Maximum Dose of Atenolol
The maximum dose of atenolol is 100 mg per day for hypertension and angina pectoris, as indicated in the FDA drug label. 1
Dosing Guidelines for Different Indications
Hypertension
- Initial dose: 50 mg once daily (alone or added to diuretic therapy)
- If optimal response not achieved after 1-2 weeks: Increase to 100 mg once daily
- Maximum dose: 100 mg daily (increasing beyond this is unlikely to produce further benefit) 1
Angina Pectoris
- Initial dose: 50 mg once daily
- If optimal response not achieved within one week: Increase to 100 mg once daily
- Some patients may require: 200 mg once daily for optimal effect 1
- Note: While 200 mg is mentioned for angina, the FDA label clearly states that for hypertension, "increasing the dosage beyond 100 mg a day is unlikely to produce any further benefit" 1
Acute Myocardial Infarction
- Initial IV dose: 5 mg over 5 minutes, followed by another 5 mg IV injection 10 minutes later
- Oral maintenance: 50 mg twice daily or 100 mg once daily for 6-9 days or until hospital discharge 1
Special Populations
Elderly Patients and Renal Impairment
Dose adjustments are necessary due to atenolol's renal excretion:
| Creatinine Clearance (mL/min/1.73m²) | Maximum Dosage |
|---|---|
| 15-35 | 50 mg daily |
| <15 | 25 mg daily |
Some elderly or renally impaired hypertensive patients may require a lower starting dose of 25 mg once daily 1
Hemodialysis Patients
- 25 mg or 50 mg after each dialysis session (under hospital supervision due to risk of significant blood pressure drops) 1
Pharmacokinetic Considerations
- Absorption: Approximately 50% of an oral dose is absorbed from the GI tract 1
- Elimination: Over 85% of an IV dose is excreted in urine within 24 hours 1
- Half-life: Approximately 6-7 hours in patients with normal renal function 1
- Protein binding: Low (6-16%) 1
Clinical Pearls and Cautions
- Beta blockers are not recommended as first-line agents for hypertension unless the patient has ischemic heart disease or heart failure 2
- Avoid abrupt discontinuation as this can precipitate angina, myocardial infarction, or ventricular arrhythmias 1
- Contraindications include marked first-degree AV block, second or third-degree heart block without pacemaker, severe bradycardia, hypotension, decompensated heart failure, and severe bronchospastic disease 2
- Atenolol is cardioselective at lower doses but may affect bronchial and vascular musculature at higher doses 1
Comparison to Other Beta Blockers
While the maximum dose of atenolol is 100 mg daily for hypertension, other beta blockers have different maximum doses:
- Metoprolol tartrate: 100-200 mg twice daily 2
- Metoprolol succinate: 50-200 mg once daily 2
- Bisoprolol: 2.5-10 mg once daily 2
- Carvedilol: 12.5-50 mg twice daily 2
Atenolol's once-daily dosing regimen may improve patient compliance compared to medications requiring multiple daily doses 3.