From the Guidelines
Atenolol commonly causes side effects such as hypotension, bronchospasm, and bradycardia, which can be managed by adjusting the dose, taking the medication with food, and monitoring for potential interactions with other medications. The management of these side effects is crucial to minimize their impact on the patient's quality of life. According to the 2015 ACC/AHA/HRS guideline for the management of adult patients with supraventricular tachycardia 1, the potential adverse effects of atenolol include hypotension, bronchospasm, and bradycardia.
Common Side Effects of Atenolol
- Hypotension: This can be managed by adjusting the dose of atenolol or other medications that may be contributing to hypotension, such as ACE inhibitors 1.
- Bronchospasm: Patients with a history of asthma or reactive airway disease should be monitored closely for signs of bronchospasm, and alternative medications may be considered if necessary.
- Bradycardia: This can be managed by adjusting the dose of atenolol or adding other medications to increase heart rate if necessary.
Management Strategies
- Taking the medication with food to reduce stomach upset
- Gradually increasing the dose to minimize dizziness
- Scheduling doses earlier in the day to prevent sleep disturbances
- Monitoring for potential interactions with other medications, such as drugs with SA and/or AV nodal–blocking properties
- Regular follow-up appointments to monitor heart rate and blood pressure, with typical atenolol dosing ranging from 25-100 mg once daily depending on the condition being treated. Patients with certain conditions, such as asthma, diabetes, or heart failure, may require special monitoring and dose adjustments to minimize the risk of adverse effects 1.
From the FDA Drug Label
ADVERSE REACTIONS Most adverse effects have been mild and transient. The frequency estimates in the following table were derived from controlled studies in hypertensive patients in which adverse reactions were either volunteered by the patient (US studies) or elicited, e.g., by checklist (foreign studies).
Volunteered (US Studies) Total- Volunteered and Elicited (Foreign + US Studies) Atenolol (n = 164) % Placebo (n = 206) % Atenolol (n = 399) % Placebo (n = 407) % CARDIOVASCULAR Bradycardia 3 0 3 0 Cold Extremities 0 0.5 12 5 Postural Hypotension 2 1 4 5 Leg Pain 0 0.5 3 1 CENTRAL NERVOUS SYSTEM/NEUROMUSCULAR Dizziness 4 1 13 6 Vertigo 2 0.5 2 0.2 Light - Headedness 1 0 3 0.7 Tiredness 0.6 0. 5 26 13 Fatigue 3 1 6 5 Lethargy 1 0 3 0.7 Drowsiness 0.6 0 2 0.5 Depression 0.6 0.5 12 9 Dreaming 0 0 3 1 GASTROINTESTINAL Diarrhea 2 0 3 2 Nausea 4 1 3 1 RESPIRATORY (See WARNINGS) Wheeziness 0 0 3 3 Dyspnea 0. 6 1 6 4
The common side effects of Atenolol include:
- Cardiovascular: Bradycardia, cold extremities, postural hypotension, and leg pain
- Central Nervous System/Neuromuscular: Dizziness, vertigo, light-headedness, tiredness, fatigue, lethargy, drowsiness, depression, and dreaming
- Gastrointestinal: Diarrhea and nausea
- Respiratory: Wheeziness and dyspnea
These side effects are usually mild and transient. Management of side effects may involve discontinuing or reducing the dosage of atenolol, and in some cases, administering other medications to counteract the effects, as outlined in the drug label 2.
From the Research
Common Side Effects of Atenolol
- Fatigue or tiredness 3
- Cold hands and feet 3
- Bradycardia (slow heart rate) 3
- Sleep disturbance 3
- Psoriasiform skin eruptions 4
- Skin necrosis 4
- Vasculitis 4
- Drug-induced connective tissue disease (rarely) 4
- Dizziness 5
- Impotence 5
- Depression 5
Management of Side Effects
- Discontinuation of atenolol may resolve side effects, as seen in a patient who developed lupus erythematosus 4
- Withdrawal of atenolol should be done with caution, especially in patients with severe coronary artery disease, to avoid potential rebound hypertension 6
- Monitoring of blood pressure and heart rate is necessary after cessation of atenolol therapy 6
- Alternative beta-blockers, such as labetalol, may be better tolerated in some patients 5