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

Dosing

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

Contraindications
  • 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.

    Counseling

    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.


    Sources:

    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.