|Trade names||Tenormin, others|
|Drug class||Selective β1 receptor antagonist|
|By mouth, IV|
|Defined daily dose||75 mg|
|Elimination half-life||6–7 hours|
|Chemical and physical data|
|Molar mass||266.341 g·mol−1|
|3D model (JSmol)|
Atenolol is a beta blocker medication primarily used to treat high blood pressure and heart-associated chest pain. Atenolol, however, does not seem to improve mortality in those with high blood pressure. Other uses include the prevention of migraines and treatment of certain irregular heart beats. It is taken by mouth or by injection into a vein. It can also be used with other blood pressure medications.
Common side effects include feeling tired, heart failure, dizziness, depression, and shortness of breath. Other serious side effects include bronchospasm. Use is not recommended during pregnancy and other medications are preferred when breastfeeding. It works by blocking β1-adrenergic receptors in the heart, thus decreasing the heart rate and workload.
Atenolol was patented in 1969 and approved for medical use in 1975. It is available as a generic medication. The defined daily dose is 75 mg by mouth. In the United States, at this dose, the wholesale cost per month is more than US$25 as of 2021. In the United Kingdom, a month of treatment costs the NHS less than £1.50 as of 2020. In 2018, it was the 42nd most commonly prescribed medication in the United States, with nearly 19 million prescriptions.
Atenolol is used for a number of conditions including hypertension, angina, long QT syndrome, acute myocardial infarction, supraventricular tachycardia, ventricular tachycardia, and the symptoms of alcohol withdrawal.
Although atenolol reduces blood pressure, how effective it is at reducing cardiovascular risk has been debated. The role for β-blockers in general in hypertension was downgraded in June 2006 in the United Kingdom, and later in the United States, as they are less appropriate than other agents such as ACE inhibitors, calcium channel blockers, thiazide diuretics and angiotensin receptor blockers, particularly in the elderly. Antihypertensive therapy with atenolol provides weaker protective action against cardiovascular complications (e.g. myocardial infarction and stroke) compared to the newer more selective β-blockers. In some cases, diuretics are superior.
Common side effects include feeling tired, heart failure, dizziness, depression, and shortness of breath. Other serious side effects include bronchospasm. Use is not recommended during pregnancy. Other medications are preferred when breastfeeding, as compared to other β-blockers, atenolol appears in breast milk in greater amounts and is associated with restricted fetal growth.
Symptoms of overdose are due to excessive pharmacodynamic actions on β1 and also β2-receptors. These include bradycardia (slow heartbeat), severe hypotension with shock, acute heart failure, hypoglycemia and bronchospastic reactions. Treatment is largely symptomatic. Hospitalization and intensive monitoring is indicated. Activated charcoal is useful to absorb the drug. Atropine will counteract bradycardia, glucagon helps with hypoglycemia, dobutamine can be given against hypotension and the inhalation of a β2-mimetic as hexoprenalin or salbutamol will terminate bronchospasms. Blood or plasma atenolol concentrations may be measured to confirm a diagnosis of poisoning in hospitalized patients or to assist in a medicolegal death investigation. Plasma levels are usually less than 3 mg/L during therapeutic administration, but can range from 3–30 mg/L in overdose victims.
Society and culture
Atenolol has been given as an example of how slow healthcare providers are to change their prescribing practices in the face of medical evidence that indicates that a drug is ineffective. In 2012, 33.8 million prescriptions were written to American patients for this drug. In 2014, it was in the top (most common) 1% of drugs prescribed to Medicare patients. Although the number of prescriptions has been declining steadily since the evidence against its efficacy was published, it has been estimated that it would take 20 years for doctors to stop prescribing it for hypertension. The BNF has advised due care in writing the prescription as atenolol has been confused with amlodipine.
In 2021, atenolol is the 42nd most commonly prescribed medication in the United States, with almost 19 million prescriptions. In the United States, the wholesale cost per month of 75mg atenolol daily is more than US$25 as of 2021. In the United Kingdom, a month of treatment at this dose costs the NHS about £1.50 as of 2020.
Atenolol tablets come in doses of 25mg, 50mg and 100mg. The Tenormin brand is atenolol alone. Atenolol combined with the diuretic chlorthalidone is available in the United States as brands Tenoretic, Tenoretic 50 and Tenoretic 100. In the UK, 50 mg of atenolol combined with 20mg of nifedipine is available in a modified release form, Tenif. An oral suspension of 500micrograms of atenolol per 1ml (Tenormin), and oral solution of 5mg atenolol per 1ml, maybe available on special order.
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