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

See how to identify renal failure stages according to GFR calculation

See how to diagnose irreversible renal disease

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