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Atenolol is a β- adrenergic receptor antagonist. It is available for parenteral use and oral use as a tablet.(1)

Hypertension Angina pectoris due to coronary atherosclerosis Acute myocardial infarction (2,3)

Sinus bradycardia, heart block greater than first degree, cardiogenic shock, and overt cardiac failure. Hypersensitivity to atenolol or any of its excipients or any other beta- blocker Asthma or history of obstructive airways disease (unless no alternative, then with extreme caution and under specialist supervision) Uncontrolled heart failure Prinzmetal angina Hypotension Sick sinus syndrome Metabolic acidosis Severe peripheral arterial disease Pheochromocytoma (unless used with alphablocker). (2,3)

Gastro-intestinal disturbances (nausea, vomiting, diarrhoea, constipation, abdominal cramps) Bradycardia, heart failure, hypotension, conduction disorders Peripheral vasoconstriction (including exacerbation of intermittent claudication and Raynaud’s phenomenon) Bronchospasm; dyspnoea Headache Fatigue Sleep disturbances including nightmares Paraesthesia Dizziness Vertigo Psychosis, depression, confusion Purpura; thrombocytopenia Visual disturbances Exacerbation of psoriasis Alopecia Dry eyes (reversible on withdrawal) Agranulocytosis Hypoglycemia or hyperglycemia Myocardial depression (2,3)

Amiodarone, digitalis glycosides, verapamil, reserpine, haloperidol, β- blockers: Additive depression of cardiac output due to decreased myocardial activity or conduction Angiotensin converting enzyme inhibitors, anti- deppressants: Additive hypotension Alpha blockers: Exacerbation of first dose hypotension Isoproterenol, dobutamine: reverse the effects of atenolol Non-steroidal anti- inflammatory drugs: Blunt the anti- hypertensive effect of atenolol Warfarin: Increased levels of warfarin Ergot alkaloid: Concomitant administration with beta-blockers may enhance the vasoconstrictive action of ergot alkaloids. (2)

Renal impairment: The drug should be used with caution in patients with impaired renal function. (2)

Hypertension: The initial dose is 50 mg given as a single tablet, either alone or added to diuretics. Maximum dose of up to 100 mg per day may be used. Angina Pectoris: The initial dose is 50 mg given as a single tablet once a day. Maximum dose of up to 200 mg per day may be used. Myocardial infarction: Early treatment: Initiated soon after patient arrives in the hospital. Treatment should begin with 5 mg atenolol intravenously over 5 minutes followed by another 5 mg intravenous injection 10 minutes later. In patients who tolerate the full intravenous dose (10 mg), atenolol tablet 50 mg should be initiated 10 minutes after the last intravenous dose followed by another 50 mg oral dose 12 hours later. Thereafter, atenolol can be given orally either 100 mg once daily or 50 mg twice a day for a further 6-9 days or until discharge from the hospital. (2,3)

1 Michael T, Hoffman B. Treatment of myocardial ischemia and hypertension. In: Brunton L, Chabner B, Knollmann B eds. Goodman & Gilman’s The Pharmacological basis of Therapeutics. 12th ed. USA: McGraw Hill; 2011: 745- 788. 2 Atenolol tablets. Product monograph. [Online] [Cited 2013 Sept 9]. Available from: URL: 3 National Formulary of India. 4th ed. Government of India, Ministry of Health and Family Welfare. India: Indian Pharmacopoeia Commission; 2011.