Atenolol (Tenormin) Considerations for Use*

US/FDA Approved Indication: Heart Rate Control for Atrial Fibrillation

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Black Box Warning* Abrupt cessation may exacerbate angina pectoris and MI.

Mechanism of Action

Blocks binding of catecholamines to beta-1 receptors; Beta-1 selective


Non-acute setting or maintenance: 25 to 100 mg PO daily

Elderly: Start at 25 mg PO daily; titrate to desired heart rate

Hepatic Impairment: No dosage adjustment needed

Renal Impairment:
CrCl > 35 ml/min: No dosage adjustment needed
CrCl 15 - 35 ml/min: Maximum recommended dose is 50 mg/day PO
CrCl < 15 ml/min: Maximum recommended dose is 25 mg/day PO

  • AV block
  • Bradycardia
  • cardiogenic shock
  • decompensated heart failure
  • Major Side Effects

    Hypotension, heart block, bradycardia, asthma, heart failure

    Dosage forms and Strengths

    PO: 25 mg, 50 mg, 100 mg tablets

    Special Notes

    Abrupt cessation my precipitate angina, MI, arrhythmias, or rebound HTN; discontinue by tapering over 1-2 weeks.

    Concomitant amiodarone, digoxin, disopyramide, or non-dihydropyridine calcium channel blockers may increase the risk of bradycardia.

    Monitor closely f or HF exacerbation and hypotension when titrating dose.


    Do not abruptly discontinue without physician’s advice.

    * Refer to prescribing information for more complete information.
    †Dosages given in the table may differ from those recommended by the manufacturers.


    1. American College of Cardiology (ACC), American Heart Association (AHA), and the European Society of Cardiology (ESC). ACC/AHA/ESC 2006 Guidelines for the Management of Patients with Atrial Fibrillation. Washington, DC: American College of Cardiology.
    2. Heart Rhythm Society. AF360 Pocket Guide: Practical Rate and Rhythm Management of Atrial Fibrillation. 2010, Washington, DC: Heart Rhythm Society.
    3. Tarascon Pocket Pharmacopoeia® 2012.