Maximum Dosing of Atenolol for Hypertension
The maximum recommended dose of atenolol for hypertension is 100 mg per day. 1
Dosing Guidelines
Atenolol is a beta-1 selective blocker that is commonly used in the management of hypertension. According to FDA labeling and clinical guidelines, the dosing parameters are as follows:
- Initial dose: 50 mg once daily 1
- Usual maintenance dose: 50-100 mg once daily 2
- Maximum dose: 100 mg per day 1, 3
Dose Titration
- Start with 50 mg once daily
- If blood pressure response is inadequate after 1-2 weeks, increase to 100 mg once daily
- Further increases beyond 100 mg daily are not recommended as they provide minimal additional benefit but increase risk of side effects 3
Special Populations
Elderly Patients
Renal Impairment
Dosage adjustment based on creatinine clearance:
- CrCl 15-35 mL/min: Maximum 50 mg daily 1, 2
- CrCl <15 mL/min: Maximum 25 mg daily 1, 2
- Hemodialysis patients: 25-50 mg after each dialysis session (under hospital supervision) 1
Efficacy Considerations
A dose-response study found that 100 mg daily was the optimal dose for treating mild to moderate hypertension, providing a mean reduction of 25/16 mmHg compared to placebo 3. Increasing the dose to 200 mg daily did not provide additional blood pressure reduction but increased the incidence of side effects, particularly fatigue 3.
Administration
- Atenolol can be administered once daily due to its long half-life (6-7 hours) 4
- Food does not significantly affect absorption
- When discontinuing therapy, gradual tapering is recommended to avoid rebound hypertension 1
Common Side Effects
- Fatigue/tiredness (more common at doses >100 mg) 3
- Bradycardia
- Hypotension
- Cold extremities
- Dizziness
Contraindications
- Cardiogenic shock
- Sinus bradycardia (<50 bpm)
- Second or third-degree heart block
- Overt cardiac failure
- Severe peripheral arterial disease
- Severe bronchospastic conditions (asthma, COPD) 2
Clinical Pearls
- Beta blockers are no longer recommended as first-line agents for uncomplicated hypertension 2
- When used for hypertension, atenolol is most effective when combined with a diuretic 5
- Blood pressure monitoring should include measurement just before the next dose ("trough" blood pressure) to ensure 24-hour efficacy 1
- For acute situations requiring IV administration, the maximum recommended dose is 10 mg (given as 5 mg over 5 minutes, followed by another 5 mg after 10 minutes) 1
Remember that exceeding the maximum recommended dose of 100 mg per day does not provide additional antihypertensive benefit but significantly increases the risk of adverse effects.