What is the recommended dose and frequency of Atenolol (Beta Blocker)?

From the Guidelines

Atenolol should be prescribed at a dose of 50 to 200 mg per day for the management of angina. This recommendation is based on the guidelines for the management of patients with unstable angina/non-ST-elevation myocardial infarction, which suggest that beta blockers, including atenolol, should be initiated orally in the absence of contraindications within the first 24 hours 1. The choice of beta blocker, such as atenolol, is based primarily on pharmacokinetic and side effect criteria, as well as on physician familiarity.

• Key considerations for atenolol dosing include:
  • Initial dose: 50 mg per day
  • Maximum dose: 200 mg per day
  • Frequency: once daily
• It is essential to monitor patients for potential side effects, such as bradycardia, hypotension, and bronchospasm, and adjust the dose accordingly.
• The target resting heart rate is 50 to 60 beats per minute unless a limiting side effect is reached, as stated in the guidelines 1.
• Atenolol works by blocking beta-1 adrenergic receptors primarily in the heart, reducing heart rate and contractility, which lowers blood pressure and myocardial oxygen demand.
• Patients should not stop taking atenolol abruptly, as this can lead to rebound hypertension or worsening angina; dosage should be gradually reduced over 1-2 weeks when discontinuation is necessary.

From the FDA Drug Label

DOSAGE & ADMINISTRATION Hypertension The initial dose of atenolol is 50 mg given as one tablet a day either alone or added to diuretic therapy. The full effect of this dose will usually be seen within one to two weeks. If an optimal response is not achieved, the dosage should be increased to atenolol 100 mg given as one tablet a day Increasing the dosage beyond 100 mg a day is unlikely to produce any further benefit. Angina Pectoris The initial dose of atenolol is 50 mg given as one tablet a day If an optimal response is not achieved within one week, the dosage should be increased to atenolol 100 mg given as one tablet a day. Some patients may require a dosage of 200 mg once a day for optimal effect. Acute Myocardial Infarction ... atenolol tablets 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 to 9 days or until discharge from the hospital.

The recommended dose and frequency of atenolol are as follows:

• Hypertension: 50 mg once daily, increasing to 100 mg once daily if necessary
• Angina Pectoris: 50 mg once daily, increasing to 100 mg once daily or 200 mg once daily if necessary
• Acute Myocardial Infarction: 50 mg orally 10 minutes after the last intravenous dose, followed by 50 mg orally 12 hours later, then 100 mg once daily or 50 mg twice daily for 6 to 9 days or until discharge from the hospital 2

From the Research

Atenolol Dose and Frequency

• The optimal dose of atenolol for treating patients with mild to moderate hypertension is 100 mg daily, as it produced statistically significant falls in systolic and diastolic pressure and pulse rate 3.
• A study comparing atenolol and metoprolol once daily in hypertension found that 50 mg and 100 mg atenolol/day were almost as effective, suggesting that lower doses may be sufficient 4.
• Atenolol is often used as a first-line therapy for hypertension, but its effects on mortality and cardiovascular disease are inferior to those of other antihypertensive drugs 5.
• The choice of beta-blocker is important, as benefit is not a class-effect, and atenolol may not be as effective as other beta-blockers such as bisoprolol, metoprolol succinate, and carvedilol in certain patient populations 6.

Comparison with Other Beta-Blockers

• A meta-analysis comparing carvedilol with beta 1 selective beta-blockers (atenolol, bisoprolol, metoprolol, and nebivolol) found that carvedilol significantly reduced all-cause mortality in systolic heart failure patients 7.
• Carvedilol also significantly reduced all-cause mortality compared with beta 1 selective beta-blockers in acute myocardial infarction patients using the fixed-effects model 7.
• Atenolol was the beta-blocker most used in studies comparing beta-blockers to other antihypertensive drugs, but its effects were often inferior to those of other drugs 5.