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

  1. See Beta Blocker
  2. Apple juice or orange juice
    1. May reduce Atenolol absorption
    2. Separate dose from juice by at least 4 hours

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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Related Studies

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

Ontology: Atenolol (C0004147)

Definition (MSH) A cardioselective beta-1 adrenergic blocker possessing properties and potency similar to PROPRANOLOL, but without a negative inotropic effect.
Definition (CHV) a drug that treats rapid heart rate and high blood pressure
Definition (NCI) A synthetic isopropylamino-propanol derivative used as an antihypertensive, hypotensive and antiarrhythmic Atenolol acts as a peripheral, cardioselective beta blocker specific for beta-1 adrenergic receptors, without intrinsic sympathomimetic effects. It reduces exercise heart rates and delays atrioventricular conduction, with overall oxygen requirements decreasing. (NCI04)
Definition (CSP) l-p-carbamoylmethylphenoxy-3-isopropylamino -2-propanol, is a peripheral beta blocker used as an antihypertensive; propranolol, by contrast, also has CNS effects.
Concepts Pharmacologic Substance (T121) , Organic Chemical (T109)
MSH D001262
SnomedCT 391790005, 387506000, 87652004
LNC LP16037-1, MTHU015491
English Atenolol, Benzeneacetamide, 4-(2-hydroxy-3-((1-methylethyl)amino)propoxy)-, atenolol, ATENOLOL, atenolol (medication), Atenolol [Chemical/Ingredient], Atenolol - chemical (substance), Atenolol - chemical, Atenolol (product), Atenolol (substance)
Swedish Atenolol
Czech atenolol
Finnish Atenololi
Russian ATENOLOL, ICI 66082, АТЕНОЛОЛ
Japanese アテノロール
Croatian ATENOLOL
Polish Atenolol
Spanish atenolol (producto), atenolol (sustancia), atenolol, Atenolol
French Aténolol
German Atenolol
Italian Atenololo
Portuguese Atenolol

Ontology: Tenormin (C0592168)

Concepts Pharmacologic Substance (T121) , Organic Chemical (T109)
MSH D001262
English Tenormin, tenormine, tenormin, Tenormine