Selective beta-1 adrenergic blocker
Updated · Methodology
Second line
Hypertension. Per 2023 and SEH-LELHA 2022, atenolol is not first-line (LIFE 2002 trial showed inferiority to losartan in elderly cardiovascular outcomes). Used in CHD with tachycardia or beta-blocker intolerance. Dose 25–100 mg once daily.
Sources
ICD-10: I10 · ICD-11: BA00
The drug is promoted for these uses outside international guidelines. Each entry below is analyzed against AEMPS, FDA, EMA, Cochrane and major RCTs.
Not recommended
Atenolol while breastfeeding – undesirable choice. RID 5.7–19.2% – the highest among beta-blockers. Cases of infant cyanosis, bradycardia, hypothermia, and hypoglycemia in breastfed infants have been reported (LactMed). Hale L3. Per 2020 and SEGO 2023, prefer labetalol, metoprolol, or propranolol. If atenolol was prescribed to a nursing mother, consider a second opinion.
Sources
ICD-10: I10 · ICD-11: BA00
Selective beta-1 adrenergic receptor blocker in myocardium. Reduces heart rate, cardiac output, myocardial oxygen demand. Minimal effect on bronchial and vascular beta-2 receptors at usual doses. Hydrophilic, poor BBB penetration. T½ 6–7 h, renal elimination.
AEMPS summary of product characteristics (section 4.6): atenolol crosses the placenta and appears in the umbilical cord. No studies of atenolol use in the first trimester have been done, so fetal harm cannot be excluded; atenolol has been used in individual cases under close supervision to treat hypertension in the third trimester. Its use for mild to moderate hypertension in pregnant women has been associated with intrauterine growth retardation. In women who are pregnant or planning a pregnancy, atenolol is used only if the expected benefit justifies the possible risks, especially in the first and second trimesters. Newborns of mothers taking atenolol at delivery may be at risk of hypoglycaemia and bradycardia.
Not preferred during breastfeeding. RID 5.7–19.2%, infant cyanosis, bradycardia, hypoglycemia have been reported. Hale L3. Prefer labetalol, metoprolol, propranolol.
Reference information, not a clinical decision. Discuss feeding pauses or changes with your physician or an IBCLC.
Verbatim lines from the interaction sections, in the language of the label
«En pacientes, particularmente los que padecen alteración ventricular y/AEMPS, section 4.5 · Open on CIMA
«En pacientes, particularmente los que padecen alteración ventricular y/AEMPS, section 4.5 · Open on CIMA
«Los betabloqueantes pueden exacerbar la hipertensión arterial de rebote que puede aparecer por la retirada de clonidina. En el caso de que se administre clonidina concomitantemente con…»AEMPS, section 4.5 · Open on CIMA
«Los fármacos antiarrítmicos de clase I (por ej. disopiramida) y la amiodarona pueden tener un efecto potenciador sobre los tiempos de conducción auricular e inducir un efecto inotrópico negativo.»AEMPS, section 4.5 · Open on CIMA
«Drug Interactions: Amiodarone is an antiarrhythmic agent with negative chronotropic properties that may be additive to those seen with beta-blockers.»FDA, section 7 · Open on DailyMed
«Drug Interactions: Disopyramide is a Type I antiarrhythmic drug with potent negative inotropic and chronotropic effects. Disopyramide has been associated with severe bradycardia, asystole and heart…»FDA, section 7 · Open on DailyMed
«Los fármacos antiarrítmicos de clase I (por ej. disopiramida) y la amiodarona pueden tener un efecto potenciador sobre los tiempos de conducción auricular e inducir un efecto inotrópico negativo.»AEMPS, section 4.5 · Open on CIMA
«Drug Interactions: Calcium channel blockers may also have an additive effect when given with atenolol tablets (see WARNINGS ).»FDA, section 7 · Open on DailyMed
«Drug Interactions: Beta-blockers may exacerbate the rebound hypertension which can follow the withdrawal of clonidine. If the two drugs are coadministered, the beta-blocker should be withdrawn…»FDA, section 7 · Open on DailyMed
«Los glucósidos digitálicos en asociación con betabloqueantes pueden aumentar el tiempo de conducción auriculo-ventricular.»AEMPS, section 4.5 · Open on CIMA
«Drug Interactions: Both digitalis glycosides and beta-blockers slow atrioventricular conduction and decrease heart rate. Concomitant use can increase the risk of bradycardia.»FDA, section 7 · Open on DailyMed
«Los fármacos antiarrítmicos de clase I (por ej. disopiramida) y la amiodarona pueden tener un efecto potenciador sobre los tiempos de conducción auricular e inducir un efecto inotrópico negativo.»AEMPS, section 4.5 · Open on CIMA
«Drug Interactions: Disopyramide is a Type I antiarrhythmic drug with potent negative inotropic and chronotropic effects. Disopyramide has been associated with severe bradycardia, asystole and heart…»FDA, section 7 · Open on DailyMed
«El empleo concomitante de fármacos inhibidores de la prostaglandina-sintetasa, tales como ibuprofeno e indometacina, puede disminuir los efectos hipotensores de los betabloqueantes.»AEMPS, section 4.5 · Open on CIMA
«La terapia concomitante con dihidropiridinas (por ejemplo, nifedipino) puede aumentar el riesgo de hipotensión y se puede producir insuficiencia cardíaca en pacientes que la presenten de forma…»AEMPS, section 4.5 · Open on CIMA
«El empleo concomitante de agentes simpaticomiméticos, como adrenalina, puede contrarrestar el efecto de los betabloqueantes.»AEMPS, section 4.5 · Open on CIMA
«Se han notificado efectos acumulativos que dieron lugar a bradicardia (lo cual puede resultar en síncope) con el uso combinado de varios beta-bloqueantes (incluyendo atenolol) y rivastigmina. Se…»AEMPS, section 4.5 · Open on CIMA
«Otros tratamientos concomitantes: No se observó ninguna interacción farmacocinética o farmacodinámica clínicamente significativa cuando se administró apixabán con atenolol o f amotidina. La…»AEMPS, section 4.5 · Open on CIMA
«Drugs with No Observed Interactions with Atazanavir: No clinically significant drug interactions were observed when atazanavir was coadministered with methadone, fluconazole, acetaminophen, atenolol…»FDA, section 7 · Open on DailyMed
«Se han realizado diversos ensayos clínicos en los que se administró clopidogrel junto con otros medicamentos para investigar el potencial de interacción farmacocinético y farmacodinámico. No se…»AEMPS, section 4.5 · Open on CIMA
«Casos de incremento de efectos adversos: Fluvoxamina no altera las concentraciones plasmáticas de atenolol.»AEMPS, section 4.5 · Open on CIMA
«Verapamilo: en combinación con medicamentos beta bloqueantes (descrito para atenolol, propranolol y pindolol) verapamilo puede causar bradicardia e hipotensión. Verapamilo y los beta-bloqueantes…»AEMPS, section 4.5 · Open on CIMA
«intervalo QT. El uso simultáneo de ondansetrón con fármacos cardiotóxicos (p. ej., antraciclinas como doxorubicina, daunorubicina o trastuzimab), antibióticos (como eritromicina), antifúngicos (como…»AEMPS, section 4.5 · Open on CIMA
«La administración conjunta con cimetidina provocó una disminución sustancial del aclaramiento de sertralina. Se desconoce el significado clínico de estos cambios. Sertralina no tiene ningún efecto…»AEMPS, section 4.5 · Open on CIMA
«Clinically Significant Drug Interactions: Drugs Having No Clinically Important Interactions with Sertraline Hydrochloride Based on pharmacokinetic studies, no dosage adjustment of sertraline…»FDA, section 7 · Open on DailyMed
«No se han observado interacciones cuando hidrocloruro de tamsulosina se ha administrado junto con atenolol, enalapril, o teofilina.»AEMPS, section 4.5 · Open on CIMA
«Nifedipine, Atenolol, Enalapril: Dosage adjustments are not necessary when tamsulosin hydrochloride capsules are administered concomitantly with nifedipine, atenolol, or enalapril [see Clinical…»FDA, section 7 · Open on DailyMed
«Drug Interactions:: atenolol metoprolol»FDA, section 7 · Open on DailyMed
«En estudios de interacción farmacológica con valsartán, no se han hallado interacciones clínicamente significativas entre valsartán y cualquiera de las siguientes sustancias : cimetidina, warfarina…»AEMPS, section 4.5 · Open on CIMA
Opens the checker prefilled with this drug. Pick the second one from your regimen.
Summary of a multi-drug list →
Medicine list: everything you take in one place →
Atenolol is evaluated for the following indications with varying evidence strength: Hypertension (evidence tier B), Hypertension during breastfeeding (evidence tier D). See the full indication matrix with dosing and citations above on this page.
Common side effects of Atenolol (≥ 1 in 100): Fatigue, Bradycardia, Cold extremities, Decreased libido, Depressive episodes. See the Safety section for uncommon and serious reactions.
AEMPS summary of product characteristics (section 4.6): atenolol crosses the placenta and appears in the umbilical cord. No studies of atenolol use in the first trimester have been done, so fetal harm cannot be excluded; atenolol has been used in individual cases under close supervision to treat hypertension in the third trimester. Its use for mild to moderate hypertension in pregnant women has been associated with intrauterine growth retardation. In women who are pregnant or planning a pregnancy, atenolol is used only if the expected benefit justifies the possible risks, especially in the first and second trimesters. Newborns of mothers taking atenolol at delivery may be at risk of hypoglycaemia and bradycardia.
Not preferred during breastfeeding. RID 5.7–19.2%, infant cyanosis, bradycardia, hypoglycemia have been reported. Hale L3. Prefer labetalol, metoprolol, propranolol.
Atenolol is contraindicated in: Hypersensitivity; Bradycardia <50; 2nd-3rd AV block; Cardiogenic shock; Severe COPD/asthma. Full list in the Safety section.
Direct links to regulator labels. Open in a new tab.
Bisoprolol, Carvedilol, Labetalol, Metoprolol, Nebivolol, Propranolol, Sotalol