From the Guidelines
Atenolol is contraindicated in patients with severe bradycardia, second or third-degree heart block, cardiogenic shock, decompensated heart failure, bronchial asthma, severe COPD, and untreated pheochromocytoma. The use of atenolol in these conditions can worsen a patient's health status and lead to severe consequences, including increased morbidity and mortality. According to the guidelines for the management of patients with unstable angina/non-ST-elevation myocardial infarction 1, patients with marked first-degree AV block, any form of second- or third-degree AV block, a history of asthma, severe LV dysfunction or HF, or at high risk for shock should not receive beta blockers on an acute basis.
Some of the key contraindications to atenolol include:
- Severe bradycardia (heart rate below 45-50 beats per minute)
- Second or third-degree heart block
- Cardiogenic shock
- Decompensated heart failure
- Bronchial asthma
- Severe COPD
- Untreated pheochromocytoma
- Severe peripheral arterial disease
- Pregnancy (relative contraindication, FDA pregnancy category D)
It is essential to use atenolol cautiously in patients with diabetes, as it may mask hypoglycemic symptoms, and in those with renal impairment, since the drug is primarily eliminated through the kidneys, often requiring dose adjustment 1. The choice of beta blocker for an individual patient is based primarily on pharmacokinetic and side effect criteria, as well as on physician familiarity 1.
In patients with significant chronic obstructive pulmonary disease who may have a component of reactive airway disease, beta blockers should be given very cautiously, with initial low doses of a beta-1–selective agent 1. If there are concerns about possible intolerance to beta blockers, initial selection should favor a short-acting beta-1–specific drug such as metoprolol or esmolol 1.
Overall, the use of atenolol requires careful consideration of the patient's medical history and current health status to minimize the risk of adverse effects and ensure the best possible outcome in terms of morbidity, mortality, and quality of life.
From the FDA Drug Label
Atenolol tablets are contraindicated in sinus bradycardia, heart block greater than first degree, cardiogenic shock, and overt cardiac failure. (SeeWARNINGS.) Atenolol tablets are contraindicated in those patients with a history of hypersensitivity to the atenolol or any of the drug product's components. The contraindications to atenolol are:
- Sinus bradycardia
- Heart block greater than first degree
- Cardiogenic shock
- Overt cardiac failure
- History of hypersensitivity to atenolol or its components 2
From the Research
Contraindications to Atenolol
The following are contraindications to atenolol, a beta blocker:
- Peripheral vascular disease, specifically in patients with vasospastic disorders, rest pain with severe peripheral vascular disease, or nonhealing lesions 3
- Diabetes mellitus, with caution in patients with signs of autonomic disease or difficult glycemic control, and in patients on oral long-acting antidiabetic drugs 3
- Chronic obstructive pulmonary disease (COPD) and asthma, with specific guidelines for contraindication based on disease severity and FEV1 values 3
- Heart failure, although beta blockers like atenolol can provide benefits supplementary to high-dose enalapril treatment in patients with advanced left ventricular dysfunction 4
Relative Contraindications
Some studies suggest that atenolol may not be the best choice for certain patient populations, including:
- Patients at risk of cardiovascular disease, where atenolol was found to be inferior to angiotensin receptor blockers (ARB) in reducing total mortality 5
- Patients with certain comorbidities, where atenolol may increase the risk of diabetes or heart failure compared to other antihypertensive medications 5
Pharmacological Considerations
The clinical pharmacology of beta blockers like atenolol is complex, with varying effects on beta 1 and beta 2 receptors 6
- Atenolol is a selective beta 1-antagonist, which can reduce heart rate, cardiac output, and arterial pressure, but may also increase peripheral vascular resistance 6