From the FDA Drug Label
The effect on exercise tachycardia of a single 10 mg intravenous dose is largely dissipated by 12 hours, whereas beta-blocking activity of single oral doses of 50 mg and 100 mg is still evident beyond 24 hours following administration. Following oral doses of 50 mg or 100 mg, both beta-blocking and antihypertensive effects persist for at least 24 hours The elimination half-life of oral atenolol is approximately 6 to 7 hours
The typical beta blocker washout period for atenolol is around 24 hours for oral doses of 50 mg or 100 mg, as the beta-blocking and antihypertensive effects persist for at least this duration 1. However, the elimination half-life is approximately 6 to 7 hours.
From the Research
The typical beta blocker washout period is approximately 5 half-lives of the specific medication, which generally ranges from 1 to 2 weeks for most beta blockers. For short-acting agents like propranolol or metoprolol, a washout period of 24-48 hours may be sufficient, while longer-acting agents such as nadolol or extended-release formulations may require 1-2 weeks for complete elimination. Atenolol, with its renal clearance, typically needs about 3-5 days. This washout period is necessary before starting new medications, conducting diagnostic tests like exercise stress tests, or evaluating a patient's baseline cardiovascular status without beta blocker effects. The duration is based on pharmacokinetic principles, as 5 half-lives allows for approximately 97% of the drug to be eliminated from the body.
Key Considerations
- Patients should never abruptly discontinue beta blockers without medical supervision due to the risk of rebound hypertension, tachycardia, or angina, and a gradual tapering schedule is often recommended, especially for those with coronary artery disease or heart failure 2.
- The beta blocker rebound phenomenon can have dangerous consequences, including increased risk of events related to coronary artery disease, in-hospital mortality in heart failure patients, and precipitation of angina pectoris attack 2.
- Recent studies suggest that early use of beta-blockers may provide a survival advantage in patients with critical heart failure, with administration within 24 hours of admission to the intensive care unit associated with reduced risk of mortality 3.
Medication-Specific Washout Periods
- Short-acting agents like propranolol or metoprolol: 24-48 hours
- Longer-acting agents like nadolol or extended-release formulations: 1-2 weeks
- Atenolol: 3-5 days It is essential to consider the specific medication and its pharmacokinetics when determining the washout period, as well as the individual patient's medical history and condition. The most recent and highest quality study on this topic is from 2025, which highlights the importance of early beta-blocker administration in critical heart failure patients 3.