Atenolol

CLINICAL USE

Beta-adrenoceptor blocker:Hypertension, angina, arrhythmias

DOSE IN NORMAL RENAL FUNCTION

Oral: Hypertension: 25–50 mg daily Angina: 100 mg daily in 1 or 2 divided doses

Arrhythmias: 50–100 mg daily

IV:Arrhythmias: 2.5 mg at a rate of 1 mg/ min repeated at 5 minute intervals to a maximum of 10 mg

Infusion:150 mcg/kg, repeated every 12 hours if required

PHARMACOKINETICS

Molecular weight :266.3

%Protein binding :3

%Excreted unchanged in urine : >90

Volume of distribution (L/kg) :1.1

half-life – normal/ESRD (hrs) :6–7/15–35

DOSE IN RENAL IMPAIRMENT

GFR (mL/MIN)

20 to 50 : Dose as in normal renal function

10 to 20 : Dose as in normal renal function

<10 : Dose as in normal renal function

DOSE IN PATIENTS UNDERGOING RENAL REPLACEMENT THERAPIES

CAPD :Not dialysed. Dose as in normal renal function

HD :Dialysed. Dose as in normal renal function

HDF/high flux :Dialysed. Dose as in normal renal function

CAV/VVHD :Dialysed. Dose as in normal renal function

IMPORTANT DRUG INTERACTIONS

Potentially hazardous interactions with other drugs

Anaesthetics: enhanced hypotensive effect Analgesics: NSAIDs antagonise hypotensive effect

Anti-arrhythmics: increased risk of myocardial depression and bradycardia; increased risk of bradycardia, myocardial depression and AV block with amiodarone

Antidepressants: enhanced hypotensive effect with MAOIs

Antihypertensives: enhanced hypotensive effect; increased risk of withdrawal hypertension with clonidine; increased risk of first dose hypotensive effect with post-synaptic alpha-blockers such as prazosin

Antimalarials: increased risk of bradycardia with mefloquine

Antipsychotics enhanced hypotensive effect with phenothiazines

Calcium-channel blockers: increased risk of bradycardia and AV block with diltiazem; hypotension and heart failure possible with nifedipine and nisoldipine; asystole, severe hypotension and heart failure with verapamil

Diuretics: enhanced hypotensive effect Moxisylyte: possible severe postural hypotension

Sympathomimetics: severe hypertension with adrenaline and noradrenaline and possibly with dobutamine

Tropisetron: increased risk of ventricular arrhythmias – use with caution

ADMINISTRATION

Reconstition

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Route

Oral, IV

Rate of Administration

Infusion: 20 minutes IV injection: 1 mg/minute

Comments

Dilute with glucose 5% or sodium chloride 0.9%

OTHER INFORMATION

SM advise that beta-blockers are contraindicated in patients with asthma or history of obstructive airway disease

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