From the Guidelines
Atenolol has a half-life of 6-7 hours in patients with normal renal function, but this increases significantly in patients with impaired renal function. For patients with normal renal function, atenolol is typically dosed once daily at 25-100 mg 1. However, dosage adjustments are necessary for patients with renal impairment. The half-life of atenolol is highly dependent on kidney function, and reduced renal function leads to drug accumulation 1.
- In patients with normal renal function, the dosing interval is typically once daily.
- In patients with impaired renal function, the half-life of atenolol increases, and dosage adjustments are necessary to avoid enhanced beta-blockade effects.
- For patients with a creatinine clearance of 15-35 mL/min, the maximum recommended dose is 50 mg daily.
- For patients with severe renal impairment (creatinine clearance <15 mL/min), the maximum dose should be reduced to 25 mg daily or 50 mg every other day. Regular monitoring of heart rate, blood pressure, and renal function is essential when using atenolol in patients with kidney disease 1.
From the FDA Drug Label
The elimination half-life of oral atenolol is approximately 6 to 7 hours, and there is no alteration of the kinetic profile of the drug by chronic administration Following intravenous administration, peak plasma levels are reached within 5 minutes. Declines from peak levels are rapid (5- to 10-fold) during the first 7 hours; thereafter, plasma levels decay with a half-life similar to that of orally administered drug. When renal function is impaired, elimination of atenolol is closely related to the glomerular filtration rate; significant accumulation occurs when the creatinine clearance falls below 35 mL/min/1.73m2. Atenolol excretion would be expected to decrease with advancing age. No significant accumulation of atenolol occurs until creatinine clearance falls below 35 mL/min/1. 73m2. Accumulation of atenolol and prolongation of its half-life were studied in subjects with creatinine clearance between 5 mL/min and 105 mL/min. Peak plasma levels were significantly increased in subjects with creatinine clearances below 30 mL/min The following maximum oral dosages are recommended for elderly, renally-impaired patients and for patients with renal impairment due to other causes: Creatinine Clearance (mL/min/1. 73m2) Atenolol Elimination Half-Life (h) Maximum Dosage 15-35 16-27 50 mg daily <15 >27 25 mg daily
The half-life of Atenolol is approximately 6 to 7 hours in patients with normal renal function. In patients with impaired renal function, the half-life of Atenolol is:
- 16-27 hours for creatinine clearance between 15-35 mL/min/1.73m2
- >27 hours for creatinine clearance <15 mL/min/1.73m2 The dosing interval of Atenolol is typically once daily for patients with normal renal function, but may need to be adjusted in patients with impaired renal function. The recommended maximum oral dosages for elderly, renally-impaired patients and for patients with renal impairment due to other causes are:
- 50 mg daily for creatinine clearance between 15-35 mL/min/1.73m2
- 25 mg daily for creatinine clearance <15 mL/min/1.73m2 2 2
From the Research
Atenolol Half-Life and Dosing Interval
- The half-life of Atenolol is approximately 6 to 9 hours in patients with normal renal function 3.
- In patients with impaired renal function, the elimination half-life of Atenolol increases, reaching up to 36 hours in patients with severe renal impairment (glomerular filtration rate less than 10 ml/min) 3.
- The dosing interval of Atenolol is typically once daily, due to its long duration of beta-blocking activity 4.
- However, in patients with moderate to severely impaired renal function, the dosage of Atenolol needs to be reduced to avoid accumulation of the drug 4, 3, 5.
- The relationship between glomerular filtration rate (GFR) and Atenolol plasma clearance, as well as renal clearance, is significant, and a close correlation exists between the two 3.
Renal Function and Atenolol
- Atenolol is eliminated primarily through the kidneys, and its clearance is directly related to renal function 3, 5.
- In patients with impaired renal function, the clearance of Atenolol is reduced, leading to increased plasma levels and a prolonged half-life 3, 5.
- The use of Atenolol in patients with renal impairment requires careful monitoring and dose adjustment to avoid adverse effects 4, 3, 5.
- Studies have shown that Atenolol can be used safely in patients with mild to moderate renal impairment, but caution is advised in patients with severe renal impairment 6, 7.