Atenolol | A Second-Generation beta-1-selective adrenergic antagonist

Hypertension
Atenolol’s starting dose for adults is 50 mg per day, either either as a single tablet or along with diuretic medication. After a few weeks, if there hasn’t been a significant therapeutic response, the dosage may be increased to one 100 mg tablet taken once daily. Higher daily doses are unlikely to result in additional advantages.  If the patient has a creatinine clearance of less than 15 ml/min, a lower dose of 25 mg per day may be utilised for elderly or renally impaired patients. Before giving them a new dose, careful blood pressure monitoring is required.

Chronic chest pain
The initial adult dose for non-vasospastic angina is 50 mg once daily. One 100 mg pill should be used each day if, after a week, the patient has not had the best results. For the best therapeutic outcome, some patients could require 200 mg per day. The patient should be observed and told to reduce their physical activity during this period since withdrawal should be accomplished gradually. [

Myocardial Infarction Acute
Within 12 hours after the myocardial infarction, intravenous injection should take place as soon as the patient enters the hospital.

For instance, the FDA advises giving an adult a 5-minute IV atenolol injection followed by a 10-minute IV injection of another 5-mg dose. After 12 hours, an oral dose of 50 mg should be taken. Then, for the following 6 to 9 days or until the patient is discharged from the hospital, oral dose might be either 50 mg twice daily or 100 mg once daily.

Migraine Prevention
The initial adult dose is 25 mg once daily, which is increased to 100 mg once daily over the course of 1-2 weeks.

T-wave supraventricular rhythm
The first dose of atenolol for adults, as recommended by the ACC and AHA, is 25 to 50 mg per day, which is increased to 100 mg once daily based on tolerance and response.

Coronary infarction
Most patients should begin taking beta-blockers within 24 hours of their myocardial infarction, and they should continue taking them for secondary prophylaxis, gradually increasing their dose up to 50 mg twice day depending on their blood pressure, heart rate, and side effects.

Thyrotoxicosis
The initial dose is 25–50 mg once daily, which is increased as necessary to a maximum of 100 mg twice daily in order to treat tachycardia, palpitations, and trembling.

Employing in the Particular Patient Populations
Patients with hepatic impairment: The manufacturer’s labelling does not mention changing the dosage. Additionally, as was already mentioned, atenolol undergoes very little hepatic metabolism.
Patients with Impairment of Renal Function: Patients with impaired renal function should be watched closely, and the dose has to be changed in accordance with creatinine clearance.
No dose change is required if creatinine clearance is more than 30 mL/min.
Creatinine clearance 10–30 mL/min: 50 mg/day as the maximum dose.
Maximum dose up to 25 mg per day for creatinine clearance 10 mL/minute.
Those undergoing hemodialysis Hemodialysis effectively removes atenolol; provide atenolol after hemodialysis.

Considerations for Pregnancy:
Former FDA pregnancy category D drug is atenolol. [19] Atenolol is not advised during pregnancy, under the recommendations of The American College of Obstetricians and Gynecologists (ACOG), due to the possibility of growth restriction and low birth weight. Labetalol is the chosen beta blocker for pregnant women with persistent hypertension.

Considerations When Breastfeeding: Plasma protein binding is primarily responsible for the excretion of beta blockers in breast milk Drugs like atenolol (10% PPB), which have low plasma protein binding, are extensively excreted in breast milk.

Avoid stopping atenolol suddenly because doing so could make your angina, acute myocardial infarction, or ventricular arrhythmias worse. It is advised that the dose be reduced gradually.
It is advised that atenolol be swiftly reintroduced briefly if angina worsens or acute coronary insufficiency develops.
Bradycardia, dizziness, constipation, confusion, dyspnea, headaches, erectile dysfunction, nausea, lethargy, paraesthesia, peripheral numbness, rash, sleep disturbances, syncope, visual impairment, and bronchospasm are a few of the more typical adverse effects.
Alopecia, dry mouth, postural hypotension, psychosis, psoriasis, thrombocytopenia, depression, moderate transaminitis, and depression are uncommon adverse reactions.
Severe bradycardia, renal failure, atrioventricular blockage, shock, and hyperkalemia are the traits of the BRASH syndrome. If you suspect BRASH syndrome, stop taking atenolol.