Drug reference

Atenolol

Beta Blocker · Antihypertensive

Also known as Aten, Betacard, Tenolol, Coroten, Olon

START

25-50 mg PO once daily

TYPICAL MAX

100 mg/day

STOP IF

Severe bradycardia · 2nd-3rd degree AV block · decompensated HF · severe peripheral vascular disease

WATCH

HR · BP · fatigue · cold extremities

CDSCO approvedSchedule HJan AushadhiNPPA price-controlledATC C07AB03

Dose laddermg/d

Renal dose adjustmenteGFR mL/min/1.73m²

KDIGO 2024 + manufacturer label

Pharmacokineticsplasma · t hours

ONSET: 1h · β-blockade onset
PEAK: 3h · Cmax
t½: 7h · plasma t½
DURATION: 1d · once-daily dosing window

EXCRETION

85% renal unchanged · no CYP metabolism

route + CYP

INTERACTIONS

12 major

SEVERE in our sources

PREGNANCY

Category D — fetal growth restriction; labetalol preferred

FDA category + note

Top interactionssee all 12 →

LidocaineSevereTextbook-citedKDT 7e · p950
AdrenalineSevereTextbookKDT 7e · p133
AmilorideSevereTextbookKDT 7e
SofosbuvirSevereTextbookHarrison 22e · unknown

Available in India

3,412 branded formulations and 284 fixed-dose combinations. Look up specific brands in the Drugs workspace.

Jan Aushadhi — generic available at GoI pharmacies

Mechanism

Atenolol selectively blocks beta-1 adrenergic receptors primarily located in the heart, reducing heart rate, myocardial contractility, and cardiac output. This leads to a decrease in blood pressure and myocardial oxygen demand. It also inhibits renin release from the juxtaglomerular cells in the kidneys, contributing to its antihypertensive effect.

Indications

HypertensionAngina pectorisCardiac arrhythmias (e.g., supraventricular tachycardias)Myocardial infarction (early intervention and long-term prophylaxis)Migraine prophylaxis (off-label)Anxiety (off-label, for symptomatic relief of somatic manifestations)coronary heart diseasearrhythmiasreduce risk of heart complications following myocardial infarctionhypertension accompanying Graves diseasesymptomatic treatment of thyrotoxicosisAnginaPrevention of arrhythmiasRate control in atrial fibrillationMigraine

Dosing

Adult: Hypertension: Initial 25-50 mg orally once daily; may increase to 100 mg once daily after 1-2 weeks if needed. Angina pectoris: Initial 50 mg orally once daily; may increase to 100 mg once daily after 1 week. Arrhythmias: 50-100 mg orally once daily. Acute MI (Oral follow-up): 50 mg orally 12 hours after IV dose, then 100 mg once daily or 50 mg twice daily for 6-9 days.
Pediatric: Not routinely recommended for pediatric use. If used, dose should be individualized based on weight (e.g., 0.5-1 mg/kg/day, max 100mg/day).
Renal adjustment: Creatinine Clearance (CrCl) 15-35 mL/min: Max 50 mg once daily. CrCl <15 mL/min: Max 25 mg once daily or 50 mg every other day. Hemodialysis: 25-50 mg after each dialysis session.
Hepatic adjustment: No specific dose adjustment required for hepatic impairment as atenolol is minimally metabolized by the liver.
Geriatric: Initiate with lower doses (e.g., 25 mg once daily) and titrate slowly, monitoring for exaggerated hypotensive or bradycardic effects due to potential for reduced renal function and increased sensitivity.
Max dose: 100 mg orally once daily

Pharmacokinetics

Onset

Oral: 1 hour

Peak effect

Oral: 2-4 hours

Duration

24 hours

Half-life

6-7 hours (prolonged in renal impairment)

Bioavailability

Oral: Approximately 40-50%

Protein binding

<10%

Metabolism

Minimal hepatic metabolism (<10%).

Excretion

Primarily excreted unchanged by the kidneys (approx. 85-100% of absorbed dose).

Contraindications

Sinus bradycardia (<50 bpm)
Second- or third-degree atrioventricular (AV) block
Sick sinus syndrome
Cardiogenic shock
Uncontrolled decompensated heart failure
Severe peripheral arterial disease
Phaeochromocytoma (untreated)
Metabolic acidosis
Severe asthma or chronic obstructive pulmonary disease (COPD)
Hypotension
abrupt discontinuation (withdrawal syndrome)
Asthma
AV block (grade 2-3)

Side effects

Common

BradycardiaFatigue/LethargyDizzinessNauseaDiarrheaCold extremitiesMuscle fatigueSleep disturbances/Insomniafewer CNS side effects (depression, nightmares)fewer bronchospastic reactionsBronchospasmPeripheral vasoconstrictionWorsening of acute heart failureDepressionWorsening of psoriasisIncreased triglyceridesDecreased HDL cholesterolSide effects related to CNS action are less likelyNo deleterious effects on lipid profile

Serious

Exacerbation of heart failure
Severe bradycardia or AV block
Bronchospasm (especially in patients with underlying lung disease)
Hypotension
Peripheral vascular insufficiency exacerbation
Masking of hypoglycemia symptoms
Rebound hypertension/angina upon abrupt discontinuation
Elevated LFTs and/or bilirubin, Hallucinations, Psoriatic rash, Thrombocytopenia, Visual disturbances, Dry mouth, Neonatal hypoglycemia risk from maternal use.
life-threatening bradyarrhythmias (with AV conduction defects or other drugs)
exacerbation of angina (abrupt discontinuation)
increased risk of sudden death (abrupt discontinuation)
blunted recognition/delayed recovery from hypoglycemia
increased risk of all-cause mortality, cardiovascular mortality, stroke (compared to other active treatments)
Withdrawal syndrome (rebound hypertension, exacerbation of CAD symptoms)
Severe hypertension and bradycardia (if used with epinephrine in nonselective beta blockers)

Pregnancy & lactation

Pregnancy

Category D — fetal growth restriction; labetalol preferred

Lactation

Atenolol is excreted into breast milk. Monitor infants for signs of beta-blockade (bradycardia, hypotension, cyanosis). Use with caution, or consider alternatives with less excretion into milk.