotropic and inotropic effects, increasing risk of bradycardia and heart block.
* **Other antihypertensives:** Additive hypotensive effects.
* **Insulin/Oral hypoglycemics:** May mask symptoms of hypoglycemia.
* **Non-dihydropyridine calcium channel blockers:** Increased risk of AV block and heart failure.
* **Sympathomimetic agents:** May antagonize the effects of beta-blockers.
## Monitoring
* Blood pressure
* Heart rate
* Signs and symptoms of heart failure
* Renal function
* Blood glucose (in diabetic patients)
## Clinical Pearls
* Atenolol is renally eliminated; monitor renal function and adjust dose accordingly.
* Abrupt discontinuation can lead to rebound hypertension, angina, or myocardial infarction. Taper dose gradually over 1-2 weeks.
* Use with caution in patients with asthma or reactive airway disease due to potential for bronchospasm.
* Selective beta-1 blockade is dose-dependent; higher doses may lose selectivity.
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**Disclaimer:** This information is intended for healthcare professionals. Always consult the most current prescribing information and relevant literature for complete drug details before making clinical decisions. Dosing may vary based on local protocols and individual patient factors.
