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| {{CMG}}
| | #REDIRECT [[Atenolol#Warnings]] |
| __NOTOC__
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| ==List of warnings==
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| <font size="4">[[Atenolol warnings#Cardiac Failure|Cardiac Failure]]</font>
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| <br>
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| <br>
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| <font size="4">[[Atenolol warnings#In Patients Without a History of Cardiac Failure|In Patients Without a History of Cardiac Failure]]</font>
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| <br>
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| <br>
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| <font size="4">[[Atenolol warnings#Cessation of Therapy with Atenolol|Cessation of Therapy with Atenolol]]</font>
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| <br>
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| <br>
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| <font size="4">[[Atenolol warnings#Concomitant Use of Calcium Channel Blockers|Concomitant Use of Calcium Channel Blockers]]</font>
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| <font size="4">[[Atenolol warnings#Bronchospastic Disease|Bronchospastic Disease]]</font>
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| <br>
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| <br>
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| <font size="4">[[Atenolol warnings#Anesthesia and Major Surgery|Anesthesia and Major Surgery]]</font>
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| <br>
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| <font size="4">[[Atenolol warnings#Diabetes and Hypoglycemia|Diabetes and Hypoglycemia]]</font>
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| <br>
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| <br>
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| <font size="4">[[Atenolol warnings#Thyrotoxicosis|Thyrotoxicosis]]</font>
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| <br>
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| <br>
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| <font size="4">[[Atenolol warnings#Untreated Pheochromocytoma|Untreated Pheochromocytoma]]</font>
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| <font size="4">[[Atenolol warnings#Pregnancy and Fetal Injury|Pregnancy and Fetal Injury]]</font>
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| <br>
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| <br>
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| ----
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| ===Cardiac Failure===
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| Sympathetic stimulation is necessary in supporting circulatory function in [[congestive heart failure]], and beta blockade carries the potential hazard of further depressing myocardial contractility and precipitating more severe failure. In patients who have congestive [[heart failure]] controlled by [[digitalis]] and/or [[diuretics]], Atenolol should be administered cautiously. Both [[digitalis]] and Atenolol slow AV conduction.
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| In patients with [[acute myocardial infarction]], [[cardiac failure]] which is not promptly and effectively controlled by 80 mg of intravenous [[furosemide]] or equivalent therapy is a contraindication to [[beta blocker]] treatment.
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| ''[[Atenolol warnings#List of warnings|Return to top]]''
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| <br>
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| ===In Patients Without a History of Cardiac Failure===
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| Continued depression of the [[myocardium]] with beta blocking agents over a period of time can, in some cases, lead to [[cardiac failure]]. At the first sign or symptom of impending [[cardiac failure]], patients should be treated appropriately according to currently recommended guidelines, and the response observed closely. If [[cardiac failure]] continues despite adequate treatment, Atenolol should be withdrawn.
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| ''[[Atenolol warnings#List of precautions|Return to top]]''
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| <br>
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| ===Cessation of Therapy with Atenolol===
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| Patients with coronary artery disease, who are being treated with Atenolol, should be advised against abrupt discontinuation of therapy. Severe exacerbation of angina and the occurrence of [[myocardial infarction]] and [[ventricular arrhythmias]] have been reported in angina patients following the abrupt discontinuation of therapy with [[beta blocker]]s. The last two complications may occur with or without preceding exacerbation of the [[angina pectoris]]. As with other [[beta blocker]]s, when discontinuation of Atenolol is planned, the patients should be carefully observed and advised to limit physical activity to a minimum. If the angina worsens or acute coronary insufficiency develops, it is recommended that Atenolol be promptly reinstituted, at least temporarily. Because [[coronary artery disease]] is common and may be unrecognized, it may be prudent not to discontinue Atenolol therapy abruptly even in patients treated only for [[hypertension]].
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| ''[[Atenolol warnings#List of warnings|Return to top]]''
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| <br>
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| ===Concomitant Use of Calcium Channel Blockers===
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| [[Bradycardia]] and heart block can occur and the left ventricular end diastolic pressure can rise when [[beta blocker]]s are administered with [[verapamil]] or [[diltiazem]]. Patients with preexisting conduction abnormalities or left ventricular dysfunction are particularly susceptible.
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| ''[[Atenolol warnings#List of warnings|Return to top]]''
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| <br>
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| ===Bronchospastic Disease===
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| '''PATIENTS WITH BRONCHOSPASTIC DISEASE SHOULD, IN GENERAL, NOT RECEIVE BETA BLOCKERS.'''
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| Because of its relative beta1selectivity, however, Atenolol may be used with caution in patients with bronchospastic disease who do not respond to, or cannot tolerate, other antihypertensive treatment. Since beta1selectivity is not absolute, the lowest possible dose of Atenolol should be used with therapy initiated at 50 mg and a beta2-stimulating agent (bronchodilator) should be made available. If dosage must be increased, dividing the dose should be considered in order to achieve lower peak blood levels.
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| ''[[Atenolol warnings#List of warnings|Return to top]]''
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| <br>
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| ===Anesthesia and Major Surgery===
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| It is not advisable to withdraw beta-adrenoreceptor blocking drugs prior to surgery in the majority of patients. However, care should be taken when using anesthetic agents such as those which may depress the [[myocardium]]. Vagal dominance, if it occurs, may be corrected with [[atropine]] (1 to 2 mg IV).
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| Atenolol, like other [[beta blocker]]s, is a competitive inhibitor of beta-receptor agonists and its effects on the heart can be reversed by administration of such agents: e.g., [[dobutamine]] or [[isoproterenol]] with caution.
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| ''[[Atenolol warnings#List of warnings|Return to top]]''
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| <br>
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| ===Diabetes and Hypoglycemia===
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| Atenolol should be used with caution in diabetic patients if a beta blocking agent is required. [[Beta blocker]]s may mask [[tachycardia]] occurring with [[hypoglycemia]], but other manifestations such as [[dizziness]] and sweating may not be significantly affected. At recommended doses Atenolol does not potentiate insulin-induced [[hypoglycemia]] and, unlike nonselective [[beta blocker]]s, does not delay recovery of blood glucose to normal levels.
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| ''[[Atenolol warnings#List of warnings|Return to top]]''
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| <br>
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| ===Thyrotoxicosis===
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| Beta-adrenergic blockade may mask certain clinical signs (e.g., [[tachycardia]]) of [[hyperthyroidism]]. Abrupt withdrawal of beta blockade might precipitate a thyroid storm; therefore, patients suspected of developing [[thyrotoxicosis]] from whom Atenolol therapy is to be withdrawn should be monitored closely.
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| ''[[Atenolol warnings#List of warnings|Return to top]]''
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| <br>
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| ===Untreated Pheochromocytoma===
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| Atenolol should not be given to patients with untreated [[pheochromocytoma]].
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| ''[[Atenolol warnings#List of warnings|Return to top]]''
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| <br>
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| ===Pregnancy and Fetal Injury===
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| Atenolol can cause fetal harm when administered to a pregnant woman. Atenolol crosses the placental barrier and appears in cord blood. Administration of Atenolol, starting in the second trimester of pregnancy, has been associated with the birth of infants that are small for gestational age. No studies have been performed on the use of Atenolol in the first trimester and the possibility of fetal injury cannot be excluded. If this drug is used during pregnancy, or if the patient becomes pregnant while taking this drug, the patient should be apprised of the potential hazard to the fetus.
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| Neonates born to mothers who are receiving Atenolol at parturition or breast-feeding may be at risk for [[hypoglycemia]] and [[bradycardia]]. Caution should be exercised when Atenolol is administered during pregnancy or to a woman who is breast-feeding.
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| Atenolol has been shown to produce a dose-related increase in embryo/fetal resorptions in rats at doses equal to or greater than 50 mg/kg/day or 25 or more times the maximum recommended human antihypertensive dose.*1 Although similar effects were not seen in rabbits, the compound was not evaluated in rabbits at doses above 25 mg/kg/day or 12.5 times the maximum recommended human antihypertensive dose (Based on the maximum dose of 100 mg/day in a 50 kg patient)
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| ''[[Atenolol warnings#List of warnings|Return to top]]''
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| <br>
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| {{FDA}}
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| [[Category:Drugs]]
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