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Cautions

Contraindications

• Patients with sinus bradycardia, AV block greater than first degree, cardiogenic shock, overt or decompensated cardiac failure. Patients with AMI not promptly and effectively controlled by 80 mg IV furosemide or equivalent therapy.
• Do not use in patients with untreated pheochromocytoma.
• Hypersensitivity to atenolol or any ingredient in the formulation.

Warnings/Precautions

Warnings

Cardiac Failure

Possible precipitation of CHF; possible decreased exercise tolerance in patients with left ventricular dysfunction.

Initiate therapy and subsequent dosage adjustments in patients with CHF under close medical supervision. Prior to initiation of the drug, stabilize patient on other therapy (e.g., ACE inhibitor, diuretic, and/or cardiac glycoside). Symptomatic improvement may not be evident for 2–3 months after initiating therapy.

Avoid use in patients with decompensated CHF; use cautiously in patients with inadequate myocardial function and, if necessary, in patients with well-compensated heart failure (e.g., those controlled with ACE inhibitors, cardiac glycosides, and/or diuretics); use with extreme caution in patients with substantial cardiomegaly.

Adequate treatment (e.g., with a cardiac glycoside and/or diuretic) and close observation recommended if signs or symptoms of impending cardiac failure occur; if cardiac failure continues, discontinue therapy, gradually if possible.

History of Anaphylactic Reactions

Possible increased reactivity to a variety of allergens; patients may be unresponsive to usual doses of epinephrine used to treat anaphylactic reactions.

Calcium-channel Blocking Agents

Concomitant use may cause bradycardia, heart block, increased left ventricular and diastolic blood pressure, particularly in patients with preexisting conduction abnormalities or left ventricular dysfunction. (See Specific Drugs under Interactions.)

Bronchospastic Disease

Possible bronchoconstriction, especially at dosages >100 mg daily. Cautious use recommended in patients with bronchospastic disease (patients who do not respond to or cannot tolerate other hypotensive agents).

Initiate therapy with 50 mg daily and use lowest possible dosage; β₁-selectivity is not absolute. Twice-daily dosing and concomitant use of a β₂-adrenergic agonist bronchodilator may minimize risk of bronchospasm.

If bronchospasm occurs, reduce dosage or discontinue atenolol (gradually if possible) and administer supportive treatment.

Anesthesia and Major Surgery

Possible increased risks associated with general anesthesia. (See Anesthetics, General [Myocardial Depressant] under Interactions.)

Withdrawal of β-adrenergic blocking agent prior to surgery is not recommended in most patients.

Correct vagal dominance (if any) with atropine (1–2 mg IV).

Atenolol effects can be reversed by cautious administration of β-agonists (e.g., dobutamine, isoproterenol).

Diabetes and Hypoglycemia

Possible decreased signs and symptoms of hypoglycemia, particularly tachycardia.

β₁-Selective atenolol does not potentiate insulin-induced hypoglycemia or delay recovery of blood glucose to normal levels.

Thyrotoxicosis

Signs of hyperthyroidism (e.g., tachycardia) may be masked.

Possible thyroid storm if therapy is abruptly withdrawn; carefully monitor patients having or suspected of developing thyrotoxicosis.

General Precautions

Peripheral Arterial Circulatory Disorders

May be aggravated.

Other Precautions

Atenolol shares the toxic potentials of β-adrenergic blocking agents; observe usual precautions of these agents.

When used in fixed combination with chlorthalidone, consider the cautions, precautions, and contraindications associated with thiazide diuretics.

Specific Populations

Pregnancy

Category D.

Lactation

Distributed into milk; caution if used in nursing women.

Pediatric Use

Safety and efficacy remain to be fully established in children; however, some experts have recommended dosages for hypertension based on current limited clinical experience.

Geriatric Use

Response in patients ≥65 years of age does not appear to differ from that in younger adults; however, use with caution due to greater frequency of decreased hepatic, renal, and/or cardiac function and of concomitant disease and drug therapy observed in the elderly.

Consider age-related decreases in renal function when selecting dosage and adjust dosage if necessary. Evaluation of geriatric patients with hypertension or MI should always include assessment of renal function. (See Geriatric Patients under Dosage and Administration.)

Renal Impairment

Decreased clearance; use with caution and adjust dosage based on degree of renal impairment. (See Renal Impairment under Dosage and Administration.)

Common Adverse Effects

Tiredness, hypotension, heart failure, bradycardia, ventricular tachycardia, dizziness, cold extremities, depression, supraventricular tachycardia (atrial fibrillation or flutter), bundle branch block and major axis deviation, fatigue, dyspnea.