Atenolol
Regulatory sources consulted
- openfda-label-e2d819f9-b7db-4c40-9ce9-953d58aa371c
- aemps-ft-63146
- ansm-rcp-69807042
- PubMed PMID:37350141 ↗
- PubMed PMID:34419523 ↗
- PubMed PMID:38228033 ↗
- OpenFDA · C07AB03
- RxNorm rxcui 1202 ↗
- PubMed PMID:38771738 ↗
Approved indications
- Treatment of hypertension, to lower blood pressure and reduce the risk of fatal and non-fatal cardiovascular events (strokes, myocardial infarctions).
- Long-term management of patients with angina pectoris.
- Treatment of hemodynamically stable patients with acute myocardial infarction to reduce cardiovascular mortality.
- Prevention of episodic migraine. · off-label
Contraindications
Absolute
- Sinus bradycardia, heart block greater than first degree, cardiogenic shock, and overt cardiac failure.
- Hypersensitivity to atenolol or any of the components.
- Severe forms of asthma and chronic obstructive pulmonary disease.
- Breast-feeding.
Clinical warnings
- Major warning · Abrupt Cessation of Therapy: Do not abruptly discontinue therapy, especially in patients with ischemic heart disease. It may cause severe exacerbation of angina, myocardial infarction, and ventricular arrhythmias. The dosage should be gradually reduced. — FDA
- Cardiac Failure: May further depress myocardial contractility and precipitate more severe failure. Use with caution in patients with compromised cardiac reserve. — FDA
- Diabetes and Masking of Hypoglycemia: May mask signs of hypoglycemia, particularly tachycardia. Diabetic patients should be warned. — ANSM
Drug interactions
- HighVerapamilC08DA01
Mechanism: Additive negative inotropic and chronotropic effects, with risk of severe bradycardia, sinus arrest, and heart failure.
Recommendation: Association not recommended. If necessary, use under close clinical and ECG monitoring, especially in the elderly or at the start of treatment.
ANSM RCPFDA label
- HighFingolimodL04AE01
Mechanism: Potentiation of bradycardic effects which can have fatal consequences. Beta-blockers prevent adrenergic compensation mechanisms.
Recommendation: Association not recommended. Requires continuous clinical and ECG monitoring for 24 hours after the first dose of fingolimod if co-administration is unavoidable.
ANSM RCP
- ModerateDigoxinC01AA05
Mechanism: Both drugs slow atrioventricular conduction and decrease heart rate.
Recommendation: Concomitant use can increase the risk of bradycardia. Monitor heart rate and ECG.
FDA label
Adverse events
Common (≥1%)
bradycardia · cold extremities · postural hypotension · dizziness · tiredness · fatigue · depression · diarrhea · nausea · dyspnea
Rare but serious
heart failure · complete AV block · bronchospasm · thrombocytopenia · psoriasis aggravation
Pregnancy and lactation
FDA category: D
Pregnancy: Crosses the placental barrier. Has been associated with intrauterine growth retardation, fetal/neonatal bradycardia, and hypoglycemia. Should not be used unless clearly necessary. Lactation: Excreted in breast milk in significant concentrations and is contraindicated.
Recent literature (PubMed)
Revisión sistemática y metaanálisis de 50 ensayos que demuestra que varios antihipertensivos, incluyendo el atenolol, reducen significativamente la frecuencia de las cefaleas en pacientes con migraña episódica, sugiriendo un uso más amplio que el recomendado en las guías actuales.
Revisión sobre el manejo de hemangiomas infantiles. El propranolol es el tratamiento de elección. Menciona que los betabloqueantes más selectivos, como el atenolol, muestran ser prometedores para el futuro en esta indicación.
Revisión centrada en telmisartán que lo compara con otros antihipertensivos. Señala que telmisartán tiene una eficacia superior al atenolol en el control de la presión arterial, especialmente hacia el final del intervalo de dosificación. También destaca el riesgo del atenolol durante la lactancia debido a su excreción en la leche materna.