Atenolol

About Atenolol

Atenolol blocks beta-1 receptors, mainly in the heart, slowing the heart rate and lowering blood pressure, although this selectivity is not absolute. The label covers high blood pressure, alone or with other medicines; long-term management of angina due to coronary atherosclerosis; and hemodynamically stable people with a definite or suspected heart attack, to lower the risk of cardiovascular death. Safety and effectiveness in children have not been established. For blood pressure it starts at 50 mg once a day and can go to 100 mg, beyond which more benefit is unlikely; angina also starts at 50 mg, rising to 100 mg and, for some people, 200 mg. Because the kidneys clear it, the maximum is 50 mg a day when creatinine clearance is 15 to 35 mL/min/1.73 m² and 25 mg a day below 15, and people on hemodialysis take 25 or 50 mg after each session under hospital supervision; older adults usually start at the low end of the range.

The warning on stopping, boxed on generic labels and listed among the Tenormin label’s warnings, says that in people with angina, severe worsening of angina, heart attacks and ventricular arrhythmias have followed abrupt discontinuation of beta blockers, so anyone stopping atenolol is watched closely and keeps physical activity to a minimum, it is restarted promptly if angina worsens, and it may be prudent not to stop it abruptly even when it is taken only for blood pressure. It must not be taken with sinus bradycardia, heart block greater than first degree, cardiogenic shock, overt heart failure or an allergy to atenolol, and it is not given for untreated pheochromocytoma. It can bring on more severe heart failure; people with bronchospastic disease generally should not take beta blockers, though atenolol may be used with caution at a low dose with a bronchodilator on hand; and it can hide the fast heartbeat that warns of low blood sugar and raise the risk of severe or prolonged low blood sugar, especially in diabetes, in children and during fasting or vomiting. Tiredness, dizziness, cold hands and feet, and depression were reported more often than with placebo.

Atenolol can cause fetal harm, use from the second trimester has been linked to babies who are small for gestational age, and newborns exposed at delivery may have low blood sugar or a slow heartbeat. It passes into breast milk, and clinically significant slow heartbeats have been reported in breastfed infants. It is not routinely stopped before major surgery. Of the Tenormin tablets, only the 50 mg is bisected. Tenormin is still sold, while Tenormin I.V., the injection once used in heart attacks, has been discontinued. Atenolol with chlorthalidone, a diuretic, is a separate combination tablet in 50/25 and 100/25 mg for high blood pressure, not for starting treatment; the Tenoretic brand has been discontinued, and generic versions are sold.

Taking Atenolol

How to take it

Once or twice a day as prescribed, at about the same time each day. Do not stop taking it without talking to your prescriber.

If you miss a dose

Take it as soon as you remember, unless it is almost time for the next dose; then skip the missed dose and continue your regular schedule. Do not take a double dose.

Storage

At room temperature in the container it came in, tightly closed, away from excess heat and moisture (not in a bathroom) and out of reach of children.

Interactions to know about

Verapamil and diltiazem can cause a slow heartbeat and heart block with it, digoxin, amiodarone and disopyramide add to slowing of the heart, and reserpine adds to low blood pressure. If clonidine is being stopped, atenolol is withdrawn several days before; anti-inflammatory pain relievers such as indomethacin can weaken its effect on blood pressure.

This summarizes the official prescribing information. Your prescriber’s and pharmacist’s instructions, and the leaflet that comes with your medicine, take priority.

Why the cash price for Atenolol differs from pharmacy to pharmacy

Generic atenolol has many makers, but each pharmacy sets its own cash price, including its dispensing fee, so quotes for the same tablet can differ, and a prescription that names Tenormin and blocks substitution is priced as a brand.

Atenolol with chlorthalidone is a different product with its own makers, so a quote for the combination is not a quote for plain atenolol, and the reverse.

Ways to pay less for Atenolol without insurance

• Ask for generic atenolol, and make sure the prescription does not block substitution.
• Ask whether atenolol is on the pharmacy’s flat-price generic list, and compare more than one pharmacy.
• Once your dose is stable, ask for a ninety-day supply, and refill early so you never run out.
• If you take atenolol and chlorthalidone as two separate prescriptions, ask the prescriber whether the generic combination tablet would suit you.
• Upload the prescription to Script Unlock so licensed pharmacies can quote their cash price. You pay the pharmacy directly.

Questions to ask your pharmacist about Atenolol

1. 1.Is my dose right for my kidney function?
2. 2.What should I do if I run short, since I should not stop it suddenly?
3. 3.Is it safe with my asthma, diabetes or thyroid condition?
4. 4.Do my calcium channel blocker, clonidine or pain relievers interact with it?

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