ADMINISTRATION ROUTES:
PO, NG
ALTERNATIVE NAMES:
Noten
ICU INDICATIONS:
-
Hypertension
-
Acute myocardial infarction
-
Secondary prevention in patients with coronary artery disease
-
Angina
-
Rate control
PRESENTATION AND ADMINISTRATION:
PO / NG:
Pacific atenolol: orange 50 mg and 100 mg tablets. Tablets may be crushed and administered via nasogastric tube
DOSAGE:
PO:
Start at 50 mg daily; increase to 100 mg daily as tolerated
Note: Metoprolol is the preferred first-line beta blocker in Wellington ICU
DOSAGE IN RENAL FAILURE AND RENAL REPLACEMENT THERAPY:
Dose in renal impairment
| GFR (ml/min) | DOSE |
|---|---|
| <10 | 50mg once daily |
| 10-20 | dose as in normal renal function |
| >20-50 | dose as in normal renal function |
Dose in renal replacement therapy
| MODALITY | DOSE |
|---|---|
| CAPD | 50mg once daily |
| HD | 50mg once daily |
| CVVHDF | dose as in normal renal function |
DOSAGE IN PAEDIATRICS:
1-2 mg/kg PO q12-24hrly
Safety and effectiveness in paediatric patients have not been established
CLINICAL PHARMACOLOGY:
Atenolol is a beta1-selective (cardioselective) beta-adrenergic receptor blocking agent without membrane stabilising or intrinsic sympathomimetic (partial agonist) activities. This preferential effect is not absolute, however, and at higher doses, atenolol inhibits beta2-adrenoreceptors, chiefly located in the bronchial and vascular musculature. Absorption of an oral dose of atenolol is rapid and consistent but incomplete. Approximately 50% of an oral dose is absorbed from the gastrointestinal tract, the remainder being excreted unchanged in the faeces. Peak blood levels are reached between 2 and 4 hours after ingestion.
CONTRAINDICATIONS:
-
Sinus bradycardia
-
Heart block greater than first degree
-
Cardiogenic shock
-
Overt cardiac failure
-
Asthma
WARNINGS:
Cardiac Failure
Sympathetic stimulation is necessary in supporting circulatory function in congestive heart failure, and beta blockade carries the potential hazard of further depressing myocardial contractility and precipitating more severe failure
Discontinuation of therapy
Discontinuation of therapy in a patient with coronary artery disease may lead to rebound angina, arrhythmia or myocardial infarction
Diabetes and Hypoglycaemia
Beta blockers may mask tachycardia occurring with hypoglycaemia
Thyrotoxicosis
Beta-adrenergic blockade may mask certain clinical signs (e.g. tachycardia) of hyperthyroidism. Abrupt withdrawal of beta blockade may precipitate a thyroid storm
PRECAUTIONS:
General:
Atenolol may aggravate peripheral arterial circulatory disorders
Laboratory Tests:
No tests in addition to routine ICU tests are required
Drug/Laboratory Test Interactions:
None known
IMPORTANT DRUG INTERACTIONS IN ICU:
Beta blockers may exacerbate the rebound hypertension which can follow the withdrawal of clonidine
ADVERSE REACTIONS:
Body as a Whole:
Tiredness, fatigue
Cardiovascular System:
Bradycardia , cold extremities, hypotension, leg pain
Respiratory System:
Wheeziness, dyspnoea
Digestive System:
Diarrhoea, nausea
Nervous System:
Dizziness, vertigo, light-headedness