Uses
Hypertension
Management of hypertension; used alone or in combination with other classes of antihypertensive agents.
One of several preferred initial therapies in hypertensive patients with ischemic heart disease, heart failure, or diabetes mellitus.
Can be used as monotherapy for initial management of uncomplicated hypertension; however, thiazide diuretics are preferred by JNC 7.
Angina
Management of chronic stable angina pectoris.
A component of the standard therapeutic measures in the management of unstable angina or non-ST-segment elevation/non-Q-wave MI†.
AMI
Secondary prevention following AMI to reduce the risk of cardiovascular mortality.
Supraventricular Tachyarrhythmias
Treatment of atrial fibrillation or flutter† following AMI or in states of high adrenergic tone (e.g., postoperative atrial fibrillation) when clinical left ventricular function, bronchospastic disease, or other contraindications are not present.
Treatment of ectopic or multifocal (chaotic) atrial tachycardia† in patients with preserved left ventricular function.
Treatment of paroxysmal supraventricular tachycardia (PSVT)† that is refractory to vagal maneuvers, IV adenosine (the drug of choice), AV nodal blocking agents (e.g., calcium-channel blocking agents, digoxin), and electrical cardioversion therapy or in patients for whom such therapy is not feasible or desirable.
Treatment of symptomatic junctional tachycardia† not associated with a readily identifiable and potentially correctable underlying cause in patients with preserved left ventricular function.
Ventricular Tachyarrhythmias
Reducing the incidence of ventricular fibrillation† associated with myocardial ischemia or infarction.
Treatment of hemodynamically stable, sustained polymorphic ventricular tachycardia† following AMI.
CHF
Bisoprolol, carvedilol, and extended-release metoprolol have been shown to be effective in reducing the risk of death in patients with chronic heart failure; however, these positive findings should not be considered indicative of β-adrenergic blocking agent class effect.
Vascular Headache
Prophylaxis of migraine headache†.
Atenolol is not recommended for the treatment of a migraine attack that has already started.
Alcohol Withdrawal
Management of acute alcohol withdrawal† in conjunction with a benzodiazepine.
Atenolol should not be used as monotherapy for acute alcohol withdrawal†.
Dosage and Administration
General
- Individualize dosage according to patient response.
- β1-Adrenergic blocking selectivity diminishes as dosage is increased.
- If long-term therapy is discontinued, reduce dosage gradually over a period of about 2 weeks.
Administration
Administer orally or by slow IV injection.
Oral Administration
Once-daily dosing usually is sufficient in the management of hypertension.
IV Administration
Monitor heart rate, BP, and ECG during IV therapy.
Dilution
May be administered undiluted by slow IV injection or diluted in dextrose injection, sodium chloride injection, or dextrose and sodium chloride injection prior to administration.
For solution and drug compatibility information, see Compatability under Stability.
Rate of Administration
Administer at a rate of 1 mg/minute.
Dosage
Pediatric Patients
Hypertension
Oral
Some experts recommend an initial dosage of 0.5–1 mg/kg daily given as a single dose or in 2 divided doses. Increase dosage as necessary up to a maximum dosage of 2 mg/kg (up to 100 mg) daily given as a single dose or in 2 divided doses.†
Adults
Hypertension
Monotherapy
Oral
Initially, 25–50 mg once daily. Full hypotensive response may require 2 weeks.
If necessary, increase to 100 mg once daily. Some patients may have improved BP control with twice-daily dosing.
Combination Therapy.
Oral
Atenolol in fixed combination with chlorthalidone: initially, 50 mg of atenolol and 25 mg of chlorthalidone once daily. If response is not optimal, 100 mg of atenolol and 25 mg of chlorthalidone once daily.
Initial use of fixed-combination preparations is not recommended; adjust by administering each drug separately, then use the fixed combination if the optimum maintenance dosage corresponds to the ratio of drugs in the combination preparation. Administer separately for subsequent dosage adjustment.
May add another antihypertensive agent when necessary (gradually using half of the usual initial dosage to avoid an excessive decrease in BP).
Angina
Oral
Initially, 50 mg once daily.
If optimum response is not achieved within 1 week, increase to 100 mg once daily.
Some patients may require 200 mg once daily for optimum effect.
AMI
Early Treatment
IV
Initially, 2.5–5 mg over 2–5 minutes.
If initial dose is tolerated, then 2.5–5 mg every 2–10 minutes to a total of 10 mg over 10–15 minutes.
Oral (following IV dosage)
If the total IV dose is tolerated, administer 50 mg orally 10 minutes later, then 50 mg orally 12 hours later.
Continue 100 mg daily (as a single daily dose or in 2 equally divided doses) for 6–9 days (or until a contraindication [e.g., bradycardia or hypotension requiring treatment] develops or the patient is discharged).
If necessary, may reduce to 50 mg daily.
Oral alternative dosage
May eliminate IV doses and administer orally when safety of IV use is questionable and oral therapy is not contraindicated.
Administer 100 mg once daily or in 2 equally divided doses for at least 7 days
Late Treatment
Oral
If not initiated acutely (see AMI: Early Treatment, under Dosage and Administration), initiate long-term therapy within a few days of an AMI.
Optimum duration remains to be clearly established, but studies suggest optimum benefit with at least 1–3 years of therapy after infarction (if not contraindicated).
Indefinite continuation of therapy (unless contraindicated) has been recommended.
Supraventricular Tachyarrhythmias
Atrial Fibrillation
IV
Slow IV infusion: 2.5–5 mg over 2–5 minutes as necessary to control rate, up to 10 mg over a 10- to 15-minute period.†
Monitor heart rate, BP, and ECG; discontinue when efficacy is achieved, SBP declines to <100 mm Hg, or heart rate slows to <50 bpm.†
Once adequate control of heart rate or conversion to normal sinus rhythm has been achieved with IV dosage, continuing therapy with oral dosage has been suggested.†
Oral (following IV dosage)
50 mg every 12 hours.†
Vascular Headache
Prevention of Common Migraine
Oral
Dosage has not been established; in clinical studies 100 mg daily was usual effective dosage.†
Prescribing Limits
Pediatric Patients
Hypertension
Oral
Maximum 2 mg/kg (up to 100 mg) daily.†
Adults
Hypertension
Monotherapy
Oral
Increasing beyond 100 mg daily usually does not result in further improvement in blood pressure control.
AMI
Early Treatment
IV
Maximum 10 mg over 10–15 minutes.
Supraventricular Tachyarrhythmias
Atrial Fibrillation
IV
Maximum 10 mg over a 10- to 15-minute period.†
Special Populations
Dosage in Hepatic Impairment
Minimal hepatic metabolism; no dosage adjustment recommended.
Dosage in Renal Impairment
Hypertension
Oral
Modify doses and/or frequency of administration in response to the degree of renal impairment.
Initial dose of 25 mg daily may be necessary.
Measure BP just prior to the dose to ensure persistence of adequate BP reduction.
Clcr 15–35 mL/minute per 1.73 m2
Maximum 50 daily.
Clcr<15 mL/minute per 1.73 m2
Maximum 25 mg daily or 50 mg every other day.
Hemodialysis
May administer 25 or 50 mg after each dialysis.
Marked reductions in BP may occur; give under careful supervision.
Geriatric Patients
Hypertension
Oral
Modification of dosage may be necessary because of age-related decreases in renal function.
Initially, 25 mg daily may be necessary.
Measure BP just prior to a dose to ensure persistence of adequate BP reduction.
Bronchospastic Disease
Oral
Initially, 50 mg daily and use lowest possible dosage. If dosage must be increased, consider administering in 2 divided doses daily to decrease peak blood levels. A β2-adrenergic agonist bronchodilator should be available. (See Bronchospastic Disease under Cautions.)
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