Atenolol
TENORMIN
What it isBeta-1-selective antagonist; hypertension and angina.
Why this oneHydrophilicity and renal elimination mean fewer CNS and hepatic-interaction effects than with propranolol or metoprolol.
What limits itIt prevents stroke less effectively than several alternatives in older adults and accumulates in kidney disease. Never stop abruptly.
FDA-approved for
- hypertension/angina (1981)
Off-label
- performance anxiety
FDA label
Read the full label on DailyMed ↗
| FDA dosing | Population | Start | Target | Max |
|---|---|---|---|---|
| Hypertension | Adults | 50 mg QD (25 mg QD if elderly/renally impaired) | 100 mg QD | 100 mg/day |
| Angina pectoris | Adults | 50 mg QD | 100 mg QD | 200 mg/day |
| Acute myocardial infarction | Adults | IV 5 mg over 5 min ×2 (10 min apart), then 50 mg PO ×2 (12 h apart) | 100 mg QD or 50 mg BID | 100 mg/day |
Titration Hypertension: assess after 1–2 weeks before increasing; angina: after 1 week
Renal Adjust in severe impairment: CrCl 15–35 mL/min max 50 mg/day; CrCl <15 max 25 mg/day; hemodialysis: 25–50 mg after each dialysis
Hepatic Undefined
Instructions
- Discontinue gradually in angina patients — do not stop abruptly
- Acute-MI IV regimen initiated only in a monitored setting after hemodynamic stabilization
Contraindications
- Sinus bradycardia
- Heart block greater than first degree
- Cardiogenic shock
- Overt (uncompensated) cardiac failure
Cautions
- Do not discontinue abruptly (risk of angina exacerbation/MI)
- Bradycardia and hypotension
- Bronchospasm/wheezing in bronchospastic disease
Adverse reactions
- Bradycardia
- Cold extremities
- Postural hypotension
- Dizziness
- Fatigue/tiredness
- Depression
- Nausea
- Diarrhea
- Dyspnea
- Wheezing
Pregnancy Undefined
Lactation Undefined
NO BOXED WARNINGS
Principal riskBradycardia; abrupt withdrawal can precipitate ischemia
Cost, est. cash$4–$80/month
Generic entry1988
Classes and tags
Clinical profile
Legacy pregnancy categoryC
Defining liabilityBradycardia and hypotension; renal impairment can prolong severe overdose toxicity.
Mechanism of action: Atenolol ballicule
Open Atenolol in the interactive console ↗
Memory aids: mascots and interaction avatars
LOL hat with β prongs → beta blocker cue
