III. Mechanism

  1. See Beta Adrenergic ReceptorAntagonist
  2. Selective Beta Antagonist that primarily inhibits B1 activity by blocking B1 Receptors
    1. Reduces Myocardial Contractility, Blood Pressure, myocardial oxygen demand
    2. Also Antiarrhythmic and slows ventricular response in Atrial Fibrillation
  3. Contrast with non-selective Beta Blockers (e.g. Propranolol)
    1. Non-selective Beta Blockers also act at B2 Receptors (bronchoconstriction) and B3 Receptors (block lipolysis)

IV. Adverse Effects

V. Drug Interactions

VI. Dosing: Adults

  1. Start: 25-50 mg orally daily
    1. Despite daily dosing, duration of activity is not a a full 24 hours
    2. Consider dividing dosing into twice daily (e.g. 50 mg twice daily)
  2. Target: 50-100 mg orally daily (may divide dose twice daily)
  3. Maximum dose: 100 mg (50 mg if GFR <35 ml/min, 25 mg if GFR <15 ml/min)

VII. Efficacy

  1. Not as effective as other Beta Blockers in cardiovascular disease prevention (especially with Hypertension present)
    1. Consider Metoprolol, Bisoprolol, Carvedilol or Nadolol instead
    2. Carlberg (2004) Lancet 364:1684-9 [PubMed]

VIII. Safety

  1. Pregnancy Category D
  2. Avoid in Lactation
    1. Risk of Hypoglycemia in newborns

IX. Metabolism

  1. Bioavailability 50%
  2. Not lipophilic
  3. Renal excretion

XI. References

  1. (2019) Presc Lett, Resource #350503, Comparison of Oral Beta Blockers
  2. (2020) Med Lett Drugs Ther 62(1598): 73-80
  3. Olson (2020) Clinical Pharmacology, Medmaster Miami, p. 66-7
  4. Hamilton (2020) Tarascon Pocket Pharmacopoeia

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Cost: Medications

atenolol (on 12/21/2022 at Medicaid.Gov Survey of pharmacy drug pricing)
ATENOLOL 100 MG TABLET Generic $0.05 each
ATENOLOL 25 MG TABLET Generic $0.03 each
ATENOLOL 50 MG TABLET Generic $0.03 each
ATENOLOL-CHLORTHALIDONE 100-25 Generic $0.39 each
ATENOLOL-CHLORTHALIDONE 50-25 Generic $0.33 each