· Hypertension

· Chronic stable angina

Secondary Prevention after Acute Myocardial Infarction: Rapid Intervention in the First 12 Hours

· Supraventricular arrhythmias

O, paroxysmal supraventricular tachycardia (treatment, preventive or curative)

O Atrial fibrillation and atrial flutter: in the event of insufficient response to maximum doses of digitalis, in cases where digitalis may be contraindicated or may be associated with an unfavorable risk-benefit ratio

· Ventricular arrhythmias

Ventricular extrasystoles (preventive or curative treatment), if the extrasystoles result from an increase in sympathetic activity

Ventricular tachycardias and ventricular fibrillation (preventive therapy), especially when the ventricular abnormality results from a sympathetic, important activity.


The dosage should be determined on a case-by-case basis, based more on the clinical effect. It is recommended to start with the lowest dose possible so that symptoms of heart failure, bradycardia and any symptoms of bronchitis can be noticed as early as possible
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Hypertension: an initial dose of 50 mg is recommended. The usual maintenance dose in hypertension is one tablet (50-100 mg) per day. The maximum effect will be obtained after 1 to 2 weeks. To obtain an additional improvement in blood pressure, atenolol may be combined with another antihypertensive drug, eg a diuretic.
Angor: 50-100 mg per day as a function of clinical effect. Increasing the dose to more than 100 mg per day usually does not increase the anti-anginal effect. If necessary, the dosage of 100 mg daily may be divided into two doses.
Arrhythmias: the usual maintenance dose is 50 to 100 mg of atenolol per day.
Secondary Prevention of Myocardial Infarction: In oral maintenance therapy up to discharge from hospital, the dose is 50 to 100 mg per day in 1 or 2 doses in patients who Are stabilized on the hemodynamic plane

Children

There is no experience with the use of atenolol in children. It is therefore not recommended to use atenolol in children.

Patients, aged

In elderly patients, treatment should be initiated at a lower dose. A titration of the dose will depend on the clinical effect.

Renal insufficiency

Glomerular filtration rate (ml / min / 1.73 m 2 of body surface area)

Recommended doses of atenolol (mg / day)

> 35

No change in dose

15-35

25-50 (or 50-100; / 2 days)



+; Baclofen

Causes an increase in anti-hypertensive activity.

+ Iodinated contrast agent

Atenolol may interfere with compensatory cardiovascular reactions related to hypotension or shock induced by iodinated contrast products

+; Amiodarone

The combination of this product with atenolol may result in additive depressant effects on conduction and negative inotropic effects, especially in patients with underlying dysfunction of the sinus node or atrioventricular node .

Associations to be taken into account

+ Calcium antagonists: derivatives of dihydropyridine such as nifedipine

The risk of hypotension can be increased. In patients with latent cardiac insufficiency, treatment with atenolol may lead to heart failure.

+; Drugs inhibiting prostaglandin synthetase

(Like NSAIDs) may reduce the hypotensive effects of atenolol.


(Eg, adrenaline) may counteract the effect of atenolol.


Increase in hypotensive effect.

+ Ampicillin

May reduce the bioavailability of atenolol. Therefore, the physician should seek signs of altered response to atenolol, particularly when high doses of ampicillin are administered concomitantly.

+ Antihypertensives, diuretics, vasodilators, tricyclic antidepressants, barbiturates and phenothiazine

Could potentiate the antihypertensive effect of atenolol.


Concomitant use of atenolol may increase and prolong the relaxing effect of muscle relaxants

Without object.

The symptoms of overdose are as follows

Bradycardia, hypotension, bronchospasm and acute heart failure.

After ingestion of an excessive dose or in case of hypersensitivity the patient should be kept under close supervision and treated in an intensive care unit Absorption of atenolol always present in the gastro- Intestinal tract can be prevented by gastric lavage, activated charcoal, and a laxative. The establishment of artificial respiration may be necessary. Bradycardia or major vaginal reactions should be treated by administering atropine or methylatropine. Hypotension and shock should be treated with plasma / plasma substitutes and, if necessary, with catecholamines. The betablocker effect may be counteracted by slow intravenous administration of hydrochloride, isoprenaline, starting with a dose of about 5 micrograms / minute, or dobutamine, starting with a dose of 2.5 micrograms / Minute, until the desired effect has been achieved. In refractory cases, isoprenaline may be associated with dopamine. If this does not produce the desired effect, 8-10 mg of glucagon may be administered intravenously. If necessary, this injection should be repeated within one hour and be followed, if necessary, by intravenous glucagon infusion at a rate of 1-3 mg / hour. Administration of calcium ions, or use of a cardiac pacemaker may also be contemplated. With regard to the hydrophilic nature, the low plasma protein binding and the low volume of distribution of atenolol, hemodialysis or hemoperfusion may be considered.

Pregnancy

Beta-blockers reduce placental perfusion, which can lead to the death of the fetus in utero, as well as false and preterm births. In addition, adverse effects (especially hypoglycemia, and bradycardia) may occur in the fetus and newborn. Due to the increased risk of cardiac and pulmonary complications in the newborn in the postnatal period, it should be carefully monitored.

Atenolol crosses the placental barrier. It is advisable to consult a doctor if atenolol is used regularly during pregnancy.

Atenolol has been used satisfactorily under careful monitoring for hypertension in pregnancy. Although there were no indications of fetal abnormalities, it should be noted that atenolol was only used after the 20th week of pregnancy. On the other hand, although there is no evidence of undesirable effects during childbirth or during the period of breastfeeding, the possibility of harm to the fetus can not be ruled out.

Breastfeeding

The concentration of atenolol in breast milk is three times greater than in the blood.In breastfeeding, although there are only low concentrations of atenolol in children, A beta-blocking effect in children can not be excluded in the long term. It is advisable, if possible, to observe a six-hour interval between taking atenolol and breastfeeding. During this interval, the child can be bottle-fed.
When atenolol is used during pregnancy and lactation, careful consideration should be given to the advantages and disadvantages of this use.
The following terminology has been used to classify the frequency of adverse events:
Very common, ≥1 / 10

Common: ≥1 / 100 and;